STJ neutral and Forefoot deviation

Just tryiíng to get some answers Dennis.

So the lateral arch includes the Talus, best I wait for the pictures.

 

Why wait,
Let's assume that it doesn't. I have no argument with that.

Dr Sha

 

So what bones that make up these important archs in FFT that are held together by the Vault ( mainly ligaments) are fluid and you can switch them around ?

A Roman arch is held together by a ´key stone´ your little avator, the compression force from stone to stone is what does the trick, but in FFT it doesn´t ?

 

That is because the foot is not akin to architectural arches, it is closer to a truss-tie beam scenario.

The medial longitudinal, lateral longitudinal, and transverse roof of the foot have the talus, cuboid, and intermediate cuneiform bones as keystones to the vault.

Why separate them when looking at the foot as a whole functionally?

Simplistically, without the ligaments and musculotendonous support, the arches collapse. The plantar ligaments and the muscle levers of the foot tie the inferior edges of the bones together.

Insertion on the calcaneus and navicular and first metatarsal and into the plantar plate function like a tie beam in a flexible arch. The long and short plantar ligaments provide the main support for the lateral longitudinal arch. The deep transverse ligaments support the transverse roof.

David:

What happens functionally to the arches or vault of the foot (and in your discussion, the lateral arch) if you remove the talus from the equation (i.e, a ballistic astragalectomy)?

Dr Sha

 

Received these photos in a consultation yesterday. So where is the vault in this 13 y.o. athlete's feet? Our criteria for normalcy are based on a narrow population. We run into problems when we attempt to apply those criteria to all subjects.

 

Dennis, from your writings it appears that you think the idea of the vault of the foot is important for how orthotics work. The reason that I asked you to define vault is that I wanted to understand how a centering could support the vault of the foot. I looked at your previous posts and nowhere did you describe which bones make up which arches of the foot. I'm still trying to understand what anatomical structures of the foot correspond to the vault that "sits above and along side" the medial and lateral arches of the foot. I'm questioning whether or not describing the foot as having a vault is accurate. We can make this all moot if we just admit the vault part is not relevant. Dennis, if you think the vault is relevant please explain how an orthotic effects the anatomical structures that make up the vault.

Then we can move on to how balancing based on foot typing alters the shape of the orthotic and why.

Remember Dennis, you are trying to convince us your ideas have some merit. If you can't explain the anatomy behind your ideas, then I will conclude that your ideas have no merit. This is not bias. You have not fully explained your ideas.

Eric

 

Eric,

Well written and thoughtful post. I conducted a google search of "vault of the foot" and came up with virtually nothing that wasn't written by Dennis except one o&p link: http://www.oandplibrary.org/cpo/1986_01_008.asp and one foot fetish site with vault in the name (perhaps a video vault?).

I searched for the definition of the word vault and thefreedictionary.com gave the following definition:

With respect to the cardinal body planes, the plantar surface of the foot typically demonstrates a sagittal arch and a transverse arch. The arch is more pronounced in a non-weightbearing condition than during a weightbearing condition when the forefoot and rearfoot are both contacting the supporting surface. The osseous structure of the foot creates the rigid elements of the arch, and we can certainly discuss them individually. However, I don't see how the term vault adds anything to our understanding of the foot since a vault is an arched structure.

So I would ask Dennis to not only define the vault of the foot, but I would ask him to please differentiate it in clear, standard anatomical terminology from the arch of the foot.

 

Here you go Dennis, I'll try to help you out. I guess the closest thing to the foot being analogous to a "vault" as defined above is in the one quarter ellipsoid model of the foot that Phillip Demp described:

http://www.sciencedirect.com/scienc...serid=10&md5=2fcde764453bdf2b89584eeae4eb1c3d

Now, this is definitely not related to your foot-typing system, Dennis. So don't you dare try to pretend that it is. If you "don't get the fizzicks" that we talk about here, don't suddenly start saying that you understand non-Euclidean geometry. Yet since you seem to be an expert in evidence based medicine, perhaps you could answer the question I asked you a while ago in this thread:
http://www.podiatry-arena.com/podiatry-forum/showpost.php?p=164307&postcount=13

And don't tell me to go read... I already know the answer, the question was posed in a Socratic style to help with your education.

 

No, for once you are right Dennis, we do have no idea. How many is it 1, 2 or 3? I'm sure you can evidence this answer.

 

In thinking about paradigms: How does an orthotic work in neutral position paradigm. One of the proposed mechanisms is that the forefoot to rearfoot relationship is "supported" by the orthotic. If there is no universal agreement on what that deformity is, can you support it.

I agree that we should work from the ground up (pun intended.) The neutral position theory works on forefoot to rearfoot relationship. Perhaps we should be working on the ground to foot relationship. This thread (or was it another) was started with the question of whether there is some other paradigm choice on which to base prescription writing. You can measure the wedge in your orthotic relative to the ground and not to a measure within the foot.

Regards,

Eric

 

The problem is that angulation of the ground varies. Even taking a flat, level surface we presumably need a non or semi-weightbearing foot, otherwise the forefoot to ground relationship will be parallel in many (most) feet. In our semi / non-weightbearing assessment what position do we put the rearfoot in? STJ neutral? Isn't this just skinning the cat a different way, but ending with same answer? Enlighten me, Eric.

 

Simon and Eric:

My best idea, at this time, would be to move the rearfoot and forefoot so that the forefoot is parallel to the patient's transverse plane (i.e. plantar parallel position) in a prone position and then mark the posterior heel with a longitudinal mark that would be parallel to the patient's sagittal plane (i.e. vertical). Then with weightbearing, measure the calcaneal mark relative to the ground and the number of degrees the patient is from the maximally pronated position of the STJ (i.e. maximum pronation test).

This set of measurements would provide the examiner with data that should be quite reproducible from one examiner to another and will tell us how close the patient is to the maximally pronated position, how much the STJ pronates or supinates when going from the non-weightbearing to weightbeaing position with the forefoot parallel to the transverse plane and, taken along with STJ axis location, may provide a more reliable and meaningful method by which to discuss foot structure to foot function. Just an idea to hopefully get the ball rolling.

 

Take a foot with high medial forefoot load. A foot with first MPJ pathology caused by medial forefoot load. The goal of the forefoot valgus wedge is to reduce the amount of load on the medial forefoot and increase it on the lateral forefoot. There will be a point when this wedge is too large. A wedge that is too large will try to evert the foot further than the easily available range of motion. In the prescription I give the foot a wedge of the right height, but not higher. The prescription isn't based on a foot type, but on available range of motion.

You could call this skinning the cat a different way. I certainly think there has been some success with the Root paradigm because of the use of an intrinsic forefoot valgus post. I'm just providing a different measurement to decide to use something that is already done. I believe that a forefoot valgus wedge works, but not because it supports the deformity. Different explanations for the same result.

Cheers,

Eric

 

1.Foot typing presents guidelines for building a custom footbed,
foot type specific as described on these pages.

Two examples would be rearfoot vaulting for the flexible rearfoot types (which would be disastrous for the rigid rearfoot types, for example) and forefoot vaulting for the flexible forefoot types (which would be disastrous for the rigid forefoot types, for example). That then allows each clinican faced with a patient to decide how much vaulting is necessary, patient specific, making this a true custom paradigm and not the cookbook paradigm that you have suggested.

2.Each cast for each foot and each precription for each foot is different and so there are a myriad of devices, even foot to foot.

3. So that I can offer better custom care and in addition, try to prevent offering a treatment that may be harmful to other feet that don;t share foot type specific characteristics.

4. As I realize the bias that accompanies YOUR critical thought, I welcome it and over time, I have accepted and revised Wellness Biomechanics for the better using those that I feel should be incorporated. I thank Simon (great articles), Robert, Kevin, Craig and others I am sure I am leaving out at this moment and give credit for their input often in my work.
I continue to explain my rational to many doctors and patients to varied reviews. Some say it's great, some middle of the road and some like yours have every right to declare it worthless. (I continue to learn most from the latter and that is my reason for being on sites like The Arena).
I will never profit from or change you and I don't understand why you continue to arrogantly say that that is my motive for visiting. I could care less about your acceptance of my work.

Dr Sha

PS: still unable to illustrate, color, bold or start a new thread etc.

 

Dennis,

Would you please provide an anatomically specific description or definition of the vault of the foot? What is "rearfoot vaulting" and "forefoot vaulting"? Understanding the vault is essential to understanding your work and theories. Since you haven't offered a specific anatomical description, how can you expect anyone to comprehend what you’re talking about. From what I can tell, you are using terms vault and arch interchangeable. Is that correct? If not, why not? You seem to me to be ignoring this request. Here is a great opportunity to make yourself better understood.

 

Thanks for dubbing me the originator of The Vault of The Foot as per your statement that I have virtually every reference to it on the internet.

The vault of the foot is being understood and utilized in presenting cases to patients, casting and fabricating orthotics and in teaching reasons for examining the Rootian paradigm of biomechanics for upgrading and change without requests for further information. I am not so sure why you are having such a hard time envisioning it?

So lets just say I have tried my best and have not succeeded and lets move on. or..

My next conference is in October in New Jersey and you can pay me to learn more about it (or you can continue to pay Craig for his boot camps and get the Simpson's version of my work).

 

So it is about the $$$$$$$$$$$$$$$.

 

If that works for you.

So

Let's move on, shall we?

Dr Sha

 

But I still don´t know What is "rearfoot vaulting" and "forefoot vaulting" is.

If the Vault is the liagaments as we discussed yesterday how does one Vault them ?

 

The vault of the foot, like the hollow under an architectural arch is defined by the stones or bones on top of it.
In the foot, this includes all the bones but those that are digital.

Any pitch that increases the height of the vault is vaulting and any pitch that reduces the height of the vault would be collapsing to the vault.

This means that increasing the pitch of the rearfoot (The CIA) would be vaulting and that increasing the pitch of the forefoot (1st met declination) would be vaulting, RF or FF respectively.

Once we determine where the foot needs vaulting (rear/fore/both/none) via a functional foot typing, we can apply care, foot type specific.

When discussing a case in person or on the internet, there is a reference that we all can understand and relate to, there is a body of evidence that can be grown, foot type specific and there is a simple method of communication that patients, MD's and Podiatrists can understand.

As an example, Jeff Root in his mocking of my work showed an amazingly disabled pair of feet in doing so.

Using those pictures, please define that pair of feet for us all, as best as you can, so that we can discuss it clinically.
Please [point out the STJ Neutral, the RF to FF relationship, the Subtalar Axis and anything else you care to as to predict diagnosis and a treatment plan as I have already FFT'd the patient and have a plan for care.

Then we will compare notes to the actual patient which I hope Jeff can attach to to see which of the paradigms offers better diagnosis and clinical care.

Dr Sha

PS:
I still can't impact changes on The Arena and will soon stop participating if that is not repaired because I will not accept less than full status that the rest of you enjoy.

 

Dennis, 1st I think Craig is asleep so I´m not sure he can help until he gets a few ZZZZZZZZZ.

2nd it´s very hard to assess a patient from photos,

But I will say that I beleive that the above patient will have a very medially deviated STJ axis, We can see that with the size of the Navicular, that most likely the Lever arm of the Tibialis Posterior is very much reduced adding to the load on the TP muscle.
He seems to have a thickening of the 1st MTP joint which may indicate an increase in 1st MTP joint dorsiflexion stiffness.

But all of this information is maybe and likely - need to see and assess the feet, but the major question is where is the patient feeling symptoms, as this is vital to orthotic prescriptions.

as we need to know what hurts and then using mechanical knowledge work out why the load on that tissue is too much and then using our knowledge of mechancis work and the best way to reduce this load, so I think you have asked for the impossible unless Jeff can give more information.

 

First of all, my surmise is that this is a female patient (the skirt)
She is thirteen and athletic so why don't we say she is pain free but having performance issues (wellness not get sickness).

Also, you have not discussed care (clinical application).

Dr Sha

 

1st Dennis I think your skirt are B/Ball shorts so I´ll go with male ie he and if you look at my post we can not make any treatment options without more information, plan and simple.

But if you can hit me with it

 

I also think the tubular legs look female but we'll wait and see and kudo's to the correct one.

I am waiting for the ZZZZZers and others to chime in here and then will give my complete findings of this case.

Later.

Dr Sha

 

Here is the description from Foothelper's website:

Dennis, et.al.
The foot is not like the centring described above. This is an incorrect description of the structure of the foot. The osseous components of the foot are not self supporting. Amongst other things, the arch of the foot relies on tension members that are located plantar to the osseous members to pull the ends of the arch together to prevent the center from collapsing under load. As load increases, the tensile forces in the plantar tissues increase. At some point, the load will cause the soft tissues (ligaments, tendons and fascia) to elongate and the arch will bend or deform under the increased load. This is much different than the static (rigid) arch or vault that is represented on your website.

The foot is not a static structure. It is made of living tissue. Hence, muscle activation influences tissues that cross joints to alter joint moments and influence the dynamic arch of the foot. Dr. Root once theorized that the foot had an "osseous restraining mechanism" and that the osseous structure of the foot was capable of self support. He was challenged by his coauthors so they stopped writing the book for over a year to conduct research. That research proved that the foot was not capable of self support. It became evident the moment they cut the long plantar ligament and the foot collapsed.

Dennis, you claim that Root theory needs “upgrading” and I agree. However, I feel your model of the foot is not accurate and is therefore, not an improvement over “Root theory”. I’m sorry if that angers or upsets you, but if you expect to advance a new theory of foot function, a “new paradigm”, a new treatment approach, a new system of classification or evaluation, or whatever you want to call it, you had better be prepared for scrutiny and be able to offer reasonable support for your position. I don’t believe that is being unfair to you nor should it be considered bias when others ask you to better explain yourself. We are sincerely trying to understand your propositions, but we can’t do so unless you are willing to help us and yourself.

 

Dr Sha,

After our most pleasant chat on the phone I felt I had a better understanding of you as a person. However, your postings do come across as somewhat sarcastic and "jabbing". Not at all how you present yourself in conversation.

I'm hoping your Arena presence is unintended and if so perhaps try and write a little more as you would speak. Then I feel you would have more fruitful discussions here.

Kindest Regards

 

Dennis, I was not mocking you. And ironically, I just remembered that the practitioner that sent me those photos was a former SoleSupports customer who switched to Root Lab after I treated him at a casting workshop I conducted and he replaced his SoleSupports device with the ones that were made for him by Root Lab. I had actually described this practitioner some time back in this or another thread (partially compensated ff varus case). I would be happy to invite him to comment. As far as I know, he has no knowledge of this thread or this forum and I have never spoken to him about the Podiatry Arena, as best I can recall.

For the record, I don’t consider the Podiatry Arena to be marketing opportunity nor do I wish to engage in bashing my competitors or their products. I doubt I have gained one customer in my many years of participation (anyone here that did switch to Root Lab as a result of this forum, please correct me if I’m wrong). This is an educational forum and I make every effort to respect that fact.

 

I cannot agree more with all that you have written and to me, it sounds like you are delivering the first 20 slides of my Foot Centering Lecture.

In architectural language, you are talking about a truss-tie beam scenerio which is what I claim the foot functions most as.

Dr Sha

PS: Theoretical:
What if we could create a custom foot bed that did some of the work as the ligaments and musculotenonous levers and engines that you refer to in order to reduce the tissue stresses, etc.

Would you say that that device would be balancing and centering for that foot and posture? Lets call it The Foot Centering Theory.

 

Let's not!

deformation, elastic:
the change in shape of an object under an applied load from which the object can recover or return to its original unloaded state when the load is removed.

Orthoses deform under load. The structural integrity of the shell acts to resist this motion. As the load reduces, the elastic properties of the device aid the foot in returning to its previous, higher arched position. Vertical forces activate the spring like qualities of the shell. Some orthoses undergo plastic deformation (change or lose shape). Due to the nature of the forces and the orthotic material, this means they can sometimes flatten over time. The devices are also subject to frictional forces that can abrade the surface. All this can occur with an OTC or a custom device. I would call it the laws of physics, not foot centering, Root theory and certainly not anything new.

 

Jeff, I pretty much agree with your post here. Its actually called: "structural mechanics". It's not just vertical loading that causes deformation in the shell, non-vertical loading causes shell deformation too. In order to bring about equilibrium in the foot, the orthosis develops stresses and strains until it applies an equal and opposite force to the foot. The material properties and geometry of the shell determine how much deformation and stress occurs within it and how much energy is returned to the body. So lets take it a step further: the orthosis shell develops stresses and strains and stores energy, so that the tissues don't have to so much. This reduces the mechanical stress and sometimes the strain in the tissues and provides an external energy store and off-loads these functions from the tissues to the orthoses.... we call this "tissue stress theory".

"Farewell and adieu to you, Spanish Ladies,
Farewell and adieu to you, ladies of Spain;"
http://www.contemplator.com/sea/sladies.html

 

I hope someone can explain how this post relates to the fact that we are discussing the arches of the foot?

This is not a very clever diversion.

and

do you also understand the plastic/elastic deformation of ligaments and muscles of the foot and posture and that if you stretch them out (like in a device that;s not maximally vaulted, foot type specific the foot reduces in its performance, you cause permanent damage.

Lets discuss EPF's or Night splints as PF pain removers that reduce the ability for the plantar fascia to function, too often permanently.

Jeff: Your fizzics talk doesn't carry weight for me like Simon or Robert because you are claiming that it justifies your father's work. They are just arguing fizzics.

Dr Sha

Please, is the foot like the truss/tie beam that we are discussing and now since you added plastic/elastic, let's call it a flexible tie beam with plastic/elastic properties.

 

Can you show me a biomechanical example of the foot functioning outside of the laws of physics?

What does the word "biomechanics" mean, Dennis?
http://www.youtube.com/watch?v=34v1hyfHXdQ

 

Missed that one on first read- so your devices that are "maximally vaulted and foot type specific" improve foot performance ?errrr..................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... show me the evidence. No you can't. So come back when you've grown a pair. And what the **** does maximally vaulted mean? Jeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeezus . Dennis in all honesty, are you making this **** up as you go along? That's how it comes over- made up on the spot. http://www.youtube.com/watch?v=34v1hyfHXdQ

 

Dennis my intent in asking you questions was to understand how you think your centrings work and to describe the architecture involved. Eric and others have asked you these questions prior and I can say without bias that I just never felt that the question were answered in an acceptable manner. You make a lot of claims about your devices and claim to "expand on Root theory" but at the same time tear Root orthoses down? I'll follow this thread and let the more capable minds continue, because I feel this discussion is particularly pertinent to your website and some of your posts here.

I apologize if I don't always answer timely, I participate as time allows.

 

I found a theme song for this debate:

http://www.youtube.com/watch?v=8_VbImuG71M

 

Sorry you're so upset but I thought that we were beyond this dialogue.

The answer is NO MORE THAN Kevin or Glaser or Root or _______!!

Can we get past that and examine our paradigms or tell me which one or other you use in practice that is evidenced

Graham, one of us is pissing again.

Dr Sha

 

No Dennis, you and your new best friend Graham may be beyond this dialogue, but you'll have to try much, much harder with me. You can't just make claims like the one you made above. I don't care about the names you seem to want to be part of. I do care about science and the scientific method. You can't just say whatever comes into your head and then when somebody says "prove it" answer by saying "well there's no proof for anything so I'll say what the **** I like".

One of us is pissing Dennis, and it's me, I'm pissing myself laughing at you. Here we are again, Dennis Shavelson singing his same old song, ignoring the questions and selling his product. Absolutely nothing has changed. Enough. http://www.youtube.com/watch?v=34v1hyfHXdQ

 

This thread is basically a debate more than it is a discussion. We have a local issue in my community that has created significant discussion and debate in our newspaper's blog. Frustrated with the methods of debate employed in both forums, I decided to search the internet tonight to review debate tactics. I found a website that summarizes the reasons for my frustration. I have bolded some of them for emphasis. The title is "Intellectually-honest and intellectually-dishonest debate tactics" and the link is http://www.johntreed.com/debate.html Sorry for the length of the posting, but I hope it will create a better foundation for future debate.

 

Thanks Jeff thats good stuff..

The emotional aspect is key in a lot of debates as well....

Yesterday I was thinking it´s easier to get blood out of a stone, and maybe Simon hit the nail of the head with ......

and then a quote by the Great MR T comes to mind, but why throw petrol on a fire.

 

Jeff: With all this knowledge and research I would think you would be a more skiled debater #1

I use this as an example of how this excellent posting can be utillzed to edit the postings on The Arena.

I preface by stating that my edits reflect my opinioon only and should not be used as having any importance #4.



1.Name calling: debater tries to diminish the argument of his opponent by calling the opponent a name that is subjective and unattractive
2.Changing the subject: debater is losing so he tries to redirect the attention of the audience to another subject area
3.Questioning the motives of the opponent: this is a form of tactic number 2 changing the subject; it is prohibited by Robert’s Rule of Order
4.Citing irrelevant facts or logic:
5.False premise: debater makes a statement that assumes some other fact has already been proven when it has not; ROOT's and KEVIN's WORLD
6.Hearsay: debater cites something he heard but has not confirmed through his own personal observation or research from reliable sources
7.Unqualified expert opinion
8.Sloganeering: Debater uses a slogan rather than using facts or logic. Slogans are vague sentences or phrases that derive their power from rhetorical devices like alliteration, repetition, cadence, or rhyming;
9.Motivation end justifies dishonest means:
10.Cult of personality: debater attempts to make the likability of each debate opponent the focus of the debate on the grounds that he believes he is more likable than the opponent THE ARENA
11.Vagueness: debater seems to cite facts or logic, but his terms are so vague that no facts or logic are present
12.Playing on widely held fantasies: JEFF's World debater offers facts or logic that support the fantasies of the audience thereby triggering powerful desires to believe that override normal desire for truth or logic
13.Claiming privacy with regard to claims about self: debater makes favorable claims about himself, but when asked for details or proof of the claims, refuses to provide any claiming privacy
14.Stereotyping: debater “proves” his point about a particular person by citing a stereotype that supposedly applies to the group that opponent is a member of; dismissing criticism by academic researchers by citing Ivory Tower stereotypes is an example of this debate tactic
15.Scapegoating: debater blames problems on persons other than the audience; this is a negative version of playing on widely-held fantasies; it plays on widely-held animosities or dislikes
16.Arousing envy: debater attempts to get the audience to dislike his opponent because the audience is envious of something that can be attributed to the opponent
17.Redefining words: debater uses a word that helps him, but that does not apply, by redefining it to suit his purposes
18.Citing over-valued credentials:
19.Claiming membership in a group affiliated with audience members:
20.Accusation of taking a quote out of context: debater accuses opponent of taking a quote that makes the debater look bad out of context. All quotes are taken out of context—
25.Innuendo: an indirect remark, gesture, or reference, usually implying something derogatory.
26.My resume’s bigger than yours. All the more reason why you ought to be able to cite specific errors or omissions in my facts or logic, yet still you cannot. KEVIN's WORLD
27. MY FATHER IS MERTON ROOT.
28.The use of acronyms and coined terms that once accepted, eliminate competition and reduce the impact of outside thought. KEVIN and Dr Sha's' WORLD
29. The presentation of hypothetical or unproven concepts, terms and paradigms in order to get them accepted. DENNIS's World.

I added three and await everyone to fill in mine and the blanks of others as we continue to debate.

THIS POSTING MEANS A HUGE CHANGE for THE ARENA as we can all quote whatever number is being used by a given posting in order to maintain the thread focus and reduce bias.

An example would be the thread that I started when my computor error mistakenly lead me to Craig as part of my attempt to solve it.
#1

I await also, a deluge of personal 29's.

As an ADDED THOUGHT:
Posters can include one or more numbers to their posts so that they can be interpreted at their level of intention of evidence.

For example, Kevin's recent posting discussing his new theories on rearfoot-forefoot relationship could have included a #12 so that we would all realize that although they may become accepted and proven, they are for the moment at least, HIS FANTASY.


Dr Sha