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STJ Pronation Not the Common Cause of Foot Problems

Discussion in 'Biomechanics, Sports and Foot orthoses' started by drsha, Mar 23, 2009.

  1. drsha

    drsha Banned


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    Theoretical Question #7
    If the most common functional foot type is The Rigid rearfoot, flexible forefoot foot type and by definition, the rigid rearfoot has low contact STJ pronatory moments due to the small ROM available in the direction of eversion, this foot types pathology does not respond to treatment reducing heel contact pronatory moments. Rootian Biomechanics (STJ Neutral casting) is not effective in treating this foot type and STJ neutral position is NOT the healthiest position for this foot type to be held in
    and
    In opposition, excess STJ pronation is the prime etiological factor in Flexible rearfoot type foot pathology because this foot type has pathological pronation moments available that pervert the STJ Axis medially. However, this is a relatively uncommon foot type. This foot type needs its contact phase pronatory moments compensated and Rootian Biomechancs work (albeit not effectively) to treat this foot type.

    Accepting the above as factual (I have not recieved ANY opposition to my theoretical questions numbered 4,5 and 6 on other threads in spite of hundreds of Arena Member visits to them) I am making one conclusion and asking a theoretical question.

    Conclusion:
    Excess STJ pronation is NOT the predominant biomechanical etiology of foot pathology.


    Question:
    What are the biomechanical etiologies of The Rigid Rearfoot, Flexible Forefoot Foot Type if not STJ pronation?
    Dennis
     
  2. Griff

    Griff Moderator

    Dennis,

    Is it???

    Is STJ 'neutral' the healthiest position for any foot type (irrespective of the paradigm one subscribes to) to be held in?? Is this the way any orthoses actually work?? (Clue...the answer is no)

    Nothing new here I'm afraid...

    Wen, D.Y., Puffer, J.C., and Schmalzried, T.P. (1997) Lower extremity alignment and risk of overuse injuries in runners. Medicine & Science in Sports & Exercise. 29(10):1291-1298.

    Cowan, D.N et al. (1996). Lower limb morphology and risk of overuse injury among male infantry trainees. Medicine & Science in Sports & Exercise. 28(8); 945-952.

    Kaufman, K.R et al. (1999). The effect of foot structure and range of motion on musculoskeletal overuse injuries. Am J Sports Med. 27; 585-593.

    Regards

    Ian
     
  3. Oooooooooooooo this is gonna turn ugly! :butcher:

    There is SO MUCH about that post which begs to be challenged before we get to the question at the end! Presupposition runs through it like a presumptive running thing.

    Is it? I don't see very many rigid rearfeet at all (apart from those unfortunates with triple arthrodesis)! I'm guessing your criteria for a rigid rearfoot is different to mine. What is your criteria for "rigidity" (because I've always thought of rigid as a binary state. There are no degrees of hallux rigidus)

    Not sure I follow here either. Are you saying that pronatory moments in the rearfoot are only derived from rearfoot GRF? Because if you are I'd have to disagree! Moments in the Sub talar joint are derived from forces in the whole foot!

    Whats the saying? Claims made without evidence can be dismissed without evidence. However I might offer that IF this "foot type" is most common and this claim was true, why are there a plethora of outcome studies showing favourable outcomes?

    See above

    Who seriously still believes that it is?!

    Is it? Does it not depend on the nature of the pathology and the foot in question? I went to a rather splendid talk by an antipodean gentleman (name escapes me) where he presented evidence that degree of rearfoot eversion was not a terribly reliable risk factor for pathology and that supination resistance was much more so!

    Again, hard to be sure without knowing exactly what your criteria but I see shedloads!

    How does one compensate a moment. Are you speaking of creating supination moments or reducing pronation ones?

    So if rootian biomechanics don't work AT ALL in the first type and not well in the second I ask again, how do you account for the success rates in the literature?

    I don't.

    Sorry. I steered clear of that thread. Consider this to be opposition :boxing:

    Kind regards
    Robert
     
  4. markleigh

    markleigh Active Member

    DrSha appears to want a fight or already knows the answers to his questions, or both?
     
  5. David Smith

    David Smith Well-Known Member

    Robert

    Isn't that Lithuania? or is that a republic

    Dave
     
  6. drsha

    drsha Banned

    Ian States:
    Oooooooooooooo this is gonna turn ugly!
    Dennis Replies:
    Why ugly?
    Can’t we debate as members of the same Arena?

    Ian States:
    I'm guessing your criteria for a rigid rearfoot is different to mine.
    Dennis Replies:
    The Rigid Rearfoot Type has a Rearfoot SERM that is inverted and a Rearfoot PERM that is Inverted.
    Although the articles illustrations have been removed in this url, this is a good foundational article for you to review and possibly use to foot type a few of your patients.
    http://www.podiatrytoday.com/article/7628

    Are you saying that pronatory moments in the rearfoot are only derived from rearfoot GRF? Because if you are I'd have to disagree! Moments in the Sub talar joint are derived from forces in the whole foot!
    How does one compensate a moment. Are you speaking of creating supination moments or reducing pronation ones?

    Dennis Replies:
    I have admitted that I am not conversant in moment-GRF and appreciate you correcting me.

    Ian States:
    If this "foot type" is most common and this claim was true, why are there a plethora of outcome studies showing favourable outcomes?
    So if rootian biomechanics don't work AT ALL in the first type and not well in the second I ask again, how do you account for the success rates in the literature?

    Dennis Replies:
    Because the definition of favorable used for outcomes sets the bar so low that “well placed tissue paper” would have good outcomes as do the devices studied. Stopping pain and subjective reports of “feeling good” cannot compare to preventive, corrective and performance enhancing outcomes.

    Ian States:
    Does it not depend on the nature of the pathology and the foot in question? I went to a rather splendid talk by an antipodean gentleman (name escapes me) where he presented evidence that degree of rearfoot eversion was not a terribly reliable risk factor for pathology and that supination resistance was much more so!
    Dennis Replies:
    This statement calls for a foot typing system such as mine since you bring up general points as if they apply to all feet. There ARE FFT’s where supination resistance is key but that is not our current debate.

    Ian States:
    Again, hard to be sure without knowing exactly what your criteria but I see shedloads!
    Dennis Replies:
    Maybe this subjective and poorly researched claim is the reason that you feel this should turn ugly.
    Can you describe the clinical and biomechanical presentation of these shedloads? Please select at least one of them as a bunion foot as Bunions do not strongly correlate to The Flexible Rearfoot Functional Foot Types.

    Finally, I welcome constructive rather than angry opposition. I agree that Rootian failure is well documented and that much of what I am saying is “nothing new”.
    However, a new foot typing system, a new diagnostic protocol, a new method of orthotic casting and prescribing foot type-specific creating a new foot orthotic that anecdotally has satisfies a higher standard of outcomes: Maybe that is worth giving an open minded glance to.
    Dennis
     
  7. Griff

    Griff Moderator

    Dennis,

    Read the posts again - whilst I'd love to take credit for those quotes they are infact the good Mr Isaacs' intellectual property...

    Ian
     
  8. drsha

    drsha Banned

    Oooops. sorry I got my names crossed.

    Ian Replied to my Posting:
    If the most common functional foot type is The Rigid rearfoot, flexible forefoot foot type

    Is it???

    Dennis Replies:

    Ian, if the rigid rearfoot, flexible forefoot foot type is not the most common type in your experience, WHAT Is?

    Perhaps this table will help explain The Functional Foot Types to the readership.





    Dennis
     

    Attached Files:

  9. efuller

    efuller MVP

    It would also help to have definitions of each of the categories.

    Regards,

    Eric
     
  10. drsha

    drsha Banned

    Eric:

    The Functional Foot Typing System is based upon two positional measurements of the rearfoot and two positional measurements of the forefoot that give diagnostic information about the state of the pillars of the foot and the vault of the foot.

    The rearfoot measurements are the subtalar supinatory end range of motion (SERM) position and the subtalar pronatory end range of motion (PERM) position. The forefoot measurements are the forefoot supinatory end range of motion (SERM) position and the forefoot pronatory end range of motion (PERM) position.

    The subtalar SERM position is the open chain position the subtalar joint assumes with reference to a bisection of the lower one-third of the leg after applying a strong inversion force upon the calcaneus until it can no longer move. For FFT classification, there are two possibilities (inverted or everted) for the subtalar SERM position.

    The subtalar PERM position is the open chain position that the subtalar joint assumes with reference to a bisection of the lower one-third of the leg after applying a strong eversion force on the calcaneus until it can no longer move. For FFT classification, there are three possibilities for the subtalar PERM position — inverted, vertical or everted.

    The forefoot SERM position is the open chain position that the first metatarsal assumes with reference to the locked fifth metatarsal after applying a strong plantarflexory force downward upon the first metatarsal from above until it can no longer move. For FFT classification, there are two possibilities (dorsiflexed or plantarflexed) for the forefoot SERM position.

    The forefoot PERM position is the position that the first metatarsal assumes in an open chain with reference to the locked fifth metatarsal after applying a strong dorsiflexory upward force upon the first metatarsal from below until it can no longer move. For FFT classification, there are three possibilities for the forefoot PERM position — dorsiflexed, in line with the fifth metatarsal or plantarflexed.

    In the FFT system, the subtalar SERM position and the subtalar PERM position diagnose a specific rearfoot type, and the forefoot SERM position and the forefoot PERM position diagnose a specific forefoot type. After determining the rearfoot type and the forefoot type, every foot can be assigned a Functional Foot Type.

    In the FFT system, there are four rearfoot and four forefoot types: rigid, stable, flexible and flat. When one plots the four rearfoot types longitudinally and plots the four forefoot types horizontally, there is a 16-box matrix with each box representing a functional foot type (see “Understanding The Functional Foot Typing System” below). Diagnosing The Functional Rearfoot And Forefoot TypesComparing the subtalar SERM and the subtalar PERM positions of the subtalar joint allows one to classify all feet into one of four functional rearfoot types.

    The rigid rearfoot type has an inverted subtalar SERM and an inverted subtalar PERM.

    The stable rearfoot type has an inverted subtalar SERM and a perpendicular subtalar PERM.

    The flexible rearfoot type has an inverted subtalar SERM and an everted subtalar PERM.

    The flat rearfoot type has an everted subtalar SERM and an everted subtalar PERM.I

    Comparing the forefoot SERM position and the forefoot PERM position of the forefoot allows the clinician to classify all feet into one of four functional forefoot types.

    The rigid forefoot type, the forefoot SERM places the first metatarsal below the fifth metatarsal. The forefoot PERM places the first metatarsal below the fifth metatarsal.

    The stable forefoot type, the forefoot SERM places the first metatarsal below the fifth metatarsal. The forefoot PERM places the first metatarsal in line with the fifth metatarsal.

    The flexible forefoot type, the forefoot SERM places the first metatarsal below the fifth metatarsal. The forefoot PERM places the first metatarsal above the fifth metatarsal.

    The flat forefoot type, the forefoot SERM places the first metatarsal above the fifth metatarsal. The forefoot PERM places the first metatarsal above the fifth metatarsal.

    Dennis
     
  11. And outside of it.
     
  12. Well quite!
     
  13. Graham

    Graham RIP

    Dennis,

    Are you fishing for some peer approaval for your foot typing system? I believe this has been discussed and you are unlikely to receive any testamonials from this arena.

    regards

    graham
     
  14. Admin2

    Admin2 Administrator Staff Member

  15. Be nice to think so! But i suspect it will turn that way about the time I disagree with you.

    Oky doky. Thanks for the information on your foot typing system. Most interesting. I understand now what YOU mean by rigid, although I think its somewhat inaccurate from a point of pure pedantry. An STJ which functions in a range which has the calc inverted relative to the leg is accurate, although I will grant you it does not trip off the tongue.

    Fair enough.

    Hmmmm. Interesting. I would argue that if I was a patient "stopping pain and feeling good" would be the first things on my wish list. "Corrective and performance enhancing would be nice (assumming we know what "correct" is, anyone?) but would be well down on the list. What is the point of enhanced performance if you are still in pain and don't feel good?


    True. Lets shelve that one for another day then.

    Ah. So When I say that this "foot type" IS common i'm being subjective and poorly researched. When YOU say its NOT you're being....:rolleyes:

    As I observed before, claims made without evidence can be dismissed without evidence. Show me your data which shows the distribution of rearfoot types and how you overcame the HUGE error inherent to bisection of the calcaneum (never mind the leg), and explain how a foot which falls one degree inverted in perm (on a measurement with at best a 6 degree error according to the literature) can be considered the same as one with a 6 degree perm and treated the same way, and I'll admit your subjective claim is more vailid than mine.

    See? Ugly;). Told you.

    What, all of theM?!:eek:

    Bunion. Bit vague here. Do you mean an inflammed bursa over a 1st met head, an HAV, HA, HV, SHL, FnHL or an HR? Because the former could have all sorts of causes, not all of them endogenic.

    And again. Evidence to back your supposition?

    Yes. It is. They ALL are. :rolleyes:. Not the first
    I've seen. Thing is, I mistrust foot typing systems in general for all the vagueries they neglect. I particularly mistrust this one because it relies on binary or trinary observations of a measurement proven to be grossly unrepeatable, even in intra rater trials!

    For example. Take your rearfoot types, flexible, stable and rigid. Imagine a foot in which the true perm (loreal, you're worth it) is exactly perpendicular (assuming such a truth could be derived by means of x rays, bone pins or whatever. )

    Patient limps in. The first clinican measures it as 1 degree inverted (and i suspect nobody really claims themselves to be accurate on this measurement to within 1 degree) and prescibes as rigid. But he is knocked down by a lorry transporting 6 ton of dehydrated sushi while taking the prescription to the postbox and is put in a coma! :boohoo:(don't worry, he recovers). The patient returns and is re assessed by a clinician of Godlike biometric skill who assesses as perpendicular and prescribes as stable! Sadly his skill is at the expense of his judgement and he is mugged in a dark ally on the way to the postbox by muggers who very specifically steal his paperwork and notes (happens more often than you might think) then subject him to a humilating and unusual assault involving haddock. While he is having PTSD counseling the by now annoyed patient sees yet a third who judges the rearfoot to be slightly everted and though but one degree out declares the rearfoot to be flexible.

    Then the first recovers from the coma and the second returns to work with only a slight nervous tic and they have a bugger of a job deciding what type the foot is! After all, 1 degree is all that separates THREE foot types.

    Different casting protocol for each?

    And thats before we even LOOK at the inaccuracy implied in bisecting a LEG!

    Kind regards
    Robert
    Neither angry, nor closed minded. Just don't think much of your system.:eek: Sorry.
     
  16. Sammo

    Sammo Active Member

    There are 10 types of people in the world.

    Those who understand binary and those that don't.
     
  17. drsha

    drsha Banned

    Dr. Isaacs stated:
    As I observed before, claims made without evidence can be dismissed without evidence. Show me your data which shows the distribution of rearfoot types and how you overcame the HUGE error inherent to bisection of the calcaneum (never mind the leg), and explain how a foot which falls one degree inverted in perm (on a measurement with at best a 6 degree error according to the literature) can be considered the same as one with a 6 degree perm and treated the same way, and I'll admit your subjective claim is more vailid than mine.
    Dennis Replies:
    As you justly pointed out (not ugly), I have not bisected a leg or a calcaneum for decades and so I had to revisit how I have reported and defined Functional Foot Typing.
    All measurements, diagnosis and casting techniques start with "Root STJ and MTJ neutral position" (not the bisection I falsely reported in the past). The inversion/eversion movements andf pronatory and supinatory moments they measure do not change, only the starting position.
    THANKS TO ISAAC!!
    Furthermore, the slime I mentioned was not to define different posters (or poster types) it was to mention the need to edit the posts of brilliant men and women who flourished their posts with jokes, quips and snide remarks (of which I am one).
    The only pure slime type that I have encountered on The Arena is Graham, who I early on stated that I would n9ot dignify with replies (yet he keeps posting on my threads?).
    Dennis
     
  18. drsha

    drsha Banned

    Robert States:
    Take your rearfoot types, flexible, stable and rigid. Imagine a foot in which the true perm (loreal, you're worth it) is exactly perpendicular (assuming such a truth could be derived by means of x rays, bone pins or whatever. )
    After all, 1 degree is all that separates THREE foot types.
    Dennis Replies:
    You are mixing research dictums with those of a clinician that needs to make a judgement call in order to care for the patient of the moment.
    When faced with a patient with an IM of 14, do I perform an Austin or a CBWO. When faced with a 200 lb vs 300 lb patient, how do I decide the dosage of antibiotics? When faced with a patient needing orthotics and not willing to sacrifice style and fit when it comes to shoes, do I reduce the shell thickness, change my posts to internal, add wash to the positive cast to reduce arch height or ???
    These are decisions that we make every day based on our foundational knowledge and our clinical experience. The doctor is in the box.
    If I am standing on the place where four states meet (in the USA) does it matter what state I am in when deciding if I need a coat to warm me up?
    Would a vertical, one degree varus or one degree valgus rearfoot posting (assuming one of your three junctional or cuspid foot types has been misdiagnosed) change much clinically?
    In presenting my work, I discuss, for the most part, pure foot types in order to develop a system that has clinical applications.
    I could spend a lifetime diagnosing and treating the variations that exist in The Rigid Rearfoot, Flexible Forefoot Foot Types (probably 65% of my practice) but I choose to treat all feet and remain a generalist.
    Scanners, post to cast, OTC products, Prefabs and insurance company declarations that viable treatments are not covered until fully investigated all take the doc out of the box.
    Root developed a system that upgraded the podiatrist biomechanically for thirty years and stimulated the very work that you perform to prove the errors in it. Please do not one degree me out of the box clinically.
    Research sacrifices clinically in order to proclaim its fruit valid. A great doctor uses art and his/her scientific acumen to ad lib and improvise when confronted with exceptional and sophisticated patients in order to provide better care.
    In the apples/oranges mix of medicine, am I the apple or are you?
    Dennis
     
  19. Griff

    Griff Moderator

    Dennis,

    I think the forum would engage you more and maybe even consider entertaining your ideas if you just answered questions simply for once and stopped venturing into hyperbole

    Cut the waffling and make your point fella

    Ian
     
  20. drsha

    drsha Banned

    Ian,
    Stop the minutia and I will stop the hyperbole
    and
    you should entertain my ideas when they make sense to you irregardless of hyperbole or patents.
    and sorry for another hyperbole but if I am a waffler..
    (adj. or verb - indecisive; unable to make up one's mind; playing the safe middle ground due to one's own lack of conviction or sense of morality), I hope your other job is not as an english teacher.
    Dennis
     
  21. I can't really crititise there :eek:. The sushi lorry probably did not add to the science of the debate.... ;)

    R
     
  22. Griff

    Griff Moderator

    Dennis,

    I thought I made myself quite clear in my first reply to this thread - a post which you never responded to... perhaps as it contained actual real life references???

    And if the day ever comes that you explain yourself well enough for your 'ideas' to make sense to me then I promise you I will

    You are an absolute tool mate.

    Peace out
     
  23. I like Minutia and Hyperbole. Both can be relevant if used in moderation!

    Ad hominems, however, add nothing.

    C'mon guys, we're having a good run around here. Lets stick to the points under discussion and not the people having the discussions aye what.:eek:

    Robert

    Feeling the love.
     
  24. Sammo

    Sammo Active Member

    Minutia... Hyperbole... all sounds like Warhammer to me...

    Drsha..

    I think the main thing that has got peoples backs up is this..

    You have started the post with a statement of what is the most commonly found rear foot type, and then gone on to claim a number of other things, including alluding to the root technique of biomechanics (which is outdated and, i believe, known as incorrect) in a forum with some of the worlds top podiatric clinicians and researchers, with out backing any of your claims up. Something I have learned from being an avid reader and occasional poster on this forum is that "a claim made without evidence can be dismissed without evidence", and that everything posted is fair game for questioning, challenging, contention, ridicule and dismissal... if you can't provide evidence to back this stuff up, provide one mother of a rationale or live with the criticism.

    So.. were you asking a question or making a statement?? Do you really want to be using rootian neutrals??

    I feel tables like the one shown are useful for clinicians (generally not podiatrists) who need a criteria to work from, if they don't know podiatric biomechanics too well, or for research which needs to be able to quantify a level of foot position, however the FPI already has that space.. and besides, i feel that these measurements are useful in a research setting but perhaps not clinically... there are too many variables in each type for it to be of true clinical relevance.

    p.s. at the risk of being pedantic... Be careful of your bold type... At a glance your last post reads...

    "the doctor is in the box" "take the doctor out of the box"

    What are you trying to tell us??

    Sam

    (I need to ban myself from Pod Arena post pub...)
     
  25. We may have found a motto for the arena!

    I would add only one thing

    And stress that ridicule and dismissal, if warrented, should only follow open minded scrutiny and examination. We should all, and i count myself guilty here, resist the temptation to attack new ideas because they are new, just as we should never ACCEPT new ideas without careful and minute scrutiny.

    Regards
    Robert

    PS
    I'm stealing this phrase
    Mine now.
     
  26. drsha

    drsha Banned

    Sam Stated:
    and that everything posted is fair game for questioning, challenging, contention, ridicule and dismissal... if you can't provide evidence to back this stuff up, provide one mother of a rationale or live with the criticism.

    Dennis Replies:
    well stated and understood.
     
  27. David Smith

    David Smith Well-Known Member

    Robert

    Well done Robert, nice entertaining post, I could see you building up to it and wondered how long it would take you to point out to Dr Sha (Le Tan) this blindingly obvious 'limitation' of the Foot helpers, Neoteric biomechanics, FFT, Foot Centring system. :bash:

    The problem with some people Robert is no matter how much evidence or logical reasoning to the contrary is placed before them, they will never be disabused of their ideas and theories. They have put too much time and effort into the concept and believe with an unshakeable faith that they are right.


    E.G. If they support / believe this then what hope

    From a web site somewhere on www.[QUOTE]Klara came to The Foot Typing Center lethargic, lazy and with very poor posture. Her mother was very concerned because both her mother and grandmother ran track for their country when younger and Klara was tall and slim but not very athletic. Her flexible rearfoot, flexible forefoot foot type responded rapidly to negative cast corrected Foot Centrings® to the point where she is much more active, standing straighter posturally and is no longer lazy.[/QUOTE]

    Foot Helpers, Neoteric biomechanics, FFT, foot centring system, stops you being lazy :pigs:

    Another quote:empathy:
    Oh yeah! I'll nip down to M&S (U.S. Insert WallMart) I need Coca cola, a Hoover, some Adidas trainers oh! and a pair of Foot Centrings, ah! but I can't be bothered, I'm too lazy, if only I'de got my Foot Centring earlier. DoH!
    I think some focus on what the brand or product is called might be a start:wacko:

    Coca Cola er! the sparkly drinks company err! the neoplasmic imbibacation errr! Quench Satisfying System.

    We Demand - AIG managers jailed, Stop the whaling, an end to racism and oh yeah No1, we demand outcomes and a clinical study of Foot Centring, err Neoteric somthing or other thingy.

    SCIENCE!! besides the fact that it makes no grammatical sense, anyone with an ounce of scientific understanding you would see the absurdity of this statement.

    What is very useful though is when someone (such as our Dearest Roobeer) has the time and energy to put forward those contrary arguments so that others can see the error and are not then taken in by pseudo scientific flannel.

    I predict a Dr Sha holiday coming on or an attention diverting distraction in the form of an outraged tirade of waffling about free speech and closed minds and rudeness.

    Here's a quote
    Your Functional Foot Typing system only pays regard to the static, open chain (non-weightbearing) foot posture.

    1) How does this translate to the foot function in closed chain (weight bearing)
    and what evidence do you have that there is a correlation between the two?

    2) What evidence do you have that there is a causative relationship between your arbitrary foot posture classification and specific foot trauma or more distal pathology?

    3) Since your system pays no regard to the posture of the rest of the body, open or closed chain, one must assume that you regard this as unimportant. What evidence do you have to show that your definition of correct foot posture will automatically influence correct body posture and improve performance, as you tacitly claim that it will.?

    4) What do you mean when you infer that your Foot Centrings are corrective, preventative, posture and performance enhancing? What evidence do you have of this and what evidence do you have that they perform better than other orthotic and treatment protocols?

    5) You describe this as a Functional foot Typing system yet you only measure foot posture in open chain. By applying some vague and arbitrary condition i.e. a strong force, applied at some undefined position that causes a certain foot posture of interest.

    a)How do these conditions correlate to the conditions applied to the foot in the closed chain situation?

    b) Why do you not classify the foot function as your system name would imply?

    c) Would it not make sense to classify the nature of the motion between foot postures in the open chain?

    d) Even if you did this would it correlate well with kinematic responses from the forces applied to the foot in the closed chain.?

    To answer Dr Sah's OP's

    Your argument is completely invalid since your conclusion is not a logical consequence of your premise. Both your propositions may be false and at least one is only true if expressed in the terms of its own tautological argument. Neither supports the other and together they cannot support your conclusion. In other word this argument is a total fallacy even if the conclusion is true which is debatable depending on your point of reference and the vagaries of the statement..

    Question:
    What are the biomechanical etiologies of The Rigid Rearfoot, Flexible Forefoot Foot Type if not STJ pronation?
    Dennis

    This argument only works within the boundaries of the rules of your theoretical axiom. In other words one has to accept your argument and its rules before one can make any reasonable statement about it. I do not recognise your rigid rearfoot flexible forefoot criteria so how can I make a reasoned judgement about their aetiology. However I would hazard a guess that your question does not reflect the meaning you intended because the grammar is so rubbish.

    All the best Dave
     
  28. Among other things, Dave has intimated that 'traditional" static non-weightbearing measures may not be good predictors of dynamic function. Also several weightbearing static measures also appear poor predictors. Here are a couple of classic examples:
    http://scholar.google.com/scholar?h...wer extremity ..." &um=1&ie=UTF-8&oi=scholarr
    http://www.japmaonline.org/cgi/content/abstract/84/4/171

    However, it is true to say that other static measures have been demonstrated to be predictive of dynamic function:
    http://www.japmaonline.org/cgi/content/abstract/97/2/115
     
    Last edited: Mar 24, 2009
  29. Griff

    Griff Moderator

    Dennis,

    It is not up to me (or anyone) to prove you incorrect - it is up to you to prove to us you are correct. I await the evidence/research.

    My problem here is not that you state which foot type you believe is the most common (I can't disagree with your personal opinions/observations), but that you intimate it is the most common foot type across the board. Again I am assuming by 'most common' you simply mean the foot type you see the most frequently in your clinical practice?

    As you asked the most common foot type I see in my practice tends to be that which generates enough pathological force within a given anatomical structure to cause pain/injury via the tissue stress mechanism... but I'm guessing thats not the answer you're after...

    Ian
     
  30. David Smith

    David Smith Well-Known Member

    Simon

    Thanks for those references,

    And I, probably like most podiatrists, look at non weight bearing characteristics of the foot function and more proximal joints. I do not categorise these characteristics, rather I am looking how the quality and range may impinge on the particular condition or pathology presented. Similarly I look at the weight bearing posture of the foot and the posture of the whole body and make judgements about how they may be related to pathology. Finally I look at how the patient functions dynamically and use all those parameters to make some judgement about the design of a treatment plan. Biometrics form an important part of my assessment and evaluation process but they are not neatly boxed and packed into convenient classifications that have imaginary or arbitrary boundaries and conditions.

    As Robert neatly pointed out such systems of categorisation tend to have singularities where a value is not differentiable or has several conflicting values for the same point. As a value approximates the point of a singularity the demarkation between two categories becomes less defined due to system design limitations and system error limitations. Also what happens when a certain pathology doesn't match or doesn't respond to the orthosis design for a particular category, where does one go from there.

    All the best Dave
     
  31. drsha

    drsha Banned

    Thank s to all of the Arena Members who have participated in my recent theoretical threads.
    In jest, I comment that you guys didn’t have to hold back any punches in your postings. In the future, you should air your feelings forcefully and aggressively, come what may.

    Hyperbolically speaking, these postings were listed as Theoretical Questions.
    Websters Definition: relating to or having the character of theory: abstract, confined to theory or speculation often in contrast to practical applications.

    If you read your replies, they have been handled as if I claimed they were “double blinded researched” Medical Journal Publications?????

    Please refer to Dr. Kirby’s Theoretical Questions on The Arena and judge as to your open minds, equality and fairness.

    In addition, I cannot believe how insecure you are about your own talents and skills and how (self proclaimed) “the best minds of research and clinical skills in biomechanics" have been assembled to be judges of the rest of us and the directed plan is to feed us to the lions .

    I hope that someday I will be able to personally debate with the brilliant minds of The Arena (I will be at The Midwest and The Westren) and I feel lucky to have begun relationships with many of you.

    I will continue to participate in The Arena (after all, I have been "thanked" as many times as Graham) as it has been a great learning experience for me.

    It is for the rest of us and history to determine your worth, your weight and your impact.

    Dennis
     
  32. Just for fun, to play devils advocate, and because as one of my learned colleagues pointed out recently I would have an argument in an empty room, I will now defend Dennis's foot typing system.:boxing:

    Well and good. And this, in an ideal world is how all biomechanical assessment should be carried out. However you, Dave, are one of the more frighteningly intelligent people I know in the field. Indeed this could be said of many / most of the regular poster's on this site, we all have a keen interest in biomechanics. For many of us it constitutes our "daily bread".

    However

    On another thread Dennis alluded to the fact that most of us issue standard root Protocol, cast in neutral, balance forefoot to rearfoot, pitch rearfoot 3 degrees etc. I disagreed rather violently with this, it does not even begin to describe what I do and i suspect is not true for most here. That said i know more than a few colleagues who DO use something approximating to this protocol, or something even cruder! They are, in essence, already using a foot typing system of sorts. Forefoot varus, rearfoot varus, falt feet, we know the cliche's.

    Human nature is such that we seek patterns and boundries. Those of you unfortunate enough to have heard me lecture on Heuristics will have probably long since forgotton the extremely powerful representativeness heuristic )Tversky, A., & Kahneman, D. 1982). Whether we like to admit it or not we are ALL subject to this trick of psychology. Whilst it may not have been crystalised in the way of FFT we probably all use foot typing on some level.

    So my question is this. Accepting that this system is flawed (as all are) and that those who can would be better served using the full analogue raft of observations and measurements; Is there value to a system which is MORE effective (assuming it is) and is simply and easily accessable to those podiatrists who do not spend hours reading theories, models and research and posting on the arena at 3am?

    In simple terms, if we take an old school "Rootian" podiatrist with little time or inclination for the CPD required to do what Dave so eloquently describes, is this system likely to make them A: more effective or B: Less effective.

    What say you?

    Regards
    Dennis ;)

    The views expressed in this post are not necessarily the views of the author, or indeed anyone. They are expressed simply to offer an alternative point of view. All rights reserved, subject to status, the value of your paradigm may go down as well as up and your business may bit at risk if you do not keep up your end of the debate. The author declares no vested interest in Foot centering insoles, Functional Foot Typing, WWF, WWE, NBA, Parish and Bell, The peoples liberation front of Kent, Hamas, or the Labour party.

    Tversky, A., & Kahneman, D. (1982). Evidential Impact of Base Rates. In D. Kahneman, P. Slovic, & A. Tversky (Eds.), Judgment under Uncertainty: Heuristics and Biases. Cambridge: Cambridge University Press.
     
    Last edited: Mar 25, 2009
  33. David Smith

    David Smith Well-Known Member



    As I predicted you'll be having a break and leaving us with a post about closed minds and unfairness but crucially avoiding answering any questions with a contrary view to yours, lest you be forced to confront the weaknesses of your arguments, which are great and manifold.

    On the point of theoretical do you mean hypothetical

    Hypothetical
    1. involving ideas or possibilities: existing as or involving something that exists as an unproven idea, theory, or possibility. the hypothetical existence of a Loch Ness monster

    2. assumed for sake of argument: assumed or proposed for further investigation The question is purely hypothetical.

    Theoretical
    1. based on theory: about, involving, or based on theory

    2. dealing with theory: dealing with theory or speculation rather than practical applications

    3. speculative: inclined to or skilled in speculative contemplation or theorizing

    The two are very similar but a theory can be hypothetical and puts aside or have no base in truth or convention or axiom. However most theory is not hypothetical has its root in some accepted system of conventions.

    Therefore the theory in Dr Kirby's Thought experiments are rooted in the conventions of Newtonian mechanics and by using deductive reasoning we can apply this theory to the experimental conditions and make reasonable conclusions.

    To make these reasoned arguments we must first accept the axioms of the Newtonian mechanical conventions and use these as our system of reasoning.

    So to apply this system of reasoning to your "theoretical questions" first we must accept the conventions of your system, however we do not and so we must first discuss and determine why we do not accept those conventions. You on the other hand should put forward reasoned arguments to support your conventions that in turn underpin your theoretical questions. So far you have not done this.

    If we answered your questions using argument to evaluate your theory we would in fact be tacitly confirming that we agree with your basic tenets, which we do not. (When I say we I mean me and others that express similar opinion)


    Contrary to your assertion that these "theoretical questions" are just hypothetical, in the above you state that you are "accepting the above as factual" i.e. it is fact (not hypothetical theory) that the most common foot function is rigid rearfoot flexible forefoot and has low contact STJ pronatory moments (whatever that may mean??) and that Rootian biomechanics is not effective in treating this type of foot etc, etc.

    The reasoning for accepting this as fact is that you have no opposition to those veiws. :confused: Is this the basis of your scientific method i.e. make up some ridiculous theory and if no one can be bothered to take the time to rebuke such nonsense then this is proof of truthfulness???????????

    Only a buffoon would make that leap of logical fallacy---- or a charlatan!

    All the best Dave Smith
     
  34. David Smith

    David Smith Well-Known Member

    Robert

    As a pure exercise in argument I would have to agree with your former proposition
    that we all tend to use categorisation in some form.

    As to your second proposition i.e. it is better to teach a system that improves knowledge but does not give optimum knowledge than to rely on existing system that is weaker than both.

    In principle I would have to agree that it is, qualifying that with the proviso that the new taught system is in fact better the the original system and does not simply appear to be better simply because the system itself is easier and clearer to understand.

    The FFT system is clear as is the system of homoeopathy (ooohh! a direct thrust to the heart, nasty!!) Whether the system does actually improve outcomes compared to lazy arssed can't be bothered type diagnostic skills is yet to be proved.

    Maybe FFT is defined as the ideal system for those that can't be bothered or don't have the skill to do a full and proper assessment. Ah! but once they have made themselves some FootCentrings using neoteric biomechanics and the FFT system then they will not be so lazy any more and will get down to some serious biomechanical evaluations based on more accepted and relevant conventions. So there is the solution get your Foot Centrings - get motivated - forget about Neoteric biomechanics - everyone happy.

    Seriously tho Robert I would campaign for the best and most effective system of biomechanical intervention based on solid physics, scientific research
    and deductive reasoning supported by proven or at least accepted basic axiom.

    In my opinion theories like that of Dr Sha's just confuses education and we need to challenge these theories for better proof and for the sake of focused education for the up and coming(and the lazy). To do less just allows apathy and laziness to reign, lets strive for the best not the mediocre.

    Cheers Dave
     
  35. drsha

    drsha Banned

    David Stated
    As I predicted you'll be having a break and leaving us with a post about closed minds and unfairness but crucially avoiding answering any questions with a contrary view to yours, lest you be forced to confront the weaknesses of your arguments, which are great and manifold.
    Dennis Replies:
    I am not on a break nor am I leaving you. My affair with The Arena still has some mileage.
    I have no problem admitting that my arguments are weak (no evidence) and I accept your reactions as justified (therefore, no reply to your post or others of that ilk).
    I react similarly with my students, residents and fellow DPM's when they annoy me with pitances that are not worth my time although some of them say it weakens my ability to teach and learn.
    I send them to the library as you send me to the laboratory.

    In addition, I wish I had the knowledge base, aptitude and time to really learn your physics and principles as I am sure they would strengthen my ability to practice and teach.
    When you invent a pill or injection to accomplish that I would sign up (and don't forget to patent it.....a joke).

    Until then, I am trying to express some of my ideas for debate in a form that is tolerable to you and the other Arena Members as I wish to repay for the time you are taking to educate me.

    Summarily, I cannot debate with passion what I cannot explain with evidence, I can only debate my anecdotal success and state that so far our debate hasn't eliminated my passion.

    Dennis
     
  36. David Smith

    David Smith Well-Known Member


    Dennis

    The tag line to my posts is;

    "Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception."

    In your case the opposite is true and this would be OK if the perception was born of experimentation and inductive reasoning. However your perception and the conclusions drawn are only born from your personal experience and your passion blinds you to any contrary conclusions.

    You still have not answered any technical or clinical question put to you that ask you to validate your theories and assertions. Instead you chose to hide behind the fact that you do not understand physics or Newtonian mechanics, which under pin all biomechanics and yet you claim to have a Neobiomechanical system that surpasses and succeeds all others. Therefore you redefine the meaning of biomechanics and the concepts and axioms by which you validate its system, while at the same time dismissing, through self proclaimed ignorance and sheer unwillingness, out of hand the currently and popularly accepted conventions of standard biomechanics. This is arrogance in the extreme and at the same time not unexpected or unique.

    You create a theory and then create a basic statement or axiom and set of conventions that form a tautological argument that cannot be disproved using the conventions of your own system. Using conventions outside your system is invalid and therefore any argument that is formed in this way is also invalid since any propositions will be untrue in terms of your convention set. This has been done many times on this forum and of course through out history.

    Therefore any argument, in both directions, is meaningless and useless to each party and resolution impossible.

    You admit you are uneducated, have weak arguments, no evidence, and cannot argue well enough and your only saving grace, as you see it, is a passion for your work. How can you expect to be taken seriously?

    I cannot believe that someone that has a DPM and infers that he holds a teaching post can claim to have scant knowledge of physics and mechanics. While at the same time purports to have invented a new system of biomechanics and has the temerity to instruct and validate others in its use. :confused:
    All I can say is if it works for you good luck and if you make a living from it well good for you. But please don't try to be Kevin Kirby's arch nemesis or the new saviour of podo - biomechanics and expect to be taken seriously or treated with love and care.

    I have no personal grudge against you but I will not allow you to muddy the waters of biomechanical knowledge with flannel and snake oil. Many researchers in biomechanics and podiatry have worked hard for decades to improve knowledge and you want people to change their minds based on no more than your self proclaimed passion with no particular expertise. :mad: :bang::confused::craig::deadhorse: all those and more with bells on.

    All the best Dave Smith
     
  37. Dennis

    Over the last 12 years, seven of my patients in different parts of the UK have won more that £1,500 on the National Lottery (one very fortunate lady won over £3.7 million). There could be more. However, one interesting fact is that six of these patients were prescribed simple poron insoles as part of their management.

    With your hawkish eye for making a buck or three, do you think there is any merit in submitting a patent?

    Yours

    MR
     
  38. Dave, I can smell your frustration. I suggest you find a potato peeler and some salt.........:drinks
    I haven't laughed this much since Auntie Mavis got her left tit stuck in the mangle.
     
  39. drsha

    drsha Banned

    David Smith!!

    R U the same David Smith whose website proudly announces:

    Your feet will be scanned on the Amfit foot scanner to give a computer image that is then manipulated to give the correct prescription for you. Sometimes a plaster cast is also made if required and this is for a different type of prescription. After the full assessment the orthoses are manufactured using CAD-CAM technology ,this means turn around time is very short,...
    At this point most people find their pain has resolved and the orthoses are a natural part of their footwear, in fact they do not like to be without them.

    In asscoiation with Insole Pro we are now able to offer a mail order service for Amfit Custom Comfort insoles.
    Upon request by email or phone we will send a foam box to take an immpression of your feet. This is returned and within two weeks you will have a completely custom pair of comfort insoles.

    At the end of the day you will have the most comfortable feet ever.

    Your arrogant Arena personna is backed up by pieces of crap amfit foam box crap in practice.
    How dare you!!

    I could blow you out of the water if you would dare allow both of us to examine and treat the same patient.
    and no, we don't all treat the same.
    Your snake oil is in treatment,
    mine is in a lack of the double blind staudies, physics and mechanics that you obviously use to make believe that you know how to custom make orthotics.

    Why don't you patent your amazing foam box orthotics instead of using your time in impotent, arrogant rage.
    nothing personal
    good luck
    dennis
     
  40. Sammo

    Sammo Active Member

    Can I correct this.. I actually said "...a forum with some of the worlds top podiatric clinicians and researchers..." Which I think will be difficult to dispute looking at the regular posters in this arena, and I never ever placed myself in that category.

    Could this inability to research background information and reference properly be the source of the problem..???

    Dennis, I find your posts very interesting, but I still believe that you are making claims that I feel, in my limited clinical experience, to be incorrect.

    For example, your latest post on LLD, you state that the compensatory methods you have listed are the way that the body compensates for LLD. You have made it sound that these compensations are the only way that the body deals with LLD. I have seen a number of patients that do not compensate in this way, I have seen a child with a 3+ cm LLD where the foot of shorter leg was pronating and in closed chain the compenstaions her body was making were completely against what I have been taught and what is shown in open chain..

    I have also seen a couple of elderly but active gentlemen recently who have no compensations whatsoever for their LLD small (<1.5cm).. they step up and over it without either foot pronating more or less, with out either leg moving in an asymetrical way... how would your TIP system help in this situation, when the clinical findings fall outside proposed findings of the system??

    As a point of debateable interest.. I will at some point in the next year be hopefully posting research that I myself have carried out.. feel free to reciprocate in kind if you feel my research is flawed. I don't want to be seen to be sitting back and just blindly firing criticism for the sake of it.

    Kind Regards

    Sam
     
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