STJ Pronation Not the Common Cause of Foot Problems

Robert Stated:

Dennis Replies:

I am sorry for causing you confusion but when Jeff Root started posting, I switched my reply to you to Roots 1/3- 2/3 neutral position formula since mathematically it proved my point.

That method has long been proven totally false and useless.

In Neoteric Biomechanics, the “congruity of the STJ is used to begin all tests and castings for each of the foot types.

Your discomfort with us using any bisections of the lower leg and the posterior tubercle of the calcaneus a la Root is justified and has been shown to have error with groups of clinicians, repetitive exams by the same clinicans and the same subjects on different exams. I haven’t taken or advised bisections in decades.

Hyperbolically, I stir the pot with:
I must make another subjective point that for me has been root stifling the growth of FLEB.

The body of the calcaneus upon which the talus sits to form the STJ when vertical (rectus) is supported by a posterior tubercle that in cadaver studies, has a varus relationship to the ground.

This means that when the rearfoot is translating forces from the superstructure above or forward into the mid and forefoot a 2-3 or maybe even a 4 degree varus position (STJ Neutral) of the posterior tubercle of the calcaneus reflects a vertical STJ needing no varus posting.

Try to tell expreienced orthotic clinicians to give up their 3 degree RF Varus Posts!

Dennis

 

Jeff Root Stated:
When we reduce the amount of STJ pronation,(why) do so many patients experience symptom resolution?
We use an orthosis (custom or prefab) to reduce the compensatory STJ pronation and the elevatus reduces, the callous resolves, and the low back pain is disappears. Did STJ pronation “cause” these symptoms, did functional hallux limitus “cause” these symptoms, or what? Did reducing STJ pronation reduce these symptoms or did altering the forces (position or motion) at the other joints resolve these symptoms? I guess it depends on your perspective.
When there is evidence that other methods work better than traditional orthoses, I will gladly alter my methods of treatment and manufacturing to adapt or I will otherwise suffer the consequences.

Dennis Replies:
(I will start with hyperbole):
As you know, I taught and followed your Father’s work for many years and dispensed thousands of Root Devices over the years. I was on the waiting list for his lab for years as well but never was called. I reached out to you proactively in the past for us to begin having the very discussion that you are asking for.
I would prefer to continue it personally in order to reduce the slime that oozes from the pores of some of The Arena Members that cloud the actual content of discussion because they will try to divert its intent but for now, here goes.

My subjective opinion is that The Root device is effective in treating foot and postural pathology and STJ neutral casting technique produces a device that upgrades and expands its arch support predecessors (for the last 30 years).

There is no question that reducing rearfoot pronation momentum (and not necessarily positional control or placement)reduces symtomatology. However, Architecturally, there is a rear pillar, a fore pillar and their connecting Vault. reduces pathological forces and tissue stresses that can build up into pain and symptom complexes and deformity.

Simplistically, the subtalar joint is not the center of the universe. The arches of the foot (architecturally, The Vault) pronate (or collapse) to increase tissue stress and abnormal dorsiflexion stiffness throughout the foot and the forefoot, mainly the first and fifth rays, pronate (elevate to lower the vault) reducing dorsiflexion stiffness. In addition, the musculotendonous units (that your Father dedicated chapters in his books) have been basically avoided by Podiatry and others. These units stop functioning with power and in phase because they cannot overcome the tie beam tissue stress placed upon the plantar fascia, spring ligament (the windlass).

Subtalar joint pronation to me, defines a movement of the osseous structures of the rearfoot in the direction of the three body planes that lower and unlock the foot producing tissue stress. However, compensation for this pronatory moment is only a fraction of the job of a great foot orthotic. We can upgrade and expand Root.

Roots rearfoot varus post reduces STJ pronatory moments and hence has treatment benefits of which you speak but the #1 complaint of Root devices is that the device “feels as though it is pushing my rearfoot into varus placing too much weight under my lateral column”. These are the rigid rearfoot types that respond better to other methods of reducing rearfoot (note: I did not say STJ) pronation.
The Kirby Skive and the rearfoot vaulting technique of neoteric biomechanics are two.
One other form of rearfoot pronation is collapse of the medial side of the plantar fat pad (soft tissue pronation). This occurs apart from STJ pronation and I believe this occurs secondarily to rearfoot and vault pronatory motion and first ray dorsiflexion stiffness moments. This is the plantar pressure component of heel pain.
Roots deep heel seat reduces plantar soft tissue collapse and spread and so reduces tissue stress caused by that pathology.
UCBL’s, medial phlanges and the rearfoot vaulting correction of neoteric biomechanics do it even better.

Navicular sag, arch collapse, etc measurements are monitoring Vault pronation (collapse) and in this case, the Root and most current custom foot orthoses fall very short of supporting the vault enough to reduce tissue stress and pathologic osseous vault dorsiflexion stiffness moments.
Cuboid pads, scaphoid pads and Sole Supports and Foot Centrings (two newcomers to biomechanics)reduce dorsiflexion stiffness pathology of the vault of the foot with success beyond STJ Neutral.
Root STJ neutral casting doesn’t produce a shell high arched enough to reduce the stress of the plantar fascia and the windlass, no less eliminate it.

When we have a researched, evidenced based product that performs the 10 basic functions of the plantar fascia (Dr. Kirby) in order to reduce the tissue stress into the fascia over a lifetime, we will have revolutionized foot and postural care.

Forefoot pronation (FHL, Sagital Block) isn’t addressed at all by Root devices. As a matter of fact, the 1-5 forefoot varus posting described by Root still favored by many capable practitioners reduces dorsiflexion stiffness and produces pathological moments in the forefoot.
The Kinetic Wedge, The Cluffy Wedge, first and fifth ray cutouts and the forefoot vault correction of neoteric biomechanics are much more successful in reducing forefoot pronation than Root.

In summary, as Root upgraded and expanded the gold standard arch supports in the 70’s making devices that were deep heel seated, rearfoot and forefoot posted, more rigid materials, etc., Foot Centrings upgrade and expand Root devices in that they are shorter, narrower, higher arched (More Vaulted) and fully forefoot posted, foot type-specific.

Foot centrings address the three pathologies that must be compensated in FLEB
Rearfoot pronatory moments
Vault dorsiflexion stiffness moments (Dr. Payne please chime in)
Forefoot dorsiflexion stiffness moments

I stand on your Fathers shoulders (and those of many others including Dr’s Kirby, Dannenberg and Scherer) as The Arena echoes that many things I am promoting are not new.
But I have upgraded and organized the language, the marketing, the diagnostic testing, the casting and the prescribing techniques of foot orthotics personally to create a new and fresh strategy for practicing FLEB that deserves trial (clinical study) and research.

Hyperbole again:
As I followed Merton Root’s Work, I watched labs, lecturers and the professors at the podiatry colleges dilute it into a post to cast, step into foam or scan, intrinsic post the forefoot, lower your standards and goals as they continued to quote Root as if disciples.
This exposed to me the major mistake that Dr. Root made that would have prevented the perversion and dilution of his body of work that upgraded the arch support and biomechanics as it was known to be B.R. (before Root). HE SHOULD HAVE PATENTED HIS WORK!!!
My great grandchildren’s educations are fully funded and I have not asked any DPM for money, nor have I held back papers, information, etc from The Arena to this point but I have already stopped two labs and two DPM’s from basturdizing functional foot typing and fabricating Foot Centrings without meeting Neoteric Biomechanics Standards.

It refreshes me to see you write:
When there is evidence that other methods work better than traditional orthoses, I will be all ears and will gladly alter my methods of treatment and manufacturing to adapt or I will otherwise suffer the consequences.
“My passion is to stimulate that evidence into existence and that is why I will continue to endure the abuse of The Arena until there is evidence that other methods work better than Foot Centrings at which time I will alter my methods of treatment”.
Dennis

 

*snap*
The sound of my temper.

WHAT THE HELL METHOD ARE YOU USING?!?! MAKE UP YOUR MIND!!!!

I'm trying here Dennis, I really am honestly and sincerly trying to work out what your model involves and how it works. But I can't if you're going to flit from one method to the other!

And for the umpteenth time,

HOW DO I FIND OUT IF THE CALC IS INVERTED IN PERM WITHOUT BISECTING ANYTHING??????

How how how? Do you just eye it up and take a guess?!

Ok, which other joints fo you see pronation in? Talo crural? Seen it in a few very very hypermobile kids but never anyone over the age of 5!

Robert

 

Robert:

Continued apologies:

I will try to be accurate and specific.

Rearfoot SERM:
right foot exam

With the patient prone, take the right foot in both hands with the leg free from the lower 1/3 distally.

Using the thumb of your left hand, and utilizing the right hand to measure STJ congruity put upward pressure, not exceeding ground reactive force until the head of the talus is not protruding medially or laterlly (STJ neutral with an open chain MTJ position imitating midstance).
Take the right hand and cup the back of the foot around the calcaneus and apply an inversion force not greater than ground reactive force until the heel has reached its end range of motion in inversion and record the position of the heel relative to vertical (I am eyeballing vertical....) The test is recorded as invered or everted.

Rearfoot PERM
right foot exam

Maintaining the same position of the left hand (STJ neutral with an open chain MTJ position imitating midstance) take the right hand still cupped around the posterior calcaneus and starting in SERM position, place an eversion force, not greater than ground reactive force until the heel has reached its end range of motion in eversion and record the position (I am eyeballing vertical....) The test is recorded as inverted, vertical or everted.

Note: the eyeballing nature if the test is offset by the fact that the feet that lie from 1-2 degrees inverted, vertical and 1-2 degrees everted are all treated with a vertical heel post when prescribing the rearfoot post, foot type specific.

Dennis

 

Hi Dennis,

"Not exceeding Ground reactive forces"

How do you know hom much force the GRF force is and when you are approaching GRF with your passive movements?

Regards,

Sam

 

In general, I find practitioners are applying too much force and open up ranges of unwanted motion. It is better to err in the dirction of less force.

The ground applies a force but it does not literally push up under our feet.

Perhaps our engineers and physicists can offer a pound/square inch value>

Dennis

 

"The ground applies a force but it does not literally push up under our feet."

But isn't that exactly what GRF is.. an equal and opposite reaction.. The ground applies the exact amount of force that the foot is applying to the ground. How can you know how much this is or how it corrolates from gait to an open chain passive movement of the foot?

Sam

 

Just got back from the Dominican Republic lecturing to a group of Canadian podiatrists. Back to reality.:morning:

While I agree that foot orthoses have been more likely in scientific research studies over the past two decades to show changes in foot and lower extremity moments rather than show changes in foot and lower extremity motion, most of the best recent research on foot orthoses, where they have used true custom-molded foot orthoses [that have been designed more like an orthosis I am familiar with for my own patients] have fairly consistenly shown a signficant change in foot and lower extremity kinematics also.

Here is a great recently published article that demonstrates the significant changes in both rearfoot eversion angle, rearfoot eversion velocity and tibial internal rotation seen with well-made custom foot orthoses.

 

Jeff:

Good posting. Just because the research doesn't show a strong correlation of foot pronation to some pathologies doesn't mean that excessive foot pronation is not one of the causes. It is very complex subject especially considering the variability within the human population, how injuries are or are not produced and how we define "pronation".

We, as providers of (hopefully) quality foot care to our patients, need to know that treating patients with foot orthoses is not just about getting patients with foot and ankle pain better. It is also about optimizing gait function to prevent problems in the future, increasing weightbearing endurance, lessening weightbearing fatigue, improving athletic performance and treating symptoms distant to the feet (e.g. low back pain).

 

Sam States:
But isn't that exactly what GRF is.. an equal and opposite reaction.. The ground applies the exact amount of force that the foot is applying to the ground. How can you know how much this is or how it corrolates from gait to an open chain passive movement of the foot?

Dennis Replies:
Sam, now we are getting to my point. The Arena supposedly represents biomechanical minds involved not only in research but in practice.

The healing sciences are both science and art.
I would not dare enter a research only site and make the claims and statements that I have.
You are overweighted in science..
I am overweighted in art.
There is a beautiful place somewhere in the middle for us all.
I have learned so much science on The Arena (Thank you Kevin and Howard).
The Arena has not learned any art, it only defends its science.

You are waiting for a research paper that tells you exactly how much open chain force to apply to imitiate GRF (first time I ever wrote GRF) while I am asking you, for the benefit of your patients that until that paper exists to "Practice" (we practice, we don't perfect) doing just that. Get a feel for how much force it takes to imitate GRF without perverting the results you expect.

I can explain juggling to you, offer The Arena four balls and suggest a method for juggling.
The Arena reply remains: I will not look at your juggling or try it or find out if I can do it until you have provided me with a preliminary paper showing two people juggling followed by a followup longitudinal study showing 70 people proving they can juggle followed by another paper showing 200 people assembled in front of jugglers who benefited by the performance.
While I would have been not only juggling to the delight of audiences, I would have been perfecting my juggling in practice, FOR YEARS!!.

From a clinicians perspective, your 2 patient studies that end up in a foam box on the internet or in the same neutral STJ casted shell that I gave up decades ago didn't offer any advances or your patients.
Is that what Dr. Smith wants to offer his son for foot care as a practitrioner?
Are you going to offer your patients only the "proven" in practice?

"I'll let you be in my dream if I can be in yours"
Bob Dylan

Good fortune and great clinical (or research success) to you in your future.
Dennis

 

Kevin States:
Most of the best recent research on foot orthoses, where they have used true custom-molded foot orthoses [that have been designed more like an orthosis I am familiar with for my own patients] have fairly consistently shown a significant change in foot and lower extremity kinematics also.
And
We, as providers of (hopefully) quality foot care to our patients, need to know that treating patients with foot orthoses is not just about getting patients with foot and ankle pain better. It is also about optimizing gait function to prevent problems in the future, increasing weightbearing endurance, lessening weightbearing fatigue, improving athletic performance and treating symptoms distant to the feet (e.g. low back pain).

Dennis States:
Welcome Home.
These two statements are the future of biomechanics in a nutshell. They reveal how wise you are and why you deserve the following that you have painstakingly and thanklessly developed over decades.
I have lived my biomechanical career by these statements and Neoteric Biomechanics is the fruit of my labor.

Functional Foot Typing has matured to the point where I have foot type-specific exercises for kinematic improvement, when performed on a custom Foot Centring (Root devices and medially skived devices don’t do to the same extent in my hands) I have physical therapists who are following my RX’s and patients whose quality of life and performance problems are being reversed.
Kevin, If I told you I could make a device and institute rehab and exercise programs that would keep you functioning at eighty like you did at forty would you pay me $800? Better yet, would you try to see if there is any practical---clinical meat to that statement or would you simply dismiss it by demanding evidence?

And please, please, please..to all of The Arena Members who called me a money hungry charlatan when I raised a question calling for an orthotic on a young asymptomatic patient and those who mock me by saying that relieving pain and giving comfort are our two main goals etch this wonderful statement in your minds!!
“Treating patients with foot orthoses is not just about getting patients with foot and ankle pain better. It is also about optimizing gait function to prevent problems in the future, increasing weightbearing endurance, lessening weightbearing fatigue, improving athletic performance and treating symptoms distant to the feet (e.g. low back pain)”.
Professor Kevin Kirby

I ask Kevin to let both of us examine 1-2 patients, compare total results and publish it together as a preliminary study.

I ask one of you to actually look at and try Neoteric Biomechanics, FFT and Foot Centrings in practice and I dare just one of you to send a cast for Centring Fabrication to my lab instead of the foam box or your STJ neutral cast I have jokingly requested.
Dennis

 

Thank you for the good luck wishes. I also wish you continued success in life and practice, we are arguing on theoretical points, no need to become uncivil.. right??

 

I dare you Dennis to carry out a piece of research on one, two or 579 individuals to test the efficacy of your ideas. Then have them published in a quality peer reviewed journal. Then I'll be more than happy to send you whatever casts you like, but I won't pay for them. Why would I want to give you a penny of my money? Which BTW is what you are saying here- "use my lab and give me some of your money". Frankly, I'd rather eat my own turds than give you one cent. I passed being civil with this spent piece of used podiatry trash* some time ago.

*Tom Waits- Frank's Wild Years

Well Frank settled down in the Valley
and hung his wild years
on a nail that he drove through
his wife's forehead
he sold used office furniture
out there on San Fernando Road
and assumed a $30,000 loan
at 15 1/4 % and put down payment
on a little two bedroom place
his wife was a spent piece of used jet trash
made good bloody marys
kept her mouth shut most of the time
had a little Chihuahua named Carlos
that had some kind of skin disease
and was totally blind. They had a
thoroughly modern kitchen
self-cleaning oven (the whole bit)
Frank drove a little sedan
they were so happy

One night Frank was on his way home
from work, stopped at the liquor store,
picked up a couple Mickey's Big Mouths
drank 'em in the car on his way
to the Shell station, he got a gallon of
gas in a can, drove home, doused
everything in the house, torched it,
parked across the street, laughing,
watching it burn, all Halloween
orange and chimney red then
Frank put on a top forty station
got on the Hollywood Freeway
headed north
Never could stand that dog

http://www.youtube.com/watch?v=BU-vNpmjfsI

 

I bow to your abilities and your debating skills. You will serve The Arena well for many years.

I am quoting Dr. Smith Homepage off his website!
I know nothing more than that.
If I email him would he send me a foam box?

I say this seriously and sadly Sam,
If backing up claims means EBM (the direction where medicine is justifyably going) I am a dinosaur.
The question that you are totally avoiding with an underserved head of steam is whether or not you are attempting to destroy something that once proven may be being buried unneseccarily.
My passion needs a rest and I haven't eaten or slept in three days.
But its been a great three days

"Live.
Love.
Laugh and Be Happy".
Hoagy Charmichael
Dennis

 

Simon:
please send me your casts for the rest of your career and I will make your orthotics gratis just so that I could say that I once touched your DNA.
NAAAAAAAAAAAAAAAAAAAAAAh
Dennis

PS: where is yourt followup study to your original 2 patient preliinary three years after you STJ Axis Locator paper?

 

I totally agree Sam and this is much less confusing then LLI vs. LLD. With your permission I am going to use FnLLD from here out to describe this finding.

 

Yeah Dennis, I can't see through your tear gas or the dollar signs in your eyes*. As I said, that section of your previous post was nothing but a request for money. Your post above just proves that I'm correct- once more. Any data to support your conjectures yet? I bet you can't provide any. I bet you can't...

As for the STJAL, I believe Joseph Hamill's team are using one, and I'm currently collecting data to model the relationship between STJ axis location and a number of other variables. I can't say when, or if, Joe will include the device in a publication. Personally, I hope to publish some more work using this device, alongside another device I have invented within the next twelve months. Neither device is patented, so the gauntlet is there for anyone to pick up, should they choose. These days, my research activities have to be fitted in alongside a busy full-time private practice, so time frames have to be somewhat elastic. When will we see something, anything from you Dennis?

I tell you what Dennis, I'll design and carry out a research project for you, for free. You just supply the devices for free. I have PhD, a pretty good understanding of research methods, a publication record and I act as a reviewer for JAPMA, all I ask of you to bring to the party for free are some bits of plastic.

You can try to critique my publication record as much as you like, Dennis (hint: you may need to look further than JAPMA to get them all). But ultimately your publication record amounts to what? Jack Diddley Squat? http://www.japmaonline.org/cgi/content/citation/61/6/220. n=1 Dennis, is this the sum total? Why haven't you followed up on this study in the last 38 years?

Could you list your publications for "The ARENA" Dennis?

Moreover, once more your attempted deflections add nothing and achieve nothing. You still can't answer a straight forward question. You're still a twat- period. Please provide evidence published in a quality, peer reviewed journal to support any of the bull**** that spills from your mouth and fingers and while you're there, please find some evidence to show that you're not really a twat...... bet you can't. I BET YOU CAN"T. In the meantime, I'll beware the angels of deception; the angels of destruction.

Come on down, the devil's in town...
*http://www.youtube.com/watch?v=dxkjmq2DQPE

And he can't spell "your" or "preliminary"... I''m ****ing myself with fear... "NAAAAAAAAAAAAAAAAAAAAAAh". Dennis, I think the word you were looking for was: not.

As in: you're not very good at this, are you. As oppose to: "NAAAAAAAAAAAAAAAAAAAAAAh" which is just an irritating background noise, like a vibrating dildo makes.

Even "chicken boy" Ed was better than you, at least he's put his money where his mouth is, to buy some research that "proves" his point... I guess you blew the research budget on the patent though. Shame, as the $$$$'s would have been better invested in research and publication. That would have been better marketing than your cockatoo on here Dennis. I suspect another imaginary word: "Doh!" springs to your mind; alongside a hunger for doughnuts.

 

Dennis, I don't know if you intended to insult everyone in the arena, but saying that we have not learned any art is a pretty big claim. We may not have learned your art. Is that the fault of the teacher or the student?

Dennis, I have my art and science in the tissue stress paradigm. I don't have to make measurements of moments to use the concepts. I can look at a foot with a medially deviated STJ axis and say that it needs a varus heel wedge. I don't know exactly how much is optimal, but the art is changing the amount of wedge based on response to symptoms. The art of the tissue stretch approach is making estimates on how much change to make after looking at the relative amount of deviation of the STJ axis. There is some logic to this art.

Dennis, one of the problems I have with your paradigm is that you talk more about juggling balls than talking about anatomy of the foot. I'm not even asking for studies, I'm asking for a logical connection between pathology and treatment. There was a good start with the discussion of your rigid foot type (aka rearfoot varus) and sinus tarsi syndrome. I agree with you that there should be some correlation with this pathology and this foot type. However, I like this explanation of sinus tarsi syndrome. The pain is caused by the fact that in the maximally pronated position of the STJ the lateral process of the talus is compressed against the floor of the sinus tarsi. Then, when you decrease the pronation moment from the ground, there is less compressive force at the lateral process of the talus. This is what I mean by correlating the pathology with the anatomy.

Does functional foot typing use the same explanation? If not, how does functional foot typing explain the correlation between a ridid rearfoot (aka rearfoot varus) and sinus tarsi syndrome. If you do use the same explanation then why do you feel functional foot typing is a better way to explain the situation to a podiatry student?

Dennis, I feel that your failure to explain the connection between foot pathology and how you vary the shape of your centrings (aka orthotics) is a major reason that people are not jumping on the functional foot typing bandwagon. It is not that we are not open to new ideas, we just want to know why your idea is better. Again, I'm not asking for studies, I'm asking for your logic.

Regards,

Eric

 

Eric:
Your appropriate summary of my lack of welcome on The Arena is very accurate and I'm sorry if in order to learn and find direction for my theories, I had to frustrate some members whose main interest was to frustrate me into abandoning The Arena.

I was praying that even one member would see something in my thoughts worth investigating and in that end, at least for the moment, I have failed.

I have learned so much but most importantly, I have developed a foundation in physics, engineering and mathematics that will enable me to gradually investigate my work on my own.

My mentor, Marvin Steinberg, D.P.M., the Father of Podiatric Medicine spoke openly that he did not believe in Biomechanics. Yet I watched him put arch pads and ball of foot pads onto the feet of patients with dramatic positive effects.
Today, I realize that he was reducing rearfoot pronatory moments and increasing (or is it reducing?) first ray dorsiflexion stiffness.
I watched him plantarflex the digits to cause wincing in the faces of patients that really had no complaints of the MPJ's. He called that test "MP flexion pain test". Today I know that he had discovered a precursor test for FHL. That has grown into my precursors which exist all over the feet and lower extremities.
It was not until I began utilizing an x-ray that I call COC or contact open chain where I imitate open chain AP and Lats just before weighting.
My orthotics had no effect on the CIA or my ability to increase the height of the rearfoot pillar when viewed on x-ray.
I developed the rearfoot vault correction technique and applied it foot type-specific and now can raise the vault better than with any other orthotic.
I could not "get" medial heel skives and so I developed the rearfoot pronatory moment correction that eliiminates a great deal of the pronatory moments in those feet that need that type of correction. (please help me find the right name).
Dr. Steinberg never published and his work lives only in the hands of his podiatry bloodline (his son, grandchildren and students) but if he were alive today (and I am proud to stand on his shoulders), you would be treating him exactly as you are me.
I have admitted that I am not a researcher. I offered $2000 to three prominent members to start some research and I was mocked. I have admitted a poor understanding of physics, engineering and math and not one colleague has offered to collaborate with me. I have defended myself when abused personally (and not one of you like it when I do the same to you).
I respect Isaac, Spooner, Fuller, and of course Kevin and I feel no real respect for Smith and Graham. That doesn't change my feeling for them as colleagues with whom I share a passion for trying to improve the lives and comfort of the foot and postural suffering public.
I wish I had a drop of the Ph.D that exudes from Spooner's pores. That is why I know how to push his buttons as he does mine.
I believe the diatrobe about making money, trademarking and patenting is above our whole discussion and debate but it is ceratainly a sore spot that won't go away for The Arena.
I have thanked Isacc, Fuller and Kirby because they deserve it and even more imprortant is that I know that unlike Rothbart and Glaser, they see some glimmer of sunshine in my unsubstantiated, poorly evidenced ranting.
I will not start any more threads. I will try to enter exisitng threads without disturbing their intention and I will continue to monitor The Arena and add its valuable work into my teaching.

I am fielding a fellow in Neoteric Biomechanics in June and I would welcome a referral fromThe Arena to a possible candidate.

Peace,
Dennis

 

So, Dennis, you are saying you have invented something. I have no idea what it is because it is either not fully explained or not fully defined. Why should you expect anyone to buy into your theories if you cannot explain them.

What bones make up the rearfoot pillar?
What motions or change in position of which bones do you see with a raised vault.

What is your rearfoot vault correction technique?

How does your rearfoot vault correction technique change for different foot types? Why not use the same technique for all feet? How do you think your technique works?

Dennis, How does your rearfoot pronatory moment correction work? What is it? How is it different than a medial heel skive?

Dennis, I see in you someone who is very passionate about your ideas. When I see that I like to understand what those ideas are. The glimmer that we see is the passion. As the questions I asked above indicate, I have seen little else but the passion. You have not explained why your ideas are better. That is why you get responses like twaddle. At some point we have to wonder whether or not you can explain your ideas.

Regards,

Eric

 

Dennis, when you read my father’s descriptions of closed chain pronation of the foot, it is clear that he was well aware of the triplane contour changes of the entire foot associated with STJ pronation. For example, he wrote in reference to closed chain motion: “Also note that the inclination angle of the calcaneus increases with supination and decreases with pronation. The change in the calcaneal inclination angle is not caused by subtalar joint motion, but is caused by movement of the midtarsal joint that accompanies subtalar joint motion in the weightbearing foot.” Normal and Abnormal Function of the Foot (NAAFF), page 31.

And ”In very pathological feet that have lost the osseous restraining mechanisms, static stance produces ligamentous strain and muscle fatigue. When the compression forces between osseous structures cannot stop joint motion during static stance, ligaments and muscles must function in an attempt to maintain integrity of the skeleton of the foot. In time, the osseous structure collapses and the foot becomes totally flat.
Some cut:
Most symptomatology and trauma to the foot is occasioned by instability of the foot that primarily develops during kinetic function. Therefore, the foot should be clinically evaluated, and treatment considerations should be based primarily upon kinetic requirements of the foot. Treatment based upon static considerations has usually failed to provide more than partial relief of symptoms, and that relief may only be temporary. (NAAFF) pages 105-106

My father used a static system of analysis and measurement for classification purposes. He also used dynamic, open chain analysis of the joints of the lower extremity (range and direction of motion) to aid in his appreciation of structure and dynamic function. He also based much of his treatment on gait analysis. All this occurred in conjunction with a thorough history in an effort to develop a proper diagnosis and in order to create a plan for treatment.

A properly made functional orthotic does support the medial and lateral longitudinal arches, the transverse arches, the angle of the forefoot (ff varus or valgus), and the rearfoot in both the frontal and sagittal planes. Rearfoot support requires capturing the medial and lateral inclination angles of the heel which in fact, are the origin of the longitudinal arches of the foot. The device also acts to support the rearfoot by maintenance of the frontal plane, non-weightbearing contour of the foot.

During closed chain pronation of the foot, the calcaneus everts and the talus adducts and plantarflexes and the medial arch lowers in the process. The orthotic shell, which closely resembles the plantar, non-weightbearing contour of the foot, acts to resist lowering of the arch through direct contact with the arch and by maintenance of the inclination angle of the medial heel and posterior, medial arch (ie talonavicular unit and cuneiforms) and by maintaining the lateral arch. The sagittal plane support that is created by a functional orthosis, plays a huge role in reducing stress on the longitudinally oriented soft tissue of the foot.

Your experience of the “#1 complaint of Root devices is that the device “feels as though it is pushing my rearfoot into varus placing too much weight under my lateral column”” is not consistent with my experience. In fact, I would say the most common complaint is excessive arch pressure or irritation that is often the result of an insufficient, improperly placed, or absent accommodation of the plantar fascia. The primary rearfoot complain relates to irritation of the medial or lateral margin of the plantar fat pad. Based on your chief complaint about Root type functional orthoses, it sounds to me like the devices you received had the medial arch overfilled with plaster. This is a common error with many manufactures of orthoses.

In my experience, Root type functional orthoses are very successful in the treatment of foot related pathology. Although it is always my goal to improve our outcomes, it seems to me that you have either had atypical outcomes or may be exaggerating treatment failures to support an alternative form of therapy. Perhaps we can continue this discussion in person at the Midwest conference later this week.

 

:good: In twenty odd years of practice I've NEVER once heard a patient say: “feels as though it is pushing my rearfoot into varus placing too much weight under my lateral column”. Primarily because the vast majority of patients wouldn't have the word "varus" in their vocabulary and they wouldn't know their "lateral column" from their elbow. Even the medics and podiatrists I treat don't report their symptoms in this way. SO, I'm guessing Dennis is simply making this up. No change there, then:bash:

 

Cognitive psychology 101. Selection bias. Anyone who believes themselves immune to its seductive and subtle effect is either deluded or possibly mentally ill. We tend remember such data as supports our A priori beliefs and dismiss that which is not. We all do it. Thats why case studies can be so misleading!

Thats why we have to have well carried out research. It strives to stop unwelcome data falling through our mental cracks and, through the cold impersonality of statistics, seeks to weigh data on merit not our desire for it to fit our hypothesis.

To anyone with half an interest in how their brain works I warmly recommend this book
http://www.amazon.co.uk/Inevitable-Illusions-Mistakes-Reason-Rule/dp/047115962X

Its well written, easy to read, and both terrifying and fascinating in equal measure.

Less than a fiver second hand. Well worth it!

Regards
Robert

PS I have no vested interest, I just enjoyed it!

 

Eric Stated:
What bones make up the rearfoot pillar?

Dennis Replies:

The Rearfoot Pillar is composed of The Calcaneus and The Talus

and

The Letter after "S" in STONEWALL is "T"

I've been saving my first smile for a special moment!!
:deadhorse: :deadhorse: :deadhorse: :deadhorse:

Dennis

 

Jeff Root Stated:
I would say the most common complaint is excessive arch pressure or irritation that is often the result of an insufficient, improperly placed, or absent accommodation of the plantar fascia. Based on your chief complaint about Root type functional orthoses, it sounds to me like the devices you received had the medial arch overfilled with plaster.

Dennis Replies:

I look forward to seeing you at The Midwest (Booth #320).

In order to have a test drive for Foot Centrings, to Market Functional Foot Typing and to get patients to experience the "breakin" process for FLEB control and correction in padding and not in plastic, I have developed The Foot Centering Pad System.
An upgrade of Dr. Steinbergs pads and the work of Ron Valmassey he called TriPlane Wedging when he was chief of Podopediatrics at CCPM.
These pads are placed into a patients shoes, on a removable insole or OTC device or over their existing orthotic as an upgrade, foot type-specific. This has eliminated, for the most part, arch pains and plantar fascial tissue stress created when an orthotic is used as the primary treatment modality.
As I agree with Howard, Williams and a growing group that DPM's utilize excessive rearfoot varus posting unneccessarily. I believe that is what makes patients feel they are being forced into varus and overweighted on the lateral column. I call this "The Sliding Pond Effect". Spooner et al must not be part of this group.
My lab's default is "NO ARCH FILL" so I am not in the group that you appropriately
feel is reducing the effectiveness of the cast and Rx by reducing Vaulting in their orthotics in order to combat the very complaint that you mention (arch pain rejection).
Dennis

 

Dennis:

Some corrections:

1. Ron Valmassy is the correct spelling for my former Biomechanics Fellowship director and friend.

2. Dr. Valmassy was the head of the Department of Biomechanics at the CCPM. There was never a department of "Podopediatrics" at CCPM.

3. Merton Root was the first podiatrist to use and coin the term "triplane wedging" that Dr. Valmassy often lectured on.

 

Dennis, that was an answer to one of several questions.
My interpretation of your stonewall comment is that you think I am just stalling before trying your system. Is that what you think? Is all this really about selling your system and getting us to use it. If you really believed in your system you should have thought through those answers to all those questions. Dennis, you are failing as a salesman. You should be able to explain why your system is better, or even different, if you want us to use it. Is the problem the system or the salesman?

Eric

 

Eric:

I answered this same question from you on this very forum in October!

I am just pointing out that this is going nowhere and we all have other things to do.

Your assumptions of my motives, who I am what I think and how I conduct my life away from the Arena remain fantasy.

"I'm glad I'm not me!"
Bob Dylan

Dennis

 

Dennis,

Can you point to where you answered the other questions? Dennis, when I'm trying to convince people of my point, I don't mind repeating the comment.

Eric

Eric

 

Kevin:

sorry for the mis-spelling and the lack of appreciation that Dr. Root coined the term TriPlane Wedging.

I am referring to a JAPMA article by Dr. Valmassy entitled The Triplane Wedge published before he was Department Head. It was podopediatric in nature in thast he took a felt heel pad and skived it twice, once distally and once laterally in order to create its highest point as proximal medial.
he then applied the pads, B/L to a pediatric population (don;t remember numbers) and it showed reduction in pronatory and equinus related problems.
Soon after that article I expanded that wedge to include LA and forefoot pads and applied them foot type-specific in additon to a heel pad to be used for LLD.
That has developed into The Foot Centering Pad System.
Dennis

 

Dennis I know you have constructed your own terminology in biomechanics, foot vaults, rearfoot pillar etc, but as yet this terminology has not become widespread and recognized. It might help the debate to flow if you could resist the temptation to resort to this terminology unless needful!

This sounds like fertile ground for a meaningful debate!

There have been a few who have questioned the efficacy / relevance of rearfoot posts of late. Ed Glaser was one.

So, Dennis. Rearfoot posting. Why do you feel this is used excessively and unneccessarily? Do you mean used in patients in whom it should not be, used in patients in whom it should be too too great a degree or other.

Please support what you say with EITHER research OR a reasoned deductive explanation (just as good).

I've been using them rather less of late. Been switching almost exclusivley to skives of varying degrees.

Robert
PS, congrats on your first smilie :drinks

 

Here are a few bits to start the ball rolling



Joanne S. Paton, MSc * and Simon K. Spooner, PhD Effect of Extrinsic Rearfoot Post Design on the Lateral-to-Medial Position and Velocity of the Center of Pressure Journal of the American Podiatric Medical Association
Volume 96 Number 5 383-392 2006

Single study design which showed a statistically significant and reasonably reliable change in position of the COP indicating, in this case, a kinetic change took place.

JOHANSON MA, DONATELLI RD, WOODEN MJ, ET AL: Effects of three different posting methods on controlling abnormal subtalar pronation. Phys Ther 74: 149, 1994

Showed a small kinematic effect in 22 patients using video gait analysis.

Obviously we know from kinematic studies that a 3.5 degree rearfoot post will not affect a 3.5 degree inversion of the calc, however to me it seems reasonable to suppose that this will increase the supinatory moments around the STJ.

Of course I, and I suspect others, have come across patients who feel that their insoles "push the weight onto the outside of my feet" however in my experiance these are usually patients with insoles which have either too high an arch on the orthotic, who have low supination resistance, or whose podiatrist keeps piling medial wedging onto the orthotic if it is ineffective (usually those stuck in the pronation=bad supination=good mould) . These are, however, very much the exception and not the rule in my experiance.


Robert

 

More here Robert and "followers" (BTW, I've proof read these for quality, but please use your own knowledge and critical reading skills to make up your own minds, I shouldn't want to be accused of being "unfair", I'm calling this the "you're intelligent and not a twat reading group"; Shavelson will never be part of this group) :

http://www.japmaonline.org/cgi/content/abstract/82/4/202

http://www.japmaonline.org/cgi/content/abstract/83/8/447

Here's the full text version of the "three different posting methods" paper that Robert cited above:
http://findarticles.com/p/articles/mi_hb237/is_n2_v74/ai_n28634559

 

Attached is the paper that Jo Paton and I had published on variation in post design. I'm biased here, obviously. So this is just for the "you're intelligent and not a twat reading group", sorry Dennis.

 

Okayyyyyyyyyyyyyyyyyy.

Can I peek?

Dennis

 

What was that other noise you made?

Oh yeah, that was it. Like we'd publish it and I'd post it here if I didn't want people to look at it, Dennis? Although you're not part of the afore mentioned group, feel free. All I need now is the bite, so I can reel you in. Go ahead, make my day.

 

Simon:

You had me at hello!

Dennis

 

Update to Kirby:

J Am Podiatr Med Assoc, Vol. 76, Issue 12, 672-675, December 1, 1986

Article
The triplane wedge. An adjunctive treatment modality in pediatric biomechanics

RL Valmassy and N Terrafranca

Dennis

 

You've never "had" me.

 

Anyone else think these two are flirting ? I'm playing the laura's Diary music on my lil keyboard here!

Right now. Plethora of ground to discuss. Why is rearfoot varus wedging overused?

Robert