Skives and posts

Ed
I feel a bit put out that you feel that we are all trying to get you ( I am not paranoid, I KNOW they are out to get me!!!)
I asked QUESTIONS as requested by yourself but have only recieved qualified answers from others (thanks to those who have helped - I had better not mention names as we may then be seen as a gang).
Re your orthoses, I am among a small group of practitioners that works for a orthotic lab. I see many hundred prescriptions a week, ranging from the sublime to the ridiculus and can comfortably state that over 95% of them have a positive effect on the patient. (3 of my customers have researched this qualatatively with samples ranging from 50 - 450).
The one common denominater - angled posts.

What more can you offer?????

Phil

 

All,
This is great fun, but I have lectures to deliver and will be out of town with wife visiting friends so will be back on hopefully on Tues. or Thurs. I do want to post something that I wrote as a word of thanks to every one of you involved in this discussion.

Thank you,
Ed

To All,

I just wanted to give a word of sincere thanks to this forum and Dr. Craig Payne for setting up this forum. It has sparked a whole new wave of enthusiasm about basic biomechanics in Sole Supports (my world). Articles are being consumed and devoured, evaluated and a great aura of think-tank excitement has re-emerged all over our company.

Some of the best times I ever have in this business are the round table discussions we have at work on everything from basic science, production, new inventions (some very exciting ones coming up), engineering, orthotic modifications and how they effect foot function. We brainstorm on research ideas to improve the gait cycle even better than we currently are. Make things more accurate and improve the graphic presentation of what we have learned.

At Sole Supports, what really makes these discussions amazing is the spirit in which they occur. Ideas are freely pouring out, each trying to improve, build on and advance the cause. How are we going to test that? Can this be measured? Is there a way to show this that any Podiatrist would relate it to his/her experience in clinical practice and understand it in a way that will make it possible for them to use it? And Always…How is this going to make people better?

I guess that’s why I am better suited to the business world than the academic world. At Sole Supports, we are all on the same team with the same intention….to stay on the cutting edge of technology by improving our science. I guess ideally the science would be in place before the product was ever released but it is the trial and error, the amazing feedback that really makes improvement possible. If I had a gait lab and was paid to just study so that I could dissect and analyze the forces in a more controlled environment, I would have publishable data on everything, but we are not. We are in the trenches, making people better and I just have to fund research by brilliant biomechanists at several universities (which is really my pleasure). We look at data collection as a project. We need to know this, so we can make this, which will push here and we think it will change the gait cycle this way. Now, lets prototype one and test it. Once the data tells us what we need to know we move on. No IRB, no more statistical analysis is done than is necessary to achieve the goal, no paper written, no peer review, no re-write, no resubmission etc., etc., etc..

I don’t indulge in fancy verbage that would make it seem like I am trying to talk over people’s heads because I feel that my job is the opposite. I try to simplify concepts with illustrative 3D graphics. My lecture is aimed at the practicing doctor, not the academian. These are the guys on the front line that need something better fast. The message at the end of my lecture is not, “I am smarter than you because I am published and can talk over your head.” The message is, “I hope I have made biomechanics fun, interesting and have given you a technology that is doable for any podiatrist and fits into his busy practice while setting him/her apart with a new skill that could potentially change the way we practice and be enormously beneficial to our patients.”

Got off on a tangent there but thanks again for re-kindling the spark of the best part of our world; understanding it.

With Great Respect,
Ed

PS: At next Wednesday's Scientific Meeting at Sole Supports, we will decide what data we can release or how we can graphically demonstrate more clearly to all of you the difference between orthotics that reduce tissue stresses at the terminal Instants of pronation vs. Orthotics that reposition the foot the change the function.

 

I love the way when the questions get tough, this guy goes on vacation. It's alright Ed, you can phone a friend.

This last posting (and many previously) are just advertisements for Mr Ed's company. There is no substance and no reason for the posting other than to sell the company. So if it's OK. Visit Peninsula Podiatry Plymouth UK for all your podiatry needs, specializing in Sports Injuries and Orthoses. We will make you much better than anyone else...

BTW Craig, your silence speaks volumes.

 

I am here -- I have only just arrived back in the country to a sick wife and have 6 hrs of lectures to give tomorrow and only got 50% of the powerpoints done and its already 4.30 (not to mention all those damn exams to mark)... could be heading for one of those all nighters again ... I am watching what is happening here.

 

Dave,
One of the best posts on this thread!

Cheers,
Davidh

 

Dave H

I thank you!!

Dave S

 

Hi all

As a Podiatrist who spends his working life trying to clear an obscene NHS waiting list i can share ed's frustration with dismissing something that apparently works because it has no research backing it up. I can also share his desire to "think outside the box instead of reinforcing it's walls". I use modalities and types of orthotic which i have developed and which are not based on currant research so much as development of my own ideas. Certainly without people trying radical new ideas we'd still be eating our bison raw and sneering at the hot red burning thing that makes meat go brown and taste better.

Having said that If he is genuinly interested in "making people better" he will realise that as Javier so intelligently points out the world is full of people who claim their way is the best/only way. Thats fine for you but if you want to convince the community Ed you are going to need to give us that research data. Your rational, whether or not it is correct is clearly not as obvious to the rest of us as it is to you. Sorry but if we ain't convinced by three pages worth of posts we ain'y going to be convinced by 5! We need more to so radically shift our thinking. Helping the patients who walk through your door is, of course vital, but if your theories are correct and all you claim and await only the correct proof, then a few years research could convince us all. If we all start following suit then your product could be successfully applied to literally millions of patients.

If as you say you are genuinly worried about the direction in which Kevin Kirby and others like him are leading the profession ask yourself why we are following them! If you want to lead us in a different direction the way to do it is to do what they are doing... but better.

Eagerly awaiting that data


Robert

 

Quote
“What you are saying here is that if we can prevent the joint from reaching the end of its ROM or do so less harshly….the foot will not deform. Great…. I guess with some posting we can certainly slow down the progression of deformity.

Do you believe that “form follows function”? If we improve function through positional changes we accomplish so much more. We reverse deformity. You will have to look for yourself…. It would be a disservice to your patients to do otherwise”

Ed
Are you a supporter of the Root definition of function? I know your MASS sounds different to STJ neutral but I would hazard a guess (always dangerous) that the MASS position approximates the STJ neutral in most people. Am I correct in saying the MASS position is found by supinating the w/b foot. This is not maximum supination I would guess since with many people, including myself, the plantar surface would be almost vertical. This MASS position is somewhere between max pronation and max supination but not enough supination to cause passive eversion of the foot due to gravity ie an inversion sprain. So the foot is slightly inverted in resting stance, which is a normal STJ neutral position for most people. The rest of the function includes adaption and rigid lever propulsion.
Now it appears to me that you are proposing that the SS system works as well on rough terrain as everyday ‘flat’ surfaces. So my question now is, if the SSS tends to keep the foot in a more supinated position so as to more efficiently lock the foot into the propulsive stage and prevent tissue stress by allowing less pronation how can it also allow the foot to adapt to rough varying terrain. This is now the defining argument in my opinion.
The Root definition of function gave us a wonderful model to work on. However, more recently, by my understanding, forward thinking researchers and clinicians have realised that adaption to terrain is normal and the foot can work efficiently thru a greater range of RoM or morphology than previously was proposed. Therefore it is now proposed that the foot be allowed a large range of motion, as is natural, but to limit this before the strain becomes pathological. (this will vary between subjects)
In this way we allow the brain CNS and muscles of the foot to control the stiffness of its segments and its ability to adapt its required morphology.
To achieve this with a calibrated arch support would be a great achievement. It is difficult to imagine however that it is possible. Even with modern anisotropic or isotropic materials one cannot alter the young’s modulus or poisson ratio in any desired plane to match the required stiffness for a certain desirable magnitude of displacement.

The next part of my argument concerns the construction and action of the SSS.
When the foot is cast in the MASS position this will naturally include some angulation of the plantar surface of the heel ie the heel is supinated. This will be captured (I am assuming you do not ablate this feature) in the shell of the orthosis. Therefore since the distal edge of the orthosis rests on the ground the action of the pronating heel will apply a certain torsional stress to it. This action will of course produce a reaction that is effectively acting as a medial post for the heel.
Unless of course the heel is rotating in the heel cup and assuming a position of max pronation, which it cannot do with the SSS.
Ed have you tried testing for the magnitude of plantar pressure applied to the medial heel cup thru the stance phase of gait. This could be done using an F Scan insole.

In conclusion I believe that the SSS may work for some or even many in some situations as is possible with some OTC orthoses.
However it does not seem possible in my opinion for this single paradigm intervention to improve or resolve all pathology in all situations and furthermore restricting the RoM of the foot may induce or increase trauma in distal or proximal structures. If the SSS is not restricting foot RoM’s then it would appear to have similar actions on the foot in the same way as today’s progressive designs but without the finesse and sophistication of an orthoses designed using the SALRE / Tissue stress and engineering based models.

There are many examples which can demonstrate the above.

Ed what would you do with a patient with a plantargrade foot with an enlarged Arthritic non compliant Nav-cuneiform joint who has posterior tibial dysfunction syndrome and or Sinus Tarsi syndrome.
I am sure this person could not tolerate an SSS. But may respond well to a soft full contact orthosis with a full length medial ramp or possibly just a flat insole with a 5dg medial heel wedge. (worked for my customers many times) In fact I’ve just fitted the 4th repeat pair for a lady with just such a foot who is very pleased with the resolution of her PT dysfunction pain.

The point about the, ‘optimal stress theory’ for want of a better term, is unlike Root and especially SSS it is not constrained or limited to a certain demographic or dictum but is only limited by the skill and imagination of the practitioner who understands Newton’s principles as applied to the human body.

The SSS may be for the practitioner who wants an easier life as are OTC products and products produced solely by the algorithmic interpretation of pressure mat data.
They all ‘work’ and will sell and make nice profits for many. And fair play to you for that Ed I like a bit of profit myself (it seems hard to come by in large amounts for me though).
But I believe the dedicated professional will endeavor to make an effective product that is unique in both construction and action for each individual customer / patient and have a logical theory as to why they work and just as importantly how they will not cause harm.
The research, pondering and argument go on and it may be that the best product is not the winner but the best marketed product. Pooling and combining your research with others may produce a better result for the future but I expect you are looking for autonomy with aim to produce a ‘unique’ product that will capture a certain market.

Good luck to you Ed (really)

Cheers Dave

 

Basically, what you are describing here Dave is Spooner's ZOOS which I think was the agreed term ;-)

 

Simon

Well Thank you (jaw dropping, slightly embarrassing moment).

seriously appreciated cheers Dave Smith.

And if I may I eerrmm would just like to thank the producer, all the cast, my mum and dad who have supported me all the way, my sister who stayed up all night to sew on the sequins and eerrmm! Oh yes! all you lovely people out there without whom all this would not have been possible, Giggle shuffle, some tears, wave furiously exit stage left. (voice from stage right)-pHew thank god he's gone. Cue Elton John!!

Oh was it Spooners ZOOS Fame at last eh!

 

Nicely put Robert always good to see new input.

By the way what is the latest research on currants. I'm a raisin man myself.
Currants, sultanas, raisins so much choice . Are they the same fruit in different packages? is one supreme? or is it just a matter of choice. Then there's the Prune (much bigger you know) for the man who really needs to shift some dirt. The dried fruit debate rages on. Its all consuming, driving me so mad I could s--t. Pass the prunes.

See ya, Dave

 

Ed

Final reply to post 21st june
Quote
"Neither. We empirically through experimentation (and this is very proprietary) determined the average downward force using body weight and foot flexibility and then measure the upward force of the orthoses. We use Paschall’s law…forces inside an enclosed container are equivalent in all directions. We apply a force evenly over the entire surface of the orthotic while measuring both pressure and vertical translation of the peak of the orthosis every two thousandths of an inch. This creates a force curve on every orthotic. AS our experiments show, it turns out that the slope of the curve is indicative of flexibility of the shell. Then came a long period of data collection, putting dots on a graph like buckshot scatter. Eliminating the warranties we created a trendline that described a specific mathematical functional relationship between body weight, foot flexibility (and we developed a unique method of measuring that too (a grading scale currently used…. Something else new and then a new device now being tested at U. of Bridgeport in Conn. Called the Bors Flexometer, named after our own mad scientist). Of course new data is collected almost 400 times a day and the trendline continues to improve over time."
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What is Paschall’s Law? I have never heard of it. Is this more than a typo -- Do you mean Pascal’s law, ‘forces inside an enclosed container OF FLUID are equivalent in all directions.’
This applies to gas also Boyles law, Henry’s Law, General law of gases, none of these have anything to do with force transmission thru the foot. Now I spent about 10yrs+ with gas and hydraulic systems so I could go on a bit. What is the closed container of fluid you are referring to? If you mean the foot is a closed container of fluid and so forces are evenly displaced thru it and therefore forces applied at the TC joint are evenly dispersed over the foot then you should sack you engineer and physicist. Does the foot apply an even pressure over the orthosis NO! Is force and pressure evenly distributed thru the foot NO! See the attachment for an example of how forces might propagate thru a typical arch foot model. They are not equivalent or even in the same direction. Ed, I look forward to being blown out of the water with a sensible rebuttle based in science to prove that I’m not as clever as I thought I was. (which I don't really)
What I am saying here is that although your company may have reliably characterised the flexibility of certain materials that you use for the construction of SSS, this would seem reasonably simple, your explanation of the process leaves a lot to be desired.

Creating trendlines for the body weight to material flexibility ratio seems like good science and I would like it to be true since this would be valuable research. But unfortunately it could equally well be akin to determining the average shoe size of a population in terms of height. You could certainly produce scatter graphs with a trendline an R2 value and a calibration value but would the average shoe size fit every customer NO!
Not unless you could show that the trendline had some sort of confidence level that was high. In other words the linearity full scale calibration error would need to be very small to confidently predict that the trendline would apply to most people. But we haven’t seen any data along those lines.
Also measure the downward force or measure the upward force they will always be equal ???

Ed you wrote “bore me I love engineering, I think it’s the most fun part of my job”

Sorry to appear a bit miffed but to be honest Ed I was really looking forward to some interesting discussion of your new research and maybe learning something useful but, no offense, from what you have written so far it would appear you have lots of enthusiasm and good will but little engineering knowledge.

The arch analysis I have done may be a waste of time I hope not though. Perhaps when or if you reply you will take the time to consider your answers.

Thanks once again Dave Smith.

 

I'm sitting here in my hotel in Beijing, just finished yesterday with the conference and have a little free time before we visit the Great Wall. Sorry to see this thread get quiet so suddenly since it was certainly one of the more entertaining discussions we have had in a while.

In retrospect, much of this thread revolved around whether foot orthoses work and how they work. Since this was a topic of one of my lectures to the approximately 200 foot and ankle orthopedists here at the seminar, I thought I might summarize what we do know so far about orthoses.

First of all, contrary to what Ed Glaser said on his DVD, foot orthoses do work. They not only help relieve the pain from numerous foot and lower extremity pathologies but they also have a relatively high satisfaction rate among patients, between 70-91% in the four studies on runners I cited in my lecture.

The real question is not whether foot orthoses do work, but how they work. Ed's assertion that ground reaction force (GRF) can't cause STJ pronation or supination moments because the GRF vector acts directly at the posterior exit point of the STJ axis simply shows how little Ed understands biomechanics but also how little he knows about the latest research using inverse dynamics to determine the kinetics of the rearfoot during walking and running activities on foot and lower extremity biomechanics.

Benno Nigg's book on running shoe biomechanics published 20 years ago (Nigg, B.M. (ed.). Biomechanics of Running Shoes, Human Kinetics Publishers, Inc., Champaign, Illinois, 1986) has a great discussion on this same topic where he clearly illustrates that the GRF vector is altered by the running shoe sole geometry. At the instant of heel contact in barefoot running there is little STJ pronation moment arm. However, during running in shoes at the instant of heel contact, the GRF vector has a relatively large STJ pronation moment arm. I have been using Benno's illustration from his book for over 15 years in my lectures on running biomechanics and running shoe biomechanics.

The main point in this discussion, especially in running, is that the GRF vector is of such a large magnitude during heel contact, being probably about 1.5x body weight during the impact peak (i.e. passive peak), that even if the GRF vector is just 2 mm away from the STJ axis, it still has the ability to cause significant STJ moments. So, instead of wasting one's time lecturing that the STJ axis is not important since GRF goes through it, like Ed has, the real question is exactly where is the spatial location of the STJ axis and what is the direction, magnitude and point of application of the GRF vector on the plantar foot at any instant during gait. This is a very difficult problem technically to achieve and we are making some progress in that direction (Spooner SK, Kirby KA: The subtalar joint axis locator: A preliminary report. JAPMA, 96:212-219, 2006; Lewis GS, Kirby KA, Piazza SJ: Determination of subtalar axis location by restriction of talocrural joint motion. Gait and Posture, In Press, 2006.) Once we can accurately track the STJ axis during gait on a force plate, then we should be able to accurately determine the external STJ moments generated by GRF, which is, in many pathological conditions, the major deforming rotational force acting on the foot during gait.

I look forward to more stimulating discussion in this regard in the future.

 

Dave,

Perhaps I'm missing something, but the orthoses I make are 3D and have variable "span" distances and curvatures so I'm not sure how this kind of analysis (2D, simple curve) helps ???

 

Simon

Just to show that the forces in an arch are not equal or in the same direction especially when loaded unsymmetrically. Therefore applying an even pressure over the orthisis shell to test its response, under the premise that the foot applies even pressure to the orthosis, is unrealistic in my opinion. But I could be quite wrong (a little knowledge is dangerous so they say) and if so I am sure Ed or someone will get back to me.
The purpose of a model like this is to give a indication of the outcome to a problem of interest. Even though it may not be reliable or accurate (in terms of the real problem) it is useful.

I kept it to a single direction force vector for clarity but adding horizontal forces just means going around the moments and translation balance with the same equations again a few times.
If I took the analysis a few steps further and applied the same principle to the orthosis itself it would be possible, with the material data, to work out bending and shear stress values at certain points of interest on the shell. Regardles of the shell shape although multi plane curves would be difficult,I think, I have'nt tried that yet. It would only indicate one possibility in one moment in time though.

However the foot as you point out Simon is a mutispan space frame truss system which is highly indeterminate and not a problem I could approach at present. I am working on it though. This sort of work though, former and latter, is usually done with computers using finite element modeling otherwise it would take a lifetime of analysis for one complete example.

What I am saying to Ed is that it is entirely possible that his company is doing good work calibrating the flexibility of the orthosis in terms of the applied GRF and Body weight but his explanation of this work does'nt sound right. With words and diagrams I a trying to explain why.
If he said look I'm the ideas man, the money man, the medical man and the motivation but I leave the engineering and physics to my experts then fair enough he wouldn't be in line for so much critisism from you me and others.
I believe so far that his SSS is niche market product with limited application and not the answer to all biomechanical pathology that he would have us believe.

Cheers Dave

 

I agree, hence we see a CoP pathway.

Again, no argument from me regarding finite elements as the way to approach this problem. However, given that each custom orthoses is unique in terms of its surface geometry, and, if the shell is constructed from vac formed thermoplastic, then it is not homogenous in terms of material thickness, aren't we pissing in the wind a bit? Moreover, research shows that it just ain't necessary to be this accurate to achieve the desired outcome in Jo Public. This said, I would be interested in pursuing research into the "tuned orthotic", analagous to the tuned track concept Kevin talked about previously- for the World class athlete this may be a cost effective approach. Now there is a research project for the 2012 Olympics. Now who's the ideas man?

You carry on like this, and the next thing you know people will say that you strain to find fault in their arguments

 

One of the other main points in Ed's argument against current orthosis designs is that he feels that rearfoot posts are unnecessary. I believe that Dave Holland also chimed in to say he rarely uses rearfoot posts on orthoses. If you are using a shank independent orthosis material, such as polypropylene, graphite or acrylic, then to not use a rearfoot post is to also lose a very valuable part of a foot orthosis for your patients. In other words, it is absolute rubbish that rearfoot posts are not necessary in orthoses to optimize function and optimize symptom resolution in our patients.

Rearfoot posts have the following functions for the foot orthosis:

1. Stiffens the medial and lateral longitudinal arches of the orthosis.
2. Stabilizes the rearfoot of the orthosis to frontal plane moments from the foot.
3. Allows a platform to increase the heel height of the orthosis.
4. Allows modification of plantar rearfoot loading patterns to occur during contact phase.
5. Allows relatively easy modification of frontal plane angle of rearfoot portion of orthosis to shoe.

The rearfoot post is essential for proper orthosis treatment of conditions such as posterior tibial dysfunction, medial tibial stress syndrome, tarsal coalition, pediatric flexible flatfoot and many other pathologies. However, the rearfoot post is not essential for all foot orthoses and may be actually contraindicated for many patients.

For example, when a medial or lateral heel skive is used on an orthosis, in an attempt to shift the orthosis reaction force (ORF) on the plantar heel to a more medial or lateral position, respectively, if there is no rearfoot post then it is likely that very little of the desired medial or lateral shift of ORF will occur. Without a rearfoot post, the patient will be more likely to evert or invert the rearfoot portion of the orthosis relative to the shoe during stance phase rather than having the orthosis remain stable within the frontal plane so that it can alter the ORF plantar to the heel, as is desired.

However, it must also be pointed out that many conditions can be treated, as Ed and David point out, without adding rearfoot posts on orthoses. To say, though, that rearfoot posts don’t need to be used in any foot orthoses is ludicrous.

As I said before, those podiatrists who are not using rearfoot posts on their orthoses must be missing something or must not be treating patients with the difficult problems that I have seen on a daily basis for the past 21 years. Rearfoot posts are an invaluable part of many of my patients’ orthoses.

 

Ed

I have now recieved a copy of your CD and watched it thru a couple of times. Thats 5 hours.
There are so many things to question you on but I think the most important place to start is the hypothesis that the Bottom Block works and heel wedges don't.

I will assume that since you propose that heel wedges have no function and are a "HO-AX" your SSS has no effect on the heel in terms of a medial heel wedge resisting pronation.

A premise of your theory is that the SSS adds more time for control of pronation and you show this on a graph. The SSS controls pronation from heel contact and thru to stance phase and toe off and sets up the foot to heel strike in a more supinated position.

The way it achieves this is to control saggital plane plantarflexion rotation of the calcaneous by adding calibrated stiffness to the medial arch complex.

You say that the calc plantarflexes at heel strike but cannot pronate because the GRF are parrallel and in direct alignment with the STJ axis of the posterior calc facet. Pronation can only occur when the talar head, under the influence of the applied force from the tibia, slides forward and rotates onto the anterior facet of the calc. This force is transmitted onto the sustentaculum tali (STC), which is a lever arm that causes pronation moments about the inferior medial tubercle of the calc. Or to look at it inversely the GRF causes moments of pronation about the STC axis. Is this possible since will this not result in a compression force on the posterior facet joints.?

The action described above cannot take place before there is forefoot contact. This is because any saggital plane rotation will take place at the Talo crural Joint (TCJ). This can be varified since if the calc rotated and the talus slid forward onto the STC then there would be pronation moments caused and this is forbidden by your premise.
So from heel stike to forefoot contact the SSS have no effect on calc pronation. This cuts down considerably on Time.

Now it is proposed that the talus can slide forward onto the anterior calc facet. This seems unlikely since the GRF acting thru the medial column is pushing the Talus in a posterior direction. It seems more likely that there is a seperation tendency between the anterior facets of the Talus and calc and therefore tension in the interoseous ligaments and the talus is pulled down by the calc.
It also seems unlikely that, as you have clearly pointed out, the finely balanced mechanism of the rearfoot, which is designed to minimise the pronatory effects of GRF, eg by pointing the STJ axis directly at and parrallel with the GRF force, now suddenly find a lever arm that will continuously increase pronation momenta proportionaly to the increase in pronation. This seems to be a recipe for catasrophic trauma.
On the contrary and conclusive with Kapanji's observations the STC is maximally loaded in the supinated position. This then would make more sense. Because as the calc pronates, adducts and pulls the anterior talus down, the GRF is directed mainly thru the posterior facet, which is not only much larger a structure capable of withstanding the applied loads but has the reverse effect to that which you propose. This is that as the calcaneal pronates the joint forces move laterally onto the posterior facets and therefore reduce pronatory moments and consequently reducing the potential for trauma.

There is precedent for this if one looks at a similar action that occurs between the medial and lateral condyles of the knee joint. Frontal plane moments are potentially damaging to the knee and an analysis of the structure will show that these moments are not resisted by ligaments and muscle alone but by the translation of force across the knee which effectively resists the GRF moments in the frontal or X axis.
If one imagines that the intercondylular prominence is a hinge then as the knee adducts the medial intercondular forces increase to resist and cause an opposing abductory moment. This is not by accident I would propose this is by design and the STJ complex may be analogous to it.

Am I making sense to anyone else, hope so!

That’s all for now Ed but -- I’ll be back. In my best Arnold Shwarzennegger voice.

Cheers Dave

 

Dave and Colleagues:

Reading your discussion above, Dave, in addition to watching Ed try to describe the same thing on his DVD makes me feel even more confident that the best way to understand the complex biomechanics of the subtalar joint (STJ) is not to try and individually analyze what is happening at each facet of the STJ during gait. Rather, it is obvious to me that it is much better to try to condense the 2-3 facets of the talo-calcaneal joint into one joint complex when discussing the biomechanics of the STJ with the understanding that STJ rotational motions occur about at an axis of motion that rotates and translates three-dimensionally during weightbearing activiities.

Trying to understand the direction and magnitude of forces at each of the STJ facets during weightbearing activities is futile at this point of our knowledge/research since we simply don't know enough about the intra-articular forces at each of these facets in different foot types to begin to understand the complex interactions between joint forces, tendon and muscle forces and ligament forces. In addition, without getting into more complex free body diagram analysis or finite element modelling, how are you going to transfer this knowledge to the average podiatrist who doesn't even know what these analysis techniques are or how to use them?!

This comes back to Ed's DVD and the way he describes how the STJ works by using STJ facet analysis. I feel that STJ facet analysis is currently an inefficient and possibly inaccurate method by which to describe the mechanics of the STJ since it is based on pure conjecture as to how the forces are distributed within the STJ with each foot type and at each instant in gait. Using analysis of the STJ axis and how the forces acting across the axis affect the STJ moments as the preferred method of biomechanical analysis of the STJ at least gives us some very solid ground to work from when making assumptions about the biomechanics of the STJ.

 

Time to review the DVD again

Dear Dave,

I believe the HO-AX in the DVD refers to selling what are essentially pre-fabs as custom orthotics.

No, not simply the calcaneus but supination of the STJ.

Not parallel or in direct alignment….the distance between the point of application of the GRF at heel contact and the point of plantar, posterior, lateral exit of the STJ axis are so close as to afford minimal perpendicular distance from the force to the axis.

This is the misinterpretation: NOT onto…. Off of. The fact that the heel strikes ideally in supination with the anterior facet relatively perpendicular to the force coming down the leg (which is opposed by GRF and Friction at heel contact) and the head of the talus is articulating with this perpendicular surface of the anterior facet which blocks rotation of the talus around the cone shaped posterior facet. These forces attempt to place a rotational moment around the posterior facet are transduced to a sliding moment along the axis of the posterior facet cone which points anterior medial….right at the base of the middle facet.

What do you think causes the eversion of the calcaneus? We both see the same thing, calcaneal eversion in pronation…. We just describe it differently.

Are you saying that calcaneal eversion does not occur until midstance? In that scenario, STJ pronation would have no function in shock absorption or adaptation to the terrain. Oh, and as I seem to be corrected on my spelling so often…one g and two t’s in sagittal.

Again…not onto…off of. That changes everything. On this I suggest that you try a Sole Support and do an F-scan showing progression of COP through the foot. If our findings are consistent with what you see, you will be quite surprised. By the way… there are certainly pronation moments caused. There have to be…the foot goes into pronation soon after heel strike, right? (again, spelling: verified and strike….I really think that those correcting my spelling are being petty….I understand what you are saying here).

Mixed it up again. Off of. Don’t you see the sinus tarsi closed in the pronated foot in x-rays? The disarticulation of the anterior facet allows the talus to rotate or drop forward into plantarflexion in the sagittal plane around the axis of the cone shaped posterior facet.

What? The talus moves anterior, internally rotates and plantarflexes during pronation….are you seeing something else?

That would be possible if both the articular surfaces of the anterior facet remained in contact…which they don’t and both plantarflexed at the same rate or ended up in the same relative degree of sagittal plane rotation…which they don’t.

Only if you are landing on a flat hard tilted pancake…or have reached the end of pronation and apply tissue stresses that cause pain and deformity.

This is certainly true later in the gait cycle as pronation nears its end point and damaging tissue stresses are applied. Timing is everything.

Once again…true as the joint reaches the end of its ROM.

No argument here… Newton’s third law.

(I love this spelling: intercondylular…I am just poking fun at the spelling gurus, not you Dave)

Instead of simply attacking the concepts on equally un-researched ground I will soon propose we test, research and study what is happening (if others are brave enough to participate). You have not seen these orthotics function, have no clinical experience with them...it is amazing that you can discredit what we see clinically as such an improvement in patient care. I have a lot of experience with posted and skived orthoses. Originally I did exactly what I was taught, as I am sure we all did. When it worked so marginally, I moved on …but in a different direction. Instead of making a bigger post, I chose to re-position the foot to correct gait. Every one of my clients also has used posted and skived orthosis for most of their careers and now swear by our technology. What is wrong with these people …. They need to tell their patients that have failed with standard orthosis and are now better with Sole Supports that it is all in their imagination. Maybe I am using hypnosis….Dave…you are getting sleepy...

Respectfully,
Ed

 

Dear Kevin,

I sat down to answer all of the comments that I have gotten on everything from my DVD to some semantics about axis definitions to some very good physics questions. What I see emerging here is simple; two competing philosophies or theories:

1. Frontal plane heel posting and skives are the best method of controlling excessive pronation through moving the COP relative to the STJ axis and reduction of tissue stresses to reduce pain and deformity and “optimize function”.

2. Repositioning the foot in the MASS position with a full contact, calibrated orthotic changes foot and lower kinetic chain function to approach a more ideal gait cycle so that pathologic tissue stresses do not occur eliminating pain and facilitating deformity reversal.


I have learned a lot in this discussion. For one thing I stand corrected that rearfoot posts and skives have no effect. The problem is not that I think that rearfoot posts don’t have an effect. In fact I would describe the problem as; the rearfoot post does exactly the effect that the research says it does. In fact the research is so accurate that I would applaud their findings and even the change in vocabulary calling “tissue stresses” instead of positional changes the “cause of pain and deformity”. Further, it follows from this very theory that those stresses are usually encountered at the end of the ROM of various joints as they approach full pronation (relaxed calcaneal stance position). A post, you have convinced me, acts at the end of the ROM to dampen the pronatory moments thus measurably decreasing the tissue stresses that are placed on the bones by the ligaments and joint capsule. The post itself, has no function to decrease total pronation so positional changes do not occur. The foot is as pronated as it is in the relaxed calcaneal stance position. But at the same time, even without effecting position, the decrease in tissue stresses is adequate to eliminate pain. The pain was apparently caused by repetitive micro tears in the ligaments, compression damage to cartilage, periosteal tears, or other soft tissue damage occurring too rapidly and frequently for the body to effect simultaneous healing. Maybe there is adventitious bursitis from the bony prominences created in the associated deformity rubbing on the shoe. The skived, wedged or posted orthotic will therefore reduce these tissue stresses to a level that is manageable for the body eliminating the symptom: pain. Hey, that is great….if that is what you are attempting to accomplish….slowing down the progression of deformity and relieve pain….you have your orthotic.

I simply propose a different paradigm. Instead of tilting the ground a few degrees, Supinate the STJ before heel contact to level the anterior facet and delay the sagittal plane rotation of the talus around the cone shaped posterior facet. This will dampen pronation as well but instead of operating around the fully pronated position, the patient learns to begin each step in a more supinated heel strike. The result is firstly a dampening of pronation as the foot proceeds from heel contact in its most supinated midstance position possible. The goal is to allow enough pronation to allow sufficient shock absorption and terrain adaptation. Secondarily, and most important from a functional perspective, the MLA is sufficiently stabilized (thanks to the keystone effect of the navicular) such that the first ray gains leverage and stability against the GRF of forefoot loading. This preserves the functional integrity of the first MTP and the proper relative weight distribution at the metatarsal heads.

Basically this is bringing the patient from their current gait cycle to as close to an ideal gait cycle as each patient can tolerate with their individual anatomy and ranges of motion (which can certainly change). The foot never reaches anywhere near the end of the ROM of the STJ so that “tissue stresses” of the type described above, do not even occur. This same scenario repeats itself for many joints in the foot. In the DVD we explore numerous diagnoses and put together observations that are so common in podiatric practice to make their proof purely academic. The reason why so many practitioners switch to Sole Supports is because they want more for their patients than symptom relief.

On my way into my lecture on Sunday, I was watching the guy in front of me and analyzing his gait. Come on, we all do this. He was interesting in that his asymmetrical pronation was so blaringly obvious. It was easy to see his heel strike on the more pronated foot was rectus to slightly everted (heel striking in the middle of this shoe) whereas on the “good foot” he was considerably more supinated, inverted and heel striking laterally. The pronated foot is externally rotated, likely a pinch callus, bunion, etc. (see DVD)

Let yourself “theorize” for a second.

1. Imagine the angle of eversion of the calcaneus, at relaxed calcaneal stance standing on a round cupped heel (or a flat heel for that matter) orthotic with a Kirby skive bilateral. Both heels remain asymmetrically everted at or near the end of their individual ROM in the direction of pronation. Likely this would cause a limb length discrepancy. The orthotic will slow down the terminal pronation reducing tissue stresses and pain is relieved.

2. Imagine instead a full contact, custom molded, calibrated, MASS position device that in this case supinates the pronated foot to at or near the more ideal foot. Mechanical stresses at the end of pronation are replaced with a rebalancing of the muscles and tendons as they reposition closer to the optimal functional advantage of the “better” limb. External rotation slowly straightens out as the lowered first metatarsal head (relative to its base…or a more supinated rearfoot position) decreases dorsiflexory stiffness at the MTP and shifts forefoot loading to the first met head at toe off. The limb length difference may be equalized or is greatly improved, the knee is positioned closer to the sagittal plane, asymetric anterior pelvic tilt decreases and tissue stresses on the lower back are greatly relieved (especially when accompanied by physical therapy to insure adequate ROM for superstructure changes is available). The foot never reaches terminal pronation where the pathologic tissue stresses are applied, function improves and deformity reverses.



Is this a cure all? Absolutely Not. A cure all would be a single orthotic modification that is used exactly the same like a post or skive, person to person, and usually left to right. For what Podiatrists charge for these devices, ethically, each patient deserves a very individualized “CUSTOM” device.

My intention has always been to make Sole Supports the highest level of custom attainable. The device is custom molded; not to the shape of the arch filler but to the actual shape of the foot. The foot is not held in “neutral position”, out in space, with no frame of reference (poor repeatability). The foot is cast in the more supinated MASS position. Frame of reference in the closed chain is the floor. A casting material, also custom made for us, is used that applies tissue compressive forces upward to simulate the tissue compression that occurs in orthotic use. Mechanical efficiency is dramatically enhanced by the FULL CONTACT under the MLA. Full contact is made possible through calibration which is individual left to right measured as the resistance to vertical compression (similar to supination resistance). And on top of that each orthotic is custom designed by the practitioner for that individual patient’s weight, flexibility, shoe type, activity level, diagnosis and certain other considerations.

Clearly, more research data is needed to prove which of the above paradigms is the most effective for clinical use.
Let’s do research together. What I am proposing is a research study directly comparing Sole Support technology to Precision Intricast Kirby Skived Orthoses. Other labs are also invited to participate to show the effect of Rootian posted orthosis or some other technology.

The study must be EQUALLY FUNDED by all labs participating so that no one can point to an economic bias because it was funded by one lab.

Research structure and parameters measured are agreed upon in advance by all sponsoring labs. Those can be openly discussed in a separate thread on this site.

The length of the study should continue two to five years to show the long term effects of either technology.

I think that we could ask Craig Payne, if he is willing, to do the study as he is non-biased, objective and well respected by everyone involved.

I am confident in what we have learned and would welcome the chance to go head to head with ANY other theory or foot orthotic technology.

Respectfully,
Ed

 

Goals of Biomechanical Correction?

Wouldn't it be helpful first to define what, specifically, in biomechanical terms, we are trying to accomplish with an orthotic before we debate the best way to do it?

Don

 

I agree, and I would add how foot works. If not, we will be still walking on circles.

 

ED

Ok touché on the spelling pickups.

Well after checking you say wegdes are a Wrong, a joke, invented by spongebob etc.

You show flat (Pancake) 'custom' orthoses as an example that they are not custom. And that these custom orthoses don't work any better than prefabs.

There's a circular argument if ever I have seen one.

If you are refering to flat orthoses produced by labs using no more than pressure mat data then I would agree these are not custom. If some labs produce flat custom orthoses then more fool the podiatrist who accepts them.

Personally I have never produced a 'Pancake' orthosis.
As I have pointed out before Ed we use triplanar posting, deep heel cups,
elevated calcaneal inclination fascia, cuboid lift, lateral arch raise, lateral and medial flanges, (variable flexibility shells when using shell type orthoses). Personally I use an Amfit system most of the time. This captures the foot weight bearing or semi w/b and in any position required by the podiatrist.
How much more custom than that could my orthoses be.

If your argument is that your orthoses are better than OTC or pseudo custom orthoses then that may be quite likely.
But it is my suggestion that your design intrinsically captures all the features I have described above. But because you wish your product to be unique you seem to disregard this possibility and also you disregard the fact that true custom orthoses incorporate some or all of these features, which produces a far from flat orthosis. Unless, of course, that is what the prescription requires, which I believe, as I have stated before, is where your design falls down.
It fits into a convenient niche for the demographic that has a reasonably normal, foot alignments, Joint morphology, and gait style. Which, granted represents a fairly large market. If I had the time and money I would love to take you up on your challenge Ed. But I would need to see the SSS perform on those subjects outside the demographic described above.
As I have asked before how could the SSS possibly be applied to a person who's medial arch is flat and cannot be lifted yet has pathology such as Post tib dysfunction syndrome.
I have no problem in saying that it may be quite possible that your calibrated arch support may be a useful addition to the orthotic arsenal. However I believe there may be many labs that would argue they already use such technology. With the lab I use for my casted orthoses I usually ask for a flexible weight matched shell.
When using Amfit I choose the density of EVA or combination of densities,
I grind out as little or as much of the medial and lateral arches as is required for the patient and the shoe it will fit in.
The argument here is not that your SSS do not work but mainly that your explanation of the way they work is misrepresentational (I bet that's spelt wrong) as is your proposal that they and the theory behind them completely replace and supersede all previous theory of biomechanics of the lower limb and FFO's.

Cheers Dave

 

It's a real shame then that you still haven't answered them.

Ed, can you define "ideal gait cycle" please?

Perhaps, you should learn a bit more Ed, and go re-read all that research that Kevin posted the refs to, I think you'll find that many of the conclusions you have drawn from this are incorrect.

I'm no expert on Kuhn, but I don't think that this consitutes a new paradigm (perhaps one of the most, over-used and abused term in modern podiatry).

There goes that "ideal" word again; ideal for whom and in what environmental conditions? Still interested in what more you offer than symptom relief, lets go back to my first post to you re: your treatment claims regarding hallux valgus- do your orthoses reduce the deformity?

To quote Bill Hicks- "How scientific of you, thanks for going to so much trouble". This is utter nonesense. For starters, you don't know that he has a "good" or "bad" foot.

That's some real deep theorizing Ed. Now imagine that you aren't trying to sell a product and that you have some data to support your above commentary. What is the "ideal foot"? Show me the data were you reverse hallux valgus or for that matter any other "deformity". Crazy stuff this theorizing isn't it?

Some Cut

Firstly, I think this is a very good idea. Secondly, I think that the are other researchers who may be better placed to carry out this work than Craig, since I suspect you may already be funding Craig's research in some shape or form. Sorry Craig, but as I said previously, your silence in this speaks volumes to me and others- Perhaps you could go on the record to state that this is not the case.Thirdly, do you know how much this would cost!!!

 

Simon,
Craig has never recieved one dime from Sole Supports, Inc nor has he ever done research with our company. I personally was very impressed with Craig on his visit to Nashville because he stressed the importance of a non-biased approach not only to research but in his class as well. His students learn how to think independently. I honestly feel the the next great wave of discoveries in biomechanics will be either directly from Craig or his students.
As far as the money is concerned, I don't think it will be prohibitive if the labs donated their orthotics and contribute equally. I have no problem funding this research at all. A lot will be learned that will Make People Better.

Ed

 

Ed, I really don't know where you got the idea that you think that my theories of orthosis function are based only on frontal plane wedgings and postings and skives. Have you read either of my two books? I describe both sagittal plane and frontal plane corrections on foot orthoses. I talk about changing tissue stress and about optimizing the gait cycle. I introduce many ideas that have not been written before in the medical literature. Unfortunately, from reading your postings, I don't think that you have read what I have written over the past 20 years so you really don't know the full extent of my previously published works and that I have suggested some of the many things that you have suggested, only that I wrote about it over 10 years or more before you put it on your DVD.

The above paragraph, Ed, is some of the most intelligent and useful prose that you have written so far in these discussions. Thank you for that. However, actually as John Weed once reprimanded me 20 years ago, the correct term should be "pronation moments" and "supination moments" not "pronatory moments" and "supinatory moments", since John didn't think think that "pronatory" or "supinatory" were real words. I agree with him and have been using, and have recommended using the terms "pronation moments" and "supination moments" ever since that time. It's better English.

What you say you are doing with Sole Support (SS) orthoses is what I, and many others, have been doing with foot orthoses for many years. Even though I appreciate it that you think you have a new paradigm, I don't really think that your ideas qualify for a new paradigm. You see, Ed, you seem to assume that all I do is medial heel skives and seem to think that all I can do is think in a frontal plane manner. This could not be further from the truth. I think of medial arch support, lateral arch support, lateral heel skives, heel lifts, and all the other modifications that I have written about over the past 20 years (Kirby KA: Foot and Lower Extremity Biomechanics: A Ten Year Collection of Precision Intricast Newsletters. Precision Intricast, Inc., Payson, Arizona, 1997; Kirby KA: Foot and Lower Extremity Biomechanics II: Precision Intricast Newsletters, 1997-2002. Precision Intricast, Inc., Payson, AZ, 2002.) I helped Rich Blake make positive casts and orthoses in the first few years of when he was developing the Blake Inverted Orthosis back in 1981-1983. Now that was a new paradigm for orthoses! So I have been around a long time and seen many, many types of foot orthoses and don't see that you are doing something radically different from what many of us have already tinkered with for many years.

First of all, the orthosis techniques I invented are called the "medial heel skive" and "lateral heel skive". It is not appropriate to call these modifications the "Kirby skive", since I think this is not necessary and will likely add confusion when discussiing the medial versus lateral heel skive positive cast modification.

Secondly, again I don't know why you are limiting me to only using a medial heel skive and not allowing me to modify the medial longitidinal arch (MLA) shape and MLA stiffness as you apparently are with your SS orthoses. Ed, modifying MLA shape and stiffness to decrease tissue stress and optimize gait function are things I have been writing and lecturing on for 20 years!! Maybe you would do better (and irritate me less) if would first ask me what I think about something before you assume what I think about something since you obviously haven't read enough of my work (and other authors' works) to know what I think about foot and lower extremity biomechanics and foot orthosis therapy.

Ed, as I said before, I am a consultant for Precision Intricast and don't make decisions for them as to how they spend their money. Your idea to do research regarding foot orthoses is good and I commend you for that. I hope that you can add do meaningful, non-proprietary orthosis research and then work to have it published in a peer-reviewed journal where your and your colleagues hard work can carry significant academic weight. This will then allow you, and others that think like you, to have more firm ground to stand on when you make your arguments regarding how you think foot orthoses should be designed or how the foot works. However, until that time, your arguments are purely speculative in nature.

If you are to carry out this orthosis research, then I feel strongly that the research should never be about one lab's orthoses versus another lab's orthoses since all the orthosis labs that I know are all basically trying to do the same thing for their customer's patients: Make People Better. I strongly feel that orthosis design characteristics should be non-proprietary in nature, which is why I never patented the medial heel skive. I made the decision to allow the medial heel skive modification to be used freely by any orthosis lab around the world since I (and Precision Intricast) wanted to see this valuable modification be used by any orthosis lab that felt it would help their customer's patients.

I feel that orthosis research, instead of being proprietary, should be generic in nature and should investigate how differences in orthosis design, differences in orthosis materials, and differences in the mechanical characteristics of orthoses affect short term and long term gait kinetics and gait kinematics, short term and long term symptom relief, and short term and long term patient comfort. This is the type of research that podiatry needs, not one orthosis lab doing research in an attempt to support why they think their one orthosis design or their specific manufacturing method is better than all other orthosis designs. Propietary research funded by the company that makes a product is always viewed by intelligent clinicians with less academic weight than research that does not receive funding from the company that makes the product due to the conflicts of interest that are inherent in the former type of research.

In the perfect world, I would love to help design a good orthosis research study and help perform that research. However, I know that in order to be up to date, that this research should be done in a lab that is fully equipped to do three dimensional gait analysis, force plate analysis and have the data analyzed by inverse dynamics to determine both the kinetics and kinematics of foot orthoses. There are only a few gait labs in the world currently that have done quality work in this regard. You will see those labs in my reference list on foot orthoses.

Currently, I have already committed to a multi-year project with Penn State Biomechanics Lab to do orthosis research on cadavers. Therefore, I will not be able to take on the huge committment required to do a quality foot orthosis research project since I still have a full time practice in addition to lecturing and writing, being a husband, father and soon, a grandfather. However, thanks for the offer and I wish you luck in your orthosis research that will hopefully be published soon in a peer-reviewed journal.

 

Question for Ed Glaser

Does your concept essentially mirror the UCBL?

 

Dieter,
Good Question. The UCBL is really a brace more than a funcional orthotic device. Since it wraps plastic all around the foot with very high medial and lateral flanges it is totally stiff. The Sole Support repositions the foot into the MASS position and flexes to allow enough pronation for adequated shock absorbtion and mobile adaptation. This is accomplished via material selection (modulus of Elasticity) and callibration.

Ed

I have been away enjoying a wonderful relaxing week on the Alaskan Cruise while lecturing to the Northwest Seminar and Region VII meeting (for the second time).

I just want to thank Dr. Dockery for his wonderful intro to my lecture. He told how he had suffered for well over 10 yrs. (I think he said 13 yrs.) with plantar fasciitis and had it treated by some of the greatest "biomagicians" (biomechanical gurus) in our profession. I think he said he has a collection of 13 pairs of failed orthotics. No relief. He got his first pair of Sole Supports about five years ago, still wearing them because they succeeded where others had failed in a very short time. What surprised him was that it also straightened his semi-rigid hammer toe second. I know.... just another anecdotal testimonial by one of the most respected authors and clinicians in our profession.

 

Ed,

What is your take on the UCBL casting methodology as compared to that advocated for the SS?

I was impressed, even as a student, by the potential of the UCBL to capture the 'inverted' foot posture and the casting technique for this. Your method seems to aim for a similar effect.

In your opinion, will this capture the same profile / functionality that your casting technique aims to obtain?

 

Welcome to the Future of Foot Orthotics

Dear Kevin;

I actually got the idea from reading your writings and postings on this site. You are right, the DVD is a new production of Sole Supports, Inc., but these ideas I have been lecturing about since 1992. By the way let me reiterate the purpose of the DVD. One must be certified in order to have the privilege of using our technology. Prior to the DVD docs had to attend one of my courses in order to get certified. There grew quite a waiting list of people who wanted to learn but could not get to a seminar for one reason or another. The DVD helps people who want to try Sole Support Orthotic Technology and can’t wait to come to a lecture.

Let me put this issue about the Newness of my ideas to rest.
No you have never thought about, written about, and certainly not done what I have done at Sole Supports. Here is a partial list of some of my NEW ideas, techniques and contributions that certainly DO constitute a major paradigm shift:
1. Dynamic Casting: Gait referenced casting is a highly repeatable, accurate method of casting the foot in an entirely NEW position that uses the floor as a frame of reference and passes weight through the foot in as close to an ideal gait cycle as the patient can tolerate with their anatomy.
2. The Pen Test: to test cast accuracy and repeatability.
3. Fowler Test: To clearly demonstrate to a patient why the orthoses they currently have are not working and how a full contact orthotic makes changes in the gait cycle that precede and prepare the foot for heel strike.
4. MASS position: Capturing the foot in the maximal amount of supination possible at midstance…as opposed to neutral position.
5. Lowering the head of the First Metatarsal…aka…STJ supination. In the DVD you see how I analyze over 30 of the most common foot, ankle, knee, hip and back diagnoses and find a common denominator in terms of positioning the foot to correct them and it is not a position that you ever mention.
6. Full Contact: You are the medical director of Precision Intricast so I assume that their orthosis reflect your treatment philosophy. They have three choices of arch fill (minimal, “normal”, and extra) all of which are ARCH FILL not full contact. How can you control the foot if you do not even touch it in the arch. Our experience is that even a relatively small amount of arch fill dramatically decreases the function of the orthosis.
7. Calibration: Let’s see…Precision has four thickness of polypropylene or low density polyethylene (cheap materials without the correct modulus of elasticity).
a. 2/16 (1/8) up to 130 lbs
b. 5/32 100-180 lbs.
c. 5/16 130-325 What an absurd range, that’s almost everyone.
d. 4/16 (1/4) over 325
e. What this illustrates is a complete lack of understanding of calibration. We have pioneered the research into orthotic calibration which has evolved to where it is today; an accurate and patent pending device that applies force over the entire orthotic while simultaneously measuring vertical displacement and pressure, creating a force curve and then hand tuning each orthotic to the correct flexibility for that particular patient’s needs. This has been a very long research project that is no where near finished. Our new nine pin calibration will soon go into production and take it to the next level. THIS IS VERY NEW AND A MAJOR PARADIGM SHIFT.
8. The Gib test: A method of assessing foot flexibility that is relevant to foot function and orthotic manufacture.
9. The Bors Flexometer to more accurately asses forefoot flexibility.
10. The Clam Press: a device that applies six tons of force to compress the top cover materials onto the orthotic to prevent delamination.
11. Geometric analysis of STJ function and a new paradigm for mid foot locking based on our research at the Smithsonian Institute.
12. Carrying supination from toe-off through swing phase to level the anterior facet of the STJ prior to heel contact and prepare the foot for stance phase. In other words, preparing the foot for heel contact instead of waiting for heel contact with a frontal plane posted orthosis.
13. Debunking the myths of Neutral position, rearfoot and forefoot posting and skives, frontal plane treatment protocols and off weight bearing casting.
14. None of this includes the tremendous innovations in manufacturing technology that yields more consistency in the product while taking it always to a higher level of custom, quality and function.

Compare this to skiving off a little of the plaster on the plantar medial side of the positive cast or drawing the shadow of the STJ on the bottom of the foot to justify old time frontal plane theories or changing the terminology a little to talk about tissue stresses….all a useless attempt to justify a tired, old technology. Your approach is devoid of original thought with any practical significance and leads many podiatrists down a dismal abyss toward “custom” FO’s that are no better than prefabs. You know nothing of what I have read and continue to speak volumes about your assumptions. You attack me on the basis of my success in business which is only a testament to the effectiveness of my technology. By the way there is a recent article comparing my technology to standard podiatric posted tissue stress relieving orthoses.

http://www.humankinetics.com/JSR/vi...374&site=X3ku8WHGX6su8R26X4tf3vBAX6cv8wnBX4vx

Just acknowledging your fabulous contribution to foot biomechanics: a frontal plane increase in the angle of the posts. Brilliant and NEW.

Now there’s a 360…. From “This isn’t new” to “Ed is wrong” to “I really invented Sole Supports”….. Strike three….You are OUT.

I did ask you some simple questions in posting # 67:

In your recent newsletter about the goals of biomechanics you extensively trounce “neutral” position as not being the goal of Podiatric Biomechanics but you never even allude to what IS the correct position to capture the foot in or how to capture that position correctly, accurately and in a manner that is repeatable? Does the cast really matter to you? If we are just trying to reduce tissue stresses, will any vaguely foot shaped device work as long as it has the proper wedge in it? That is…as long as it effectively moves the COP relative to the shadow of the STJ axis. In other words, would it not be simpler and cheaper for your customers to apply pre-fab wedges to pre-fab orthosis to reduce tissue stresses?

I just have not heard any answers.

Don’t they do research? We’re not talking about a lot of money here. Don’t they want to find out how they fare against an up and coming technology?

Beware, the research is emerging. Non-proprietary is why I suggest a neutral researcher like Craig and why I think it should be funded equally by both labs.

Oh my god did you come up with “We Make People Better” too?

No this is not about one lab against another but what would make a more objective analysis of the relative effectiveness of two different orthotic approaches than getting each from the inventor himself or his associated lab. Medial Heel Skive vs. Medial Longitudinal Arch Full (not Fill) Contact Calibrated Orthoses. Let’s see objectively which is the best technology.

Sorry, at this point, Sole Supports is a proprietary technology. No one else has done it and no one has even tried. However, I do feel that the monetary remuneration you have received from the medial heel skive is disproportionately greater than its value.

See, you just designed the study right there. That is the exact study I had in mind. The highlighted above is exactly what I want to test as well. Lets do it.

If someone claims to be better, let them prove it.

Again that is why it needs to be funded equally.

You will not need an electron microscope to see gait differences that are produced by Sole Supports. We are not trying to measure the quantum differences in tissue stresses but rather gross changes in the gait cycle. We need only measure criteria that are clearly moving the current gait cycle closer to that patient’s ideal gait. Oh in answer to Simon’s question as to what is the ideal gait cycle. Anyone that does even the most cursory gait analysis must first establish what they are trying to achieve with orthoses. Major differences seen between the over-pronator and the more ideal gait seen in many top level athletes are blaringly obvious. People whose foot structure is functioning so ideally that no biomechanical faults appear in the form of deformities (those noted on the DVD) even after repetitive exercise. No hyperkeratotic lesions present in this patient. Certainly you or Simon can tell the difference between a severely over-pronated gait cycle, a supinator and a more ideal gait cycle.

You are so in luck!!! You don’t have to do anything but read the proposal on a separate thread, make a few comments and donate the orthotics and half the money. No one is busier than I.

I think that the real problem is that you are concerned that the skived orthoses will not perform as well as Sole Supports.

I certainly think that everyone on this site respects Craig Payne’s research ability and integrity. If you really think that you have a better approach…lets put it to the test…I certainly am willing. Maybe Simon can fund some research and help you with the expense.

Sincerely,
Ed Glaser

 

Ok, Ed. You win. I acknowledge that you know everything about feet and biomechanics and that you can eradicate plantar fasciitis from the face of planet Earth with your Sole Support orthotics. Hopefully, you will allow me to be one of the users of your technology and attend one of your seminars so that maybe, one day, I also can be considered to be an expert in foot and lower extremity biomechanics and foot orthosis therapy like you are.

 

At Peninsula Podiatry we've invented more technology than anyone else here's a list which doesn't stand up to scrutiny and most importantly you can't use until you've been on one of our courses (Send cheques to the value of £300 made payable to S Spooner at the address below):

1. The minger test
2. The Jerry Springer test
3. The ginger test
4. The lingerie test- my own personal favourite

Forget the fact that if you use the right adhesives your top covers won't come off anyway. We've also invented a machine called a "power-press" for laminating top covers. Forget those things calling themselves power-presses that have been around since the industrial revolution- which we started BTW, this is completely different.

Forget all the previous research on geometrical modelling of joint facets including the STJ because i invented that too. Forget all the high quality research which disproves what I am saying now, because they'll all wrong and I'm right. I can't tell you why, its a proprietry secret.

Everything you are curently doing in your practice is rubbish, we can't tell you why or provide any research to support our claims, but we'll keep plugging our product as long as no-one stops us. We'll turn this discussion site into a farce before your very eyes. So hey what about, lets do the research.

Visit Peninsula Podiatry, !a Edgcumbe Park Road Plymouth UK PL3 4NL Tel 01752 241442 for all your foot and leg care needs.

I love this free advertising disguised as academic discussion. Unless someone stops this soon it's going to turn into a problem, But hey no-one seems to care here.\\

Kevin is too polite, but I'm not: You can shove your blatent product plugging up your arse for nothing and **** off while you're doing it, you are nothing more than a door to door salesman and about as welcome here. You cannot build arguments to engage in academic debate to save your life and when the questions get too tough you either go on "vacation" or just ignore them. My colleagues and I have critiqued your concepts for all to see. The ball is in your court now-go do the research, but stop trying to drag everyone down with you. I shall not write anymore here as I believe we are becoming complicit (go look it up) in helping you to promote your product- no publicity is bad publicity hey? I've watched the DVD and quite frankly I've had better laughs watching children burn. I spurn you as I would spurn a rabid dog. Ladies and gentleman, Never mind treating my feet, I wouldn't trust this man to sit the right way round on a toilet seat.

Thank you. Goodnight. Elvis has left the building.

 

Simon, I must agree the advertising and b******* must disappear, but damn , if it does will you continue with your wit and charm? It is one of the highlights of my day.

 

Sorry I can't tell you it's a proprietry secret, please send a cheque to reveal the answer.

 

If self promotion is a bad thing, I sure don't subscribe to this level of vulgarity and, it has no place on a professional, and open, platform. I applaud Kevin for his self restraint and respect his altruism but acknowledge a good deal of the world is governed by the might of the "$".

I have mixed feelings about some aspects of self promotion and this could be goods, ideas, paradigms etc but the likes of Ed Glaser and Rothbart should not be excluded because they don't want to follow anothers' arbitrary rules of engagment. These folk are as passionate about their work as anyone.

Professionals can decide for the,selves if we agree or not and / or what the motives could be. In any case there are always plenty who will keep this in check and Admin does not seem to mind too much either.

 

You see Dieter you can't please all the people all the time, my post yesterday made HJ--Ray's day, whereas it clearly offended you. The great thing here is that the language is automatically censored. So for example if I write **** off Dieter, it will come out looking like this ****. Now it's down to your own mind to fill in the blanks= how many four letter words are there in the English language? I make the assumption that if a word isn't censored then it is deemed acceptable by the forum ownership. The other great thing about all of this Dieter is that no-one is making you read it. Now if you don't like what I say or how I say it, just don't read any future postings by me, skip right over them, like I usually do with yours. Have a nice day.

 

Simon ....

Simon. When you ask a colleague to 'shove something up his ass' there are really no blanks left to be filled in. No-one is making you read any post you find so terribly offensive. Your proclivity for the crude and vernacular is immature, implied or otherwise. I respect courtesy and professionalism, your dubious sense of 'wit' notwithstanding. You need to learn good manners young man.

 

I think Simons paroxysm is to be blamed on the abuse of this fantastic resource of certain individuals to pedal their products. If the learned people who have become agitated by these individuals didn't bother to reply, or worse, contribute their ideas to this site, then some people might have been mugged into thinking that Sole Supports were the best invention since the wheel.

Wayne Rooney was sent off Vs Portugal in the 2006 World Cup. He blew his top due to his frustration of the way he "saw things". Some have rallied behind him, some have criticised him. He does need to learn to cool it a bit, but as an Englishman, would we want Rooney to be less passionate?

A little bit of fire warms the heart.