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Silicone Dynamic Orthotics

Discussion in 'Biomechanics, Sports and Foot orthoses' started by David Wedemeyer, May 7, 2008.

  1. David Wedemeyer

    David Wedemeyer Well-Known Member


    Members do not see these Ads. Sign Up.
    I wonder if any of the luminaries here have ever come across these 'inserts'?

    http://www.drkiper.com/brochure_silicone_dynamic_orthotic.html

    I was afforded a pair of these nifty cure-alls personally and have had several rather lengthy and heated conversations with Dr. Kiper regarding his theories and methods :bash:. He was unable to convince me that they had any scientific or clinical merit, so I thought that I would ask the experts their opinion.

    Unrecognized genius or snake oil, what say you?
     
  2. Craig Payne

    Craig Payne Moderator

    Surely that says it all!

    Paynes 1st Law:
    "The amount of passion involved in supporting a theory and the amount of emotional attachment to a theory is inversely proportional to the evidence for that theory"
     
  3. I'd say probably somewhere in the middle.

    I do have some sympathy with the concept. The idea of trying to symulate the function of organic tissue as closely as possible does make a kind of sense to me. The idea of a hydraulic unit which exerts force evenly in the arch is also one i quite like. I have long had a problem with the fact that we cast the surface tissues of the foot with little regard for the depth of soft tissue overlying the bone (which is what we are trying to manipulate.) I can also see this having a use with patients with bony exostosis in their MTJ which develop WB lesions in the arch.

    On the other hand if the patient has a reasonable level of tissue viability / standardish level of soft tissue distribution i can't see that this will do anything that cannot be acheived more simply and easily with a common or garden variety polyprop / EVA shell / carbon fibre / poron / prefab.

    Non est ponenda pluritas sine necessitate.

    If i had the option i'd like to have this in my tool kit for the type of patients i mentioned. But i don't think its the "nifty cure-all" we're all waiting for.

    Possibly a good idea. But not THE good idea.

    Regards
    Robert

    PS
    Why is it almost every lab / orthotic has a comparison with "completely rigid" insoles.:mad: Its like selling it as "the new mini, MUCH smaller than an 18 wheel kenworth!!!"*

    *
    Other brands of lorry are available.
     
  4. Looking at the website there are a few things which make it look less like snake oil.

    Claiming that your product DOES cure everything is one of the dead givaways for snake oil. That this does not is a wholesome thing IMO.

    I wonder if you could persuade Dr Kiper to come out and play in the road.

    Regards
    Robert
     
  5. deco

    deco Active Member

    "Silicone Dynamic Orthotics"


    I like the way this word is thrown in!!

    Declan
     
  6. David Wedemeyer

    David Wedemeyer Well-Known Member

    Craig, Robert & Declan

    Thank you for sharing your thoughts. I met Dennis Kiper (PFOLA 07) and on a personal level liked him enough to listen to his ideas. I did try his device but I just don't subscribe to fluid in a bag to control my foot type (or many others for that matter).

    I have tried to lure him to an academic site such as this to discuss his ideas but thus far he has declined. His website is a very toned down version of his online persona in which he perpetually ululates his complete disdain for "traditional" orthoses.

    I hope that he sees this and decides to, as Robert quipped, "come out and play in the road" :butcher:
     
  7. javier

    javier Senior Member

    Dear all,

    These kind of foot orthoses were developed by two French pedorthists in 1984 (Denis A, Lavigne A. Une nouvelle orthose plantaire antialgique. Reunion Provinciale de la Societé Française et Chirurgie du Pied. Niza. Juin 1984). They are very common in France and Spain, and you can achive great results when you need an accommodative foot orthose (diabetics, rheumatic patients without plantar fat, ect). It has better comfort and shock absorption than polyurethanes like Poron. Of course, they can not cure all, neither were designed for that.

    Regards,
     
  8. efuller

    efuller MVP

    A podiatrist named Marty Krinsky came to CCPM in 1989 when I was doing the biomechanics fellowship and wanted some testing done with our newly acquired EMED force platform on his Silicon Dynamic Orthotics. This sounds like the same product. It was essentially a bag of silicon that fits into your shoe. There were fitting bags with a resivoir attached. You would have a patient stand on a bag and release silicon until you had the right amount and then you would note how much silicon was in the reservoir and call up the company and ask them to send you a bag er orthotic with that much silicon in it for that size.

    When you walked, at heel strike the silicon was pushed to the front of the bag. As gait progressed the silicon would be pushed to the back of the bag.

    I wore them for a couple of days. They felt ok for walking (better than no orthotic.) I did not like them standing in one place. They were almost dangerous with side to side forces. I remember building a deck while wearing them and I was trying to push something from my right toward my left. My right foot was on the ground and my leg abducted away from my body. So, the ground reaction force was pushing from lateral to medial on my foot. (towards supination) At the same time there was more pressure under my lateral foot and this forced the silicon under the medial side of my foot creating an unexpected supination moment. I didn't sprain my ankle or anything, but it did not feel stable.

    As with any product you can find people who will give you a testimonial saying how great they are. One of the other faculty members said it felt like stepping in a wet cow pie.

    Regards,

    Eric
     
  9. javier

    javier Senior Member

    Hello Eric,

    After your post I wonder if we all talking about the same product. I attach a photo from the orthotics I posted (you will notice that it is not the same foot :boohoo:).

    Regards,
     

    Attached Files:

  10. David Wedemeyer

    David Wedemeyer Well-Known Member

    Eric:

    "When you walked, at heel strike the silicon was pushed to the front of the bag. As gait progressed the silicon would be pushed to the back of the bag."

    This is precisely the crux of my skepticism of this device. My heel, which is very well controlled in a deep neutral heel cup with the mods mentioned previously, felt very much as Eric described in his post: like stepping in a wet cowpie.

    I had a very similar experience with this device Eric, it felt very unstable side to side and it felt much too full under the first ray and medical arch :sinking:. Given my foot type it made me supinate far too much for comfort and gait.

    I just happen to have a picture of the SDO. It is on the left in the picture (the one on the right is a carboplast shell that I was experimenting with).

    I was illustrating to Dennis with these pictures that the SDO is in fact a sulcus length insert and that I could feel the liquid moving beneath my metatarsal heads. I believe he then retracted and said the following:

    'As stated before there is no fluid directly under the forefoot itself. The orthotic template however is (even reaching up to the sulcus), so that fluid will “feather” up to the contact surface of the met heads on the ground (similarly to a traditional orthotic), except there is no lip for the forefoot to drop over), this provides that the plantar surface of the foot is in direct and stable contact on the ground, yet as propulsion is taking place, fluid is able to move as necessary with the dynamics of a footstep,'

    He makes a lot of references to Pascal, Bernoulli and other physical properties that allegedly govern the 'dynamic' control of this fluid. How can a fluid not be dispersed by pressure to the path of least resistance and least weight/pressure? Pascal's principle governs the properties of a liquid in a cylinder under a direct load and not the irregular pattern of the foot bones atop a bag of fluid and kinematics. I seriously doubt that Pascal experimented with foot orthoses :hamme

    These nifty bags defy the known physical properties of thousands of years of scientific observation and fact and disperse the weight to where it is needed, at least that is his claim. Apparently there is some form of artificial orthotic intelligence in these devices that performs outside of know physical laws....and all this for only $300+ dollars! He even provides the casting foam and diagnoses via the internet. Fantastic!

    The craftsmanship and attention to detail, stitching and overall appearance of the device warrants a much higher price, he isn't charging enough for these little gems:bang:
     

    Attached Files:

  11. efuller

    efuller MVP

    Javier, David
    Yes, David's picture looks just like what I tried almost 20 years ago.


    There's a sure snake oil sign. I always wonder what is going on in the mind of the person who is selling you something and does the quick change of story. You would need a video to get them to admit, and they still might not admit, that they changed their story.

    Again the quoting of scientific principles to people who've heard the names, but don't have the facts on the tip of their tounge to refute what was claimed. There is probably a good reason that he is not willing to come on to this web site. We've got people who would go look up Bernoulli's work to skewer a snake oil salesman. :hammer:

    Marty Krinsky, who owned developed SDO had me make him a tape of scientifically acurate statements that he could make from the EMED work. (Increased area of contact.. decreased pressure.) I saw him selling the devices later and he could convincinly use the words that I gave him. It looks like the tape did not get passed on after Marty died.

    Regards,

    Eric
     
  12. David Wedemeyer

    David Wedemeyer Well-Known Member

    Javier,

    The material in the photos that you posted (the picture on the right) looks very similar to plastazote (?). Obviously those materials and the orthoses you are describing would be beneficial in the diabetic and rheumatic patient and feet with fat pad atrophy. After viewing your photos I agree that they are not the same device.

    Eric,

    Thank you for the history on Marty Krinsky. I have never heard Dennis reveal who created these inserts nor have I witnessed him taking credit for their creation. An interesting parallel exists though with your discussion of the EMED device and his F-Scan obsession.

    At the PFOLA I was talking to the Tekscan rep and Dennis wandered over. Dennis turned the conversation to his insert and the in-shoe F-Scan results for the SDO. To my recollection the rep was hesitant to give them two big thumbs up for controlling foot kinematics. It did appear to me that they reduced plantar pressures somewhat but I didn't really study the scans.

    I am no F-Scan expert but I would like to purchase one for my TSB and orthosis patients.

    I would expect any very accommodative device to have the same results but I don't feel the SDO can be said to be very specific in reducing lesions nor offloading distinct and pressure areas. As for controlling foot kinematics........:boxing:

    Thank you all for responding.

    Regards,
     
  13. Dennis Kiper

    Dennis Kiper Active Member

    Hello all. I just recently found this site and registered to participate. I have gone through the posts here and would like to reply.

    The silicone dynamic orthotic (sdo) is predicated on a different technology that our profession has been using since Dr Root formulated his theories and ideas to control forces and motion that cause pathomechanics. The outcome for the results we want are the same, it 's only the technology that's different.

    The SDO like any orthotic has to be fit properly. In order to do this, adjustments may be necessary. One can add or remove fluid from the prescription volume in order to do this, hence if one feels lateral instability or overcorrection this would obviate the need for an adjustment. The nice thing is that one does not need to adjust by posting, spot heating etc etc. The hydraulic effect of the fluid automatically self posts the foot into its optimal position (one can adjust with artificial means as well e.g. adding a cookie to change the effect of the fluid volume).

    The fluid itself is a high viscosity silicone (10,000 poise), that is able to move with the foot (hence "dynamic”) as opposed to being a stationary position.

    What makes the SDO unique as an orthotic is that the silicone fluid is assisting the arch motion (rather than controlling) under the arch by "loading" the structure of the foot hydraulically into biomechanical alignment. It simply gives the arch a cushion that moves with the foot as if it were part of it so that the plantar surface of the foot is in solid and stable contact with the ground. In this way, normal intrinsic motion is allowed rather than locked by a stationary platform.

    It matches the way you walk. This orthosis is not for every type of foot nor every type of activity. It is not suitable for conditions of neurological disorder. It is not for activities involving lateral motion.

    In almost 20 years of experience, I have tried to continue the work of Dr Krinsky and have found the SDO suitable for almost any biomechanical problem.

    I realize this is a rather broad statement, but because the technology is based on fluid mechanics, it is just a matter of a proper fit. This does not mean that putting a pair on works like eyeglasses. It works like any orthotic should by reducing and minimizing overpronation forces that have accumulated over a period of time to cause the pathomechanics we see.

    It takes time to reverse years of accumulated inflammation and as with any problem, age, chronicity and the patients contributing postural biomechanics determine this.

    With all due respect to Dr Wedermeyer whom I did make a pair for, we never got past the point of adjusting the prescription volume of fluid even once.

    Others here who have had the opportunity to try this and not had a good response, when Dr Krinsky started doing this, there was a lot more to know and be able to explain. Follow up with colleagues is difficult, because in my opinion one feels that we all know all the knowledge we need to know and participation with questions are just not followed.

    One of the biggest problems I have faced with other colleagues and allied professionals is the unwillingness to let me guide them through the fitting process. Judgement is almost always made without the benefit of following the process through.

    I’m equally surprised by Dr Payne’s remark, without the benefit of knowing anything more about what I or the silicone dynamic orthotic is about, why does “that say it all”?

    I would hope that with Dr Payne's credentials and entity in the universe that he would investigate further, rather than accept what one or two posters have to say.
     
    Last edited: May 23, 2008

  14. Clearly, I ain't got the knowledge (always get lost around Whitehall) but you lost me Doc Kiper. I want to know more knowledge and to participate, but I don't know where to start, please help.
     
  15. Dennis Kiper

    Dennis Kiper Active Member

    I would be happy to make you a pair of orthotics regardless if you have any pathomechanics. In my opinion if orthotics could be made to fit comfortably and function to slow down and minimize the harmful effects of pronation forces over a lifetime, we could consider using them for prevention as well as medical intervention.

    I'm not a very good typist and would prefer to speak with you real time, perhaps you could contact me at 800-375-4737 and let me know how best to get back to you.
     
  16. Know, Dr. Spooner, I no that I ain't got know mo nowledge. :drinks

    I say.......bring on the silicone!!.....building better bodies in ways that we will never fully appreciate.:rolleyes:
     
  17. David Smith

    David Smith Well-Known Member

    Dr Kiper

    Now I like to give someone the benifit of the doubt but what you are saying below really stretches the privilige.


    I'm not when you look at your web site and it's full of stuff like this quote

    What studies have you done that show this?

    Oh yeah Sebastian Coe, Carl Lewis and Frankie Fredericks never stopped banging on about how good they are. How did you jump so far Carl? Its all down to me Silicon Dynamic Orthotics Ron! Well I'll be blowed.

    I did intend to be more polite but the more I read the more I saw red and smelt something fishy, perhaps its smoked herring crap.

    Cheerio Dave :butcher:
     
    Last edited: May 23, 2008
  18. Jeremy Long

    Jeremy Long Active Member

    I admit that I have come across this specific device several times. Thus far I have been able to achieve improvement and gain patient satisfaction only after removing this insert type from their method of care. I also used to believe that Dr. Kiper was diligent and well meaning in his selection and dispensal of Silicon Dynamic Orthotics. That was, until I read this part of his post:

    "It matches the way you walk. This orthosis is not for every type of foot nor every type of activity. It is not suitable for conditions of neurological disorder. It is not for activities involving lateral motion."

    Having evaluated and worked with a former patient of his, I can attest that he failed in this specific case to abide by his own words. A SDO was dispensed to a patient with significant, chronic heel inversion and lateral column instability. In addition, this patient is also a former collegiate athlete and coach in a sport that commonly exceeds average medial-lateral motion stresses.

    It's clear that a biomechanical evaluation cannot be obtained through remote internet sales, and I know in this case the patient was never personally seen nor assessed. What I am left to wonder now is whether this doctor failed to gather a proper history , and/or simply wants to sell fluid inserts to anyone showing a remote interest. Either way, both are a great disappointment to me.

    On a side note, there is always one other thing that has bothered me about this design. Since a significant amount of this insert's "correction" comes from fluid volume, there has to be a direct relationship between the patient and the internal volume of the wearer's footwear. Unless each person wears shoes of exact last shape and upper construction, it's reasonable to assume that results could greatly vary from shoe to shoe.
     
  19. Dennis Kiper

    Dennis Kiper Active Member

    Quote from your web site "(silicon) moves to the area of least resistance and greatest need," So the area of greates pressure on a diabetic foot requires the least amount of cushioning and then the area of least pressure (under the arch pressumably) fills with silicone and causes additional supination moments so the the area of high pressure continues to recieve high pressure even longer, since the foot cannot pronate off it, and without any cushioning. Whereas the arch (MLA) needs loads of cushioning. Yeah that's just wot like I woz tort at Uni. NOT!

    I didn’t think that what I said would be interpreted that way.
    What I am saying is that the area of greatest pressure under a diabetic foot has to be lessened, not eliminated. I take it from your post, that we need greater cushioning under that diabetic foot. I don’t fully agree with that. With a correct alignment, the efficiency of the foot as is, provides enough cushioning in most cases. This does not include patients with an atrophy of the plantar pad. Trying to add or reduce cushioning without biomechanical alignment is uneven and not the way to do it in my opinion.

    Certainly the complexity of diabetes and differences in the health of some of those individuals has to be considered, meaning that even under the best of circumstances and biomechanical control and cushioning, there may be little or nothing that works.

    Fluid moves from high pressure to low pressure. After heel strike and at the beginning of midstance, as silicone enters the mid-tarsus, fluid is moving predominantly along the medio-longitudinal column (elevating arch height and plantarflexing the 1st met), as fluid is also moving into the transverse arch the fluid hydraulically “self-posts” the midfoot into it’s pronator or supinator position.




    The added high-pressure areas of the lateral column and forefoot through hydrostatic pressure maintains the MTJ in a loaded and stable position as the foot makes it forward progression. In the correct volume you have effectively increased the surface area of the plantar surface of the foot on the floor and reduced force per unit area on the surface of the orthotic. Additionally, the pronatory forces at the MTJ does not push the fluid laterally (in most cases). It self posts the tarsus into alignment concurrent with all three planes of motion and STJ neutral. The tarsus in my opinion is the weakest part of the foot. As I said previously, the SDO is not for every condition. Two conditions that would force the fluid laterally is a rigid flatfoot or rocker bottom.

    Filling the arch with silicone doesn’t cause greater supinatory motion unless you’ve overcorrected the prescription just like any orthotic. The idea is that the correct volume of fluid has motion, there is just the right amount for necessary allowable pronation.






    The SDO like any orthotic has to be fit properly. In order to do this, adjustments may be necessary. One can add or remove fluid from the prescription volume in order to do this, hence if one feels lateral instability or overcorrection this would obviate the need for an adjustment. The nice thing is that one does not need to adjust by posting, spot heating etc etc. The hydraulic effect of the fluid automatically self posts the foot into its optimal position (one can adjust with artificial means as well e.g. adding a cookie to change the effect of the fluid volume).

    Obviate means - render unnecessary - did you mean that?

    What I meant was that an adjustment in the traditional sense of posting, cut outs etc would not be necessary. Adjustments with the silicone orthotic are made by adding or removing fluid only.

    The optimal position for what, injury? what if you have a foot structure that cause excessive supination moments and causes pathological stress in the peroneals

    This is one of those cases where the silicone orthotic is not intended.


    It's nice to be a lazy twat and not bother doing a biomechanical assessment and bothering with all those angle and moment thingy's eh!


    This is part of the technology and one of the advantages I’ve experienced with the SDO. NO, I do not have to measure angles or ROM. It is the patient’s proprioception that dictates the correct fit, according to certain criteria. Once the orthotic fits correctly, it’s working correctly. And for some chronic and very complex patients it takes a lot more work to evaluate if the prescription fits correctly than a “lazy twat” would or can do.


    The fluid itself is a high viscosity silicone (10,000 poise), that is able to move with the foot (hence "dynamic”) as opposed to being a stationary position.

    Is that as technical as it gets? For perspective water is 1poise and honey or molasses are 5000-10000 poise, so its fairly free flowing.
    Well it will definentely move, will it move where you want it - Doubtful.

    I was answering the poster who made reference to the name “dynamic” and yes, at that viscosity (10,000 poise) you’re correct it is fairly free flowing, but it is extremely thick and slow moving and comes reasonably close enough to move in synchrony to the density of soft tissue . That’s why initially until the patient’s muscles get used to it, there is motion felt. Once the patient fully transitions, the orthotic feels comfortably firm yet natural. The fluid flows where it’s hydraulically pushed that is not “doubtfull” that is fluid mechanics.


    What makes the SDO unique as an orthotic is that the silicone fluid is assisting the arch motion (rather than controlling) under the arch by "loading" the structure of the foot hydraulically into biomechanical alignment. It simply gives the arch a cushion that moves with the foot as if it were part of it so that the plantar surface of the foot is in solid and stable contact with the ground. In this way, normal intrinsic motion is allowed rather than locked by a stationary platform.

    Bollocks! is all that above paragraph is worth, Stable or fluid and dynamic which is it? The fluid will move to the area of least pressure. which may be the lateral foot on a severely pronated foot. In this case, a nice full length lateral post would be just what the doctor ordered eh!


    Apparently, this is a matter of semantics for you and I. Just because fluid moves, in the correct proportion, this does not mean that the foot isn’t stable on the ground. Perhaps I should have said “The full plantar surface of the necessary weight bearing portions are in solid and stable contact with the ground”.

    I said previously, this however is not stable for lateral motion sports like basketball or tennis , it is ideal for walking and running. As for a “severely” pronated foot. A “normal” flatfoot (one with flexibility of the MTJ) can be said to be severely pronated, but in fact the fluid mechanics of the silicone orthotic will correctly align the foot in its biomechanical “optimal” position. Your assumption other than the conditions I’ve listed, pronatory forces are NOT strong enough to force the fluid laterally in a pronator type foot. There is too much pressure from the hind foot, lateral column and forefoot for that to happen. That never occurs (unless there is excessive volume that is overcorrecting). A supinator does have fluid under the lateral column because that is the weakest part of that foot.


    Assisting arch motion, simply cushion, stable contact, normal intrinsic motion, matches the way you walk (below) - these are just fancy sound bites with no substance at all.

    Well made orthoses are not locked (whatever that means - do you mean too rigid?)

    Fancy soundbites? No substance? You are excising words and phrases from my website that is not intended for you. This is for lay people. My descriptions, words and phrases are to hopefully make sense to people looking for help with biomechanical problems that have gone neglected or unable to be helped by others. Many have had multiple pairs of orthotics.

    Why is it that so many people have had failures with multiple pairs? While I cannot guarantee the accuracy of what I’m going to say, but I’ll bet there aren’t near as many failures with eyeglasses, or braces for teeth . Why are those technologies so much better for their respective professions?

    I’m not saying our present technology doesn’t work, it just seems to me that it doesn’t work as well as it should after 50 some odd years. If you read running forums and several sites that talk about running injuries and orthotics, there is too much bad mouthing of our present day orthotics.

    Also, why is it that there are zero published articles on long term benefits of orthotics. Why is it that some clinical studies have shown custom fitted orthotics to be”only” as effective as many prefabs or OTC products? I believe it’s because of at least two things:
    One, there is no follow up to adjusting the prescription orthosis as the foot goes through physiologic and biomechanical changes of its "optimal" position on the ground over the long term.
    Two, is that there is too much inconsistency in duplication of pronation control with orthotics with both new and existing patients.

    I agree with you that a “well made” orthotic is not locked. The problem I see is the inconsistency in making a “well made” orthotic consistently.

    I have found over time as the foot changes in optimal position and ROM of pronation changes, the advantage of the fluid orthotic is that it is just a matter of adding or removing anywhere up to 15Gms grams of fluid (in most cases, additional fluid is necessary), the difference in fluid volume will affect the biomechanical structure and planes of motion, and the orthotic will still match the way the foot walks in its biomechanically intended manner. It allows normal joint apposition and intrinsic motion.


    It matches the way you walk. This orthosis is not for every type of foot nor every type of activity. It is not suitable for conditions of neurological disorder. It is not for activities involving lateral motion.

    No they are not for any type of foot, just for the type of foot with a silly twat attached who is gullible enough to stick his hand in his pocket and fork out for such rubbish.
    What activities do not have lateral motion pray tell, Oh I know, sitting watching telly.

    No response is necessary here.


    I thought one of the rules of engagement on this site was to not attack personally even if we disagree. At the very least out of the respect for another colleague. It’s unfortunate because you disagree that you need to be so offensive.

    I believe I’ve answered your response.
     
  20. Dr Kiper,
    There are absolutely tons of things I want to talk to you about, so I'll try and work through the list systematically; starting with: "a correct alignment". Please define this.
     
  21. Dennis Kiper

    Dennis Kiper Active Member

    Jeremy,

    Did you look at how the SDOs fit the patient? Could you tell if they were overcorrecting or not?
     
  22. Dennis Kiper

    Dennis Kiper Active Member

    I suppose I should have said a "corrected" alignment through the use of a proper fitting orthotic that balances the forefoot to rearfoot relationship concurrent with STJ neutral.
     
    Last edited: May 24, 2008
  23. Dennis:

    A friendly word of advice....stop now before you are blasted out of the water.:drinks
     
  24. Dennis Kiper

    Dennis Kiper Active Member

    Kevin,

    I appreciate your words of advice. I realize that my technology may not suit yours and others thinking, but what do you see as the problem with the presentation of a new technology and the opportunity to think about it?

    Is this forum only for one way of thinking?
     
  25. Dennis Kiper

    Dennis Kiper Active Member

    I am finding trying to respond to too many posters as too time consuming.

    If you have questions or are interested in a dialogue with me, please contact me further at:

    footdoc at drkiper.com
     
  26. David Smith

    David Smith Well-Known Member

    Dr Kiper

    First I make no apologies for the content of my post however I was being flippant and not presice in my critisism.

    Quote from your web site
    "SDO Custom-Fluid Shock Absorbers For Your Feet. Doctor-prescribed for perfect fit
    CUSTOM-FIT FOR COMFORT."

    In your reply you wrote
    The main intention, as stated by your advert heading, is shock absorption, I take it that you are writing for the general public and really mean shock or force attenuation. In which case you need some kind of material between the foot and the ground that will reduce aceleration. IE cushioning to use the vernacular.

    I agree that the SDO may attenuate force but just because optimum function may equal optimum force attenuation does not therefore mean that any device that increases attenuation of force also improves mechanical function.

    * no they are not
    **too much arch motion - Just a sound bite - How much is too much for a certain person and what if the problem is to little motion (in your terms).
    *** How do you absorb motion

    Too much motion does not necessarily = to much internal stress. Reduce motion does not necessarily = reduced stress. Applied biomechanics 101 (as the Americans say)

    You wrote
    Then you wrote
    So it can apply force to the medial arch and plantar flex the first ray, it can self post into pronator or supinator position (ignoring the poor terminology) BUT it cannot add to the supination moments about the STJ.

    First of all, which is it former or latter. Secondly how is it that the fluid can raise the medial arch and at the same time plantarflex the 1st ray. Have you got variable viscosity technology or does the 1st ray have some extra plantarflexing force?

    So you are saying that, in the foot that has a medially deviated STJ axis and is maximally pronated, and therefore has little to no pressure under the lateral column, there is not enough pressure in the silicon device to move fluid to the lateral side.

    Or is this another foot type that is not suitable for SDO? Exactly what foot types are suitable for SDO?

    Yet
    How does it (the silicon fluid) get there? If its the weakest part (I assume you mean most compliant) of the foot then presumably it has the least pressure, just like the max pronated foot???

    I previously wrote
    Yet you sell them to anyone by mail order without biomechanical assessment :sinking:

    Again -- Can you tell me which activity does not involve lateral motion or lateral forces on the foot. I defy you to name just one.

    So do my socks :rolleyes:

    Dr Kiper

    I could write a book critisising your product and your ideas about how it works but I don't have the time or inclination.

    Your science is full of holes, your theories absurd and your terminology is abhorent.

    You either have no idea about podo - biomechanics, engineering principles and fluid mechanics

    or you chose to ignore them and promote your silicon dynamic orthoses using pseudo scientific explanations to fool the public and increase sales.

    Your second hand idea has probably been thought of by almost every studuent of biomechanics and orthotics but dismissed after 5 minutes of intelligent thought.

    Sales and profit are both very nice and good luck to you in that area but don't expect any sympathy or agreement from me about your product. :empathy:

    All the best Dave Smith
     
  27. David Wedemeyer

    David Wedemeyer Well-Known Member

    I am always shocked when a fellow traveler completely ignores weather, terrain, equipment knowledge and logistics when embarking on a voyage.

    Worse I believe is when they fail to grasp a fair understanding of the native populous, their mores, customs and especially their reaction to and possible aggression towards those who behave poorly or show their motives to be undesirable :butcher: .

    The definition of obtuse is when one of these natives, especially when he has the overwhelming respect of the tribe, fires a warning shot and this potential traveler does not retreat post haste!

    Welcome to ship wreck 08' everyone and the ensuing human barbecue!
     
  28. David Smith

    David Smith Well-Known Member

    David W :good:

    Its Saturday night no time for a :boxing:

    But some people make you :craig:

    but I'm :cool:

    So I'll bring the beer and snags. :drinks

    Plus Ricky Hatton fights tonite at 2200

    Dave
     
  29. Dr. DSW

    Dr. DSW Active Member

    Gentleman,

    Although I am new to this forum, I am not new to the concept of the SDO or Dr. Kiper's comments. As a matter of fact, I actually engaged him in conversation and Dr. Kiper was kind enough to send me a pair to evaluate for my own recurrent plantar fasciitis.

    But first a quick history. I'm a DPM, board certified by the American Board of Podiatric Surgery, with 23 years of practice experience and a relatively open mind. I have a daughter that swims competitively, and as a result, didn't follow the advice I give my own patients and often walked barefoot for prolonged hours around the pools.

    This resulted in recurrent bouts of plantar fasciitis. During one of these recurrences, I tried Dr. Kiper's product. I was amazed when I saw this "orthosis", which in MY opinion was no different than the gel inserts that were sold several years ago in the Sunday newspaper sale sections for $9.95. It's a vinyl insert filled with "silicone" and covered by a Spenco like material.

    I found some initial transient relief while walking, with considerable discomfort while static. Dr. Kiper claims I did not give the product a fair try, and did not follow his instructions and did not send them back for adjustments, etc. But, since I have a busy practice, I found it much simpler to simply place my old orthoses or even a pair of OTC PowerSteps back in my foot wear and my symptoms were almost immediately alleviated.

    Then, Dr. Kiper went on the "attack", and questioned my own skills as a provider, since I could not "cure" my own plantar fasciitis. Despite my constant explanation that the ONLY time my symptoms occurred was when I walked barefoot at my daughter's swim meets, and that my symptoms resolved almost immediately when I resumed an orthoses, he still could not understand that simple concept.

    On another website, he constantly attacked the inadequacy of "traditional" orthoses and the benefits of his silicone bag of crap. He constantly quotes laws of physics, Pascal's principle, etc.

    Despite NO one subscribing to his theory, NO orthotic lab "buying" his idea, NO podiatric medical school teaching his "theories", NO biomechanical gurus believing or subscribing to his views, he still insists that we all just "don't get it".

    I will be the first to admit that my expertise is more surgically/medically oriented than biomechanically oriented, and I will defer the biomechanics to others in my profession. However, I do know enough to understand that Dr. Kiper is way out of his league in attempting to play with the big boys on this site.

    So, I'll just sit back and enjoy the show and let the true experts on biomechanics simply pick apart his "theories", but will caution everyone that Dr. Kiper is still waiting for a call from the mother ship to take him back to the planet he left years ago.

    Now, I'll just sit back and enjoy. And I'll use my SDO's as coasters for my drinks.
     
    Last edited: May 25, 2008
  30. Jeremy Long

    Jeremy Long Active Member

    Dr. Kiper .... you asked:

    Did you look at how the SDOs fit the patient? Could you tell if they were overcorrecting or not?

    The volume fit of your device had nothing to do with the patient's resultant dissatisfaction and continuation of symptoms. The chronic state of the heel's inversion forced any existing fluid AWAY from the area where the greatest amount of support was needed, eventually forcing the foot to FURTHER INVERT. In other words your device provided the opposite of what this patient specifically needed, and could have caused additional trauma. Unless you can bypass the physical laws that you profess are the basic superior elements of your SDO, fluid technology simply cannot benefit a patient in this particular mechanical deficiency population.

    I have to reiterate, what are your personal goals? Do you really want to create awareness of a potentially positive treatment paradigm, or are you so blinded by your desire to gain general acceptance of this technology that you are willing to further risk the health and welfare of a patient already in pain in order to promote your product?
     
  31. Dr. DSW

    Dr. DSW Active Member

    As I've already stated, I have actually seen, touched and felt a pair of SDO's. Jeremy, we have personally spoken regarding this matter and I know you also have experience with this product.

    Given Dr. Kiper's theories and claims, and the actual volume of fluid enclosed within the vinyl walls of his product, can you even fathom that the limited volume of fluid would have any real effect on controlling pronatory forces on the joints of an individual over 50 pounds?

    We are talking about a device that is approximately 1/4 inch thick maximum, if it's even that thick. So, when the fluid is displaced to provide support when it's "needed" on a 175 pound patient, you tell me exactly how that amount of fluid is going to control that amount of force and limit motion.

    The product simply supplies a small amount of cushioning while a patient is in motion, but statically, the fluid is dispersed away from areas of high pressure, causing increased discomfort from my personal experience. But then again, Dr. Kiper will simply say I didn't give his product a fair chance, proper adjustments, etc.

    An interesting point that has not surfaced on this site, is that on a different forum Dr. Kiper has told patients that it may take YEARS to see improvement even with the use of the SDO's. I can just imagine telling my patients that the orthoses I dispense may have to be "tweaked" for several years prior to obtaining relief.
     
  32. David Wedemeyer

    David Wedemeyer Well-Known Member

    David

    I have no wish to spar with Dennis any longer over his device, I will leave that to the better minds here should they deem it necessary. We have exhaustively discussed its design, material and fallacious biomechanical suppositions, at times very heatedly. If Dennis continues to post he will expose himself to ridicule amongst his peers on a scale that he probably has not experienced before. Trust me when I say that dogmatic is a word that does no justice to his fervor for distorting known biomechanical fact and peer reviewed, supportive literature to promote his product favorably.

    I believe that you have put his faulty notions most succinctly to rest. I also believe that Kevin has a position that is very different from Dennis' but is holding back, he did after all warn him that he will be shot out of the water should he continue on. I don't think that trying to persuade his colleagues here, many of whom are amongst the very top minds in biomechanics, are published, involved in ongoing research into the efficacy of orthoses and are not readily fooled (if ever) will aid in his cause.

    My biggest concern is that the people who are afforded this silicone bag of avarice are not examined professionally, there is no history taken beyond a questionnaire and email, no plain film or labs etc. When I complained to him that the insert he provided me was failing he asked me to simply turn them over and switch them right for left. That was the point that I was not willing to pursue this charade any further.

    As for Hatton I was not able to watch the fight but I hear that he did prevail and in his hometown. A great victory because Lazcano is a very seasoned and formidable opponent in my opinion.

    The pride of England!

    Cheers,
     
  33. You make the assumption that kinematic change occurs with SDO, what data can you offer to support this conjecture? How do SDO orthoses "balance the forefoot to rearfoot relationship concurrent with STJ neutral"? Why is this important?
     
  34. If surface stiffness is important in reduction of injuries and improving efficiency in running as suggested by McMahon and more recently, by Nigg's work, then a variable pressure "bag" my be quite a useful adjunct to more traditional orthoses- so perhaps Dr. Kiper may be partially right but for the wrong reason's? In many respects this mirrors much of the work of Root et al; right but for the wrong reasons. Perhaps Dr. K. is looking through the wrong lens to try to describe the effects he believes his insoles are capable of?

    Has anyone actually done any "proper" research, not necessarily with Dr. K's product, but with similar technologies? Clearly, the running shoe companies have which is why we have gel/ air sacs in our trainers, but has anyone really researched orthoses that incorporate these technologies? I suspect not. So maybe.... In this way Dr. K. will challenge the world! (maybe)

    Maybe, its just that I always wanted to fight for the underdog:-0. Anyway, "for the benefit of Dr. K. there's going to be a show tonight..." Not on trampoline, on You Tube instead (modern times, who'd have 'em?):
    http://www.youtube.com/watch?v=u_rbsZw_7nE
    Turin Brakes: Underdog (Save Me)
    Two black line streaming out like a guidance line.
    Put one foot on the road now where the sybourgs are driving,
    With the WD-40 in their veins the screeching little brakes complain.
    With the briefcase empty and the holes in my shoes,
    I try to stay friendly for the sugary abuse.
    So tell my secretary now to hold all of my calls,
    I believe I can hear through these walls.
    Oh please save me, save me from myself.
    I can’t be the only one stuck on the shelf.
    You said you’d always fall for the underdog.

    Well I’ve been dreaming of jetstreams and kicking up dust,
    A thirty seven thousand foot of wonderlust
    And with skyline number 9 ticked off in my mind,
    Oh can you hear me screaming out now through the telephone line.

    Oh please save me, save me from myself.
    I can’t be the only one stuck on the shelf.
    You said you’d always fall for the underdog
     
    Last edited: May 25, 2008
  35. I was really trying to keep an open mind. Up to this little gem

    :bang:
    How often do we see this? :rolleyes:

    Its a gimmick

    Regretfully
    Robert
     

  36. Dennis:

    I encourage many ways of thinking. However, selling an insole product on an academic website where you actually have people who can challenge your ideas seems to have not been as easy for you as it has on other discussion forums, has it, Dennis?

    Unfortunately, your mention of STJ neutral and aligning the forefoot to rearfoot made me realize that you have very little knowledge of the current research and theories of orthosis function. Have you now left the site because a few people have disagreed with you and you now don't have the time to answer their questions?? Come on, Dennis, I was looking forward to hearing you explain how a silicone orthosis somehow supported a "rigid forefoot valgus" and prevented "supination compensation".

    Dennis, this forum is for open discussion of ideas which have scientific merit. However, it is not for individuals with only one way of thinking who want to sell an insole product and don't want to take the time to answer the questions of critics who want to know what he is talking about and question the scientific basis behind his product.

    I'm sure you will find another forum that is much easier to deal with where people won't disagree with you so much. That is what you are looking for...aren't you?? Happy Memorial Day!:drinks
     
  37. Dr. DSW

    Dr. DSW Active Member

    Dr. Kirby/Kevin,

    You have eloquently and accurately assessed Dr. Kiper's entire method of operation. However, since this forum is unique, and there are actual experts on biomechanics, he has hit a wall regarding trying to spin his mumbo jumbo into some form of convincing "tale".

    On other forums, he has an audience without the knowledge of the members of this forum. Therefore, he rants and raves about his product and unfounded theories, while constantly stating that the "old technology" simply does not work.

    There are those of us including myself, Jeremy (a Cped), Dr. Wedemeyer, etc., that have constantly challenged his theories and challenged the ethics of treating patients over the internet without an examination, thorough history, etc. We've challenged the ridiculous idea that his "one size fits all" product can heal almost all foot pathology via stepping in a foam box and sending it to him and having him treat you over the internet.

    And despite our concerns, the reply we ALWAYS received was simply that "we just don't get it".

    So, after years of arguing, battling and attempting to reason with Dr. Kiper, it's nice to finally have him come to a website and be bombarded by experts in the field that are finding no validity/credibility in his product, and more importantly it's interesting that he suddenly "doesn't have the time" to answer all these individual questions, since it's too time consuming, but does welcome individual emails.

    I guess he simply doesn't want to be exposed publicly, but I guess that's intuitively obvious.

    Anyway, thank you Dr. Kirby for finally sealing the deal.
     
  38. Dr. DSW:

    Welcome to Podiatry Arena. Nice comments above.:good:

    Do you have a name? Where do you practice?

    BTW, I'm still waiting for my mother ship also....:drinks
     
  39. DSW:

    I am just giving Dennis Kiper the same treatment that I have also given Ed Glaser and Brian Rothbart in the past on this website...not agreeing blindly with everything they say and asking them to give scientific evidence that their insole products do all the things that they say they do.

    Luckily, I have a number of other colleagues on this site that think like I do so it makes my job much, much easier. Unfortunately, my snake oil sensor (SOS) is very sensitive....and the snake oil practitioners generally tend to get the worst of me when my SOS alarms go off.;)
     
  40. pscotne

    pscotne Active Member

     
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