STJ Pronation Not the Common Cause of Foot Problems

Dennis, very noble sentiments. But again ultimately flawed..

You have also, once again, failed to address any of the points picked up in the last couple of posts... will you ever answer a direct question? You appear to be a very gifted salesman.. always steering clear from the issue when pressed.

Your jedi mind tricks will not work on me..

:drinks

S

 

Sam Stated:
Not all feet have some level of pathology.. only injured feet have some level of pathology. Unpathological feet have no level of pathology because they are unpathological.
:craig:

Dennis Replies:
To intimate that unless and until injured, there is no pathology works in ballistic injury.
Our biomechanical pathology is inherited and starts impacting early, often at a very young age and long before it passes from the subclinical repetitive microinjury stage and presents as a clinical entity.
:drinks
Please send assymptomatic children with obvious pathological feet but no injury or patients looking to prevent injury or those who realize that their feet are deformed or tired or hard to fit in shoes but have no symptoms to Sam and I
would like to practice next door to him.
:empathy:
Dennis

 

Children are different, we all know that. And you still haven't answered any questions. What about 4 posts ago when you were talking about putting people with an obvious injury to the peroneus brevis into a medial heel wedge.. GOOD GOD MAN!

It is my belief that your system is for adult feet. Would you recommend your system for paeds cases? Would paeds cases fit neatly into your system...?? Of course not. And yes those cases you mentioned in paeds could be deemed as pathological... if they are causing problems. I have size US 13 feet.. I struggle finding shoes.. are my feet pathological??

What is an obviously pathological foot in a paeds case anyway? Is it a flat foot? Do you put all children that come to your with flat feet in orthoses???

It works very well for your system (and bank balance) to tell everyone that they have some level of pathology.. but the truth is they don't... not all feet become pathological. I've seen people who run ultra marathons with feet so flat that when they walk on a wet floor they make little shlurping noises with the soles of their feet.. you try picking them up.. surface tension is an amazing thing..

Now please stop being a pedant and start answering some questions....

 

Sam

Well Derrrrr!


DrSha

Now why didn't you say that before, for me this clarifies your intent, opinion, theory and ambition, in 8 short paragraphs, more than all you've written before.

I interpret that this means that; you are not saying everyone else is wrong per se, just that they are focused on their particular area of interest and blinkered from everything else. Can't see the wood (forest) for the trees as it were. You see these as disparate views of podo-biomechanical theory. Previously each camp has concentrated on their particular area of interest, which you define as either the rearfoot (e.g Root, Kirby) or forefoot (e.g. Dananberg, Rothbart) or midfoot or Vault (e.g. Glaser). You on the other hand have defined the three important areas of the foot that have previously been segregated and unified them into one new, fresh paradigmatic approach to foot assessment and orthotic design.

This achieves four things:

1) Integrates the the camps
2) Improves communication by standardizing terminology and concept
3) Removes the ego based self serving attitude of the leaders of each disparate camp and replaces it with your more reasonable and uniting approach.
4) Allows biomechanical knowledge to progress into a new, fresh, uncomplicated and universally understandable level.

Over time therefore you hope to acculturate (good word that I didn't know before) all biomechanical systems into the one true unambiguous system of Neoteric biomechanics.

This is a passionate ambition indeed Dennis, one might be tempted to use the terms vocation or calling. If only you could have explained this before we could have avoided the bitter dispute and aggressive argument. I for one am glad that a new light has been shed for us all to see. I think you'll agree Dennis, we all look a litttle foolish now eh? even Ed Glaser with his new Medial column system, or is that Prof Rothbart? (I get mixed up with my small brain) will need to rethink his/their position now eh?

Perhaps Dennis you would be so kind as to comment on my summary above ( as humble as it is) and even expand on it.

Best Regards Dave

P.S. Ed Glaser for sheriff I say, NOooooOOT! http://glaserforsheriff.com/ he's not radical just a reasonable American family man seeking office.
Lets have DrSha for Sheriff any seconders. What's you mandate Dennis

 

ROTFLMFAO!!!!

And there Kevin wrote all that Pseudo science babble in which GRF in the forefoot had an effect of the rearfoot and vice versa! Bet you face is red now Kevin! Rearfoot = posterior GRF, forefoot = distil GRF. Easy. Why would you have thought otherwise!?

And that pathology specific orthoses sounds like tissue stress theory to me! Shame on you, Eric, for focusing on the rearfoot! Tissue stress, such a shortsighted model. There are THREE segments you know!

SHAME ON YOU ALL why could you not be more like this NEW paradigm which is not at all closed minded and accepts all its faults. You won't catch THAT paradigm trying to replace the others!

Regards
Robert
PS. Sorry Dennis, but that is the most egotistical, self serving, ill informed pile of {SNIP} I've ever read! You dismiss the work of others as outdated and shortsighted even when by your own admission, you don't understand it! Perhaps before you seek to blaze a trail you should catch up with the others who have already done so!

Back on my meds now.

 

Epiphany

Robert

Seeing as no one's come out to play do you think there is an epiphany going on in someone's brain

Here's and oldie but goodie that has a certain synonymous irony about it I thought, naughty me eh?

Ernie ( THE FASTEST MILKMAN IN THE WEST)
11/12/1971 - 4 weeks at #1 - 17 weeks on UK chart

You tube video - http://www.youtube.com/watch?v=cLKaLvrtn-8

You could hear the hoof beats pound
As they raced across the ground
And the clatter of the wheels
As they spun round and round
And he galloped into Market Street
His badge upon his chest
His name was Ernie
And he drove the fastest milkcart in the west

Now Ernie loved a widow
A lady known as Sue
She lived all alone in Linley Lane
At number twenty two
They said she was too good for him
She was haughty, proud and chic
But Ernie got his cocoa there
Three times every week
They called him Ernie (Ernie)
And he drove the fastest milkcart in the west

She said she'd like to bathe in milk
He said alright sweetheart
And when he finished work one night
He loaded up the cart
He said you wanted pasturised
Coz pasturised is best
She says Ernie I'll be happy
If it comes up to me chest
And that tickled old Ernie (Ernie)
And he drove the fastest milkcart in the west

Now Ernie had a rival
An evil looking man
Called Two Ton Ted from Teddington
And he drove the bakers van
He tempted her with his treacle tarts
And his tasty wholemeal bread
And when she saw the size
Of his hot meat pies
It very near turned her head
She nearly swooned at his macaroon
And he said now if you treat me right
You'll have hot rolls every morning
And crumpets every night
He knew once she'd sampled his layer cake
He'd have his wicked way
And all Ernie had to offer
Was a pint of milk a day
Poor Ernie (Ernie)
And he drove the fastest milkcart in the west

One lunchtime Ted saw Ernie's horse and cart outside her door
It drove him mad to find it was still there at half past four
And as he leaped down from of his van
Hot blood through his veins did course
And he went across to Ernie's cart
And he didnarf kick his horse
Who's name was Trigger (Trigger)
And he pulled the fastest milkcart in the west

Now Ernie rushed out into the street
His goldtop in his hand
He said if you want to marry susie
You'll fight for her like a man
Oh why don't we play cards for her
He sneeringly replied
And just to make it interesting
We'll have a shilling on the side
Now Ernie dragged him from his van
And beneath the blazing sun
They stood there face to face
And Ted went for his bun
But Ernie was to quick
Things didn't go the way ted planned
And a strawberry flavoured youghurt
Sent it spinning from his hand
Now Sue she ran between them
And tried to keep them apart
And Ernie pushed her aside
And a rock cake caught him underneath his heart
And he looked up in pained surprise
As the concrete hardened crust
Of a stale pork pie caught him in the eye
And Ernie bit the dust
Poor Ernie (Ernie)
And he drove the fastest milkcart in the west

Ernie was only fifty-two, he didn't want to die
Now he's gone to make deliveries
In that milkround in the sky
Where the customers are angels
And ferocious dogs are banned
And a milkmans life is full of fun
In that fairy dairy land
But a woman's needs are many fold
And Sue she married Ted
But strange things happened on their wedding night
As they lay in their bed
Was that the trees a rustling
Or the hinges of the gate
Or Ernies ghostly goldtop a rattling in their crate
They won't forget Ernie (Ernie)
And he drove the fastest milkcart in the west



LoL Dave

 

Ian:

It's 2 Years Later!!!

With all your research. 2 years of additional proof and new evidence form Hilton, Craig and the boys,
Tissue Stress Theory,
all your phizzics...

What have you come up with to add to the clinical construction of an orthotic shell? foot type or any type or thing specific?

You (all of you)

as I have stated previously are clinically impotent, defeatest
and bound to wait for pathology and valid level 5 evidence in order to diagnose and treat.

and Simon ( and Craig Payne):

Summers over.

Happy Fall.

Where is the research that Craig was going to reveal by the end of summer blowing FFT out of the water?

Dennis

 

I have absolutely no idea what research you are talking about!

 

Dennis, is your purposeful misspelling of the word physics trying to make fun of for using science when we try to describe how an orthotic works. What is you purpose for misspelling physics?

What are you talking about?

Dennis,
FFT was never in the water to begin with. You can't even tell us how, or why you should make an orthotic differently for different foot types.

 

Oooo, feeling feisty today Dennis? You do love a good bit of provocation don't you. You scamp.

I would say that the major advance of the last few years (for me) has been a greater understanding of stiffness, moving further away from static position and range as diagnostic parameters.

Great idea for a thread actually! What have we learned this year?

So far as this,

I presume you mean level 1 evidence not level 5 evidence. But taking the spirit of what you mean rather than being nit picky, you know that's not true. We respect good deductive evidence, and theorising consistent with base principles.

But as for waiting for pathology, we ALL have to wait for a pathology before we can diagnose. That's what diagnose means! What you do, or attempt to do, with wellness biomechanics, is try to identify precursors or predictors to pathology and address those to prevent the pathology occurring. But that's not diagnosis. Smoking predicts cancer but you don't "diagnose" someone as a smoker do you?

Quid pro quo, have there been any developments in, or evidence (of any level) for fft in the last two years? Or was it perfect before .

 

Please ask Simon about that or find the quote I refer to on these pages.

Simon, please...

Dennis

 

Eric:

What have you come up with to add to the clinical construction of an orthotic shell? foot type or any type or thing specific?

was the question....?

answer or be gone.

Dennis

 

Hope u and Ginger are doing well.

Once again, you educate me as to my own work.
You're the Best!

I understand where you are going with the diagnosis semantic that I am using.

I would say to a patient that I have diagnosed their foot type and that there are inherent biomechanical pathologies that exist that can be treated.
But there are precursors and predictors that are in play as well that open up doors to prevention and performance and quality of life enhancement.

I have no problerm with calling these precursors or predictors ( I always have, even in personal discussion with you).

Advances this year have focused on additional leveraging of muscle engines via ORF's, foot type specific, that have led to better training programs. Also, the deverlopment of new props in addition to orthotics that can enhance treatment programs.

more patents. oy vey.

Robert,
How about if I say in the future:

Wellness Biomechanics diagnoses and treats disease (complaint) states. But in addition,
using precursors and predictors, alerts the astute clinician of care that can be rendered adjacent, before or after a complaint is encountered.

Dennis

 

It's your model chief. You can describe it however you like!

I'd go with "wellness biomechanics identifies structural and functional patterns which are likely to predispose specific tissues or groups of tissues to pathological levels of stress, and aims to reduce those stresses before a pathological threshold or event is reached."

But then I'm all tissue stress so my definition will always be prejudiced that way.

 

Dennis,
We all build on what we have learned. You built FFT on Scherer and Morris' chapter in Valmassey. Kevin proposed the medial heel skive to build on the Blake inverted. Both are ways of making a varus wedge device. My contribution to the field of of podiatric biomechanis lies in bringing in real biomechanics (you did google the definition and it does use physics) to explain why what we do works.

I'm not sure I can really take credit for it, but I have described the maximum eversion height test on the internet. It is a test that built on the teachings of Root Orien and Weed, that attempts to look at the foot and foot types in relation to the ground. John Weed talked about placing fingers under the foot to assess where the load was in stance. I have described how I use the information from the maximum eversion height test to alter how the orthotic is made. You will often cause problems when you add more intrinsic forefoot valgus post than there is available eversion range of motion in stance. This is building on the another's idea, but that is the nature of progress. So, I would call that a contribution to the clinical construction of an orthotic.

Dennis, I've read through your patent which you appear to consider your "contribution" to podiatric biomechanics. After reading through it, I've asked you some questions about FFT which you seem unable to answer. If you can't explain how, or why, you construct an orthotic differently, why should we consider this a contribution to podiatric biomechanics.

To quote you Dennis, "Answer or be gone."
Eric

 

Eric:

Patent applications are just that applications for patents.

They explain why something advances an existing art.

My patent application is 6 years old (3-4 years old when published and you read it) and offers no contribution to biomechanics as an entity.

Have you ever read, been told to read, quoted or derived anything evidentiary from a patent application? It shows a total lack of understanding of the process on your part.



Is subtalar joint pronation the common cause of foot pathology?

You have become so boringly easy to debate as you have nothing to offer on subject.

Dennis

 

Dennis, now you are trying to insult my patent knowledge. The reason that I referenced your patent is that is the only source I've seen that describes Functional Foot typing in detail (more detail than your website). If you have a better source, you could direct me to it. Or better yet answer the questions about FFT when they are asked.

Dennis this is comical. You resurrected this 2 year old thread and posted 3 times and none of them were related to the topic of the thread. It is getting boring watching you avoid questions by hiding behind the not on topic ploy.

Nice debate tactic: declare victory and go home.

Eric

 

I for one actually lost track of this debate a bit ago. What are we actually discussing now?

My memory was that we all agreed on the OP anyway. Pronation is no more the cause of foot pathology than flexion is the cause of knee OA. It's just a movement is all. It's forces which hurt, not movement.

The real debate for me is what's the best way to identify / predict the pathological forces? Is fft a reliable model for doing this?

Personally i'm yet to be convinced. For me to be comfortable with fft I'd need to see strong correlation between foot types and the pathology / excessive stresses in the tissue the associated prescription is designed to treat.

I prefer tissue stress because it removes that ambiguity. The prescription is simply designed to reduce stress in the affected tissue.

 

Robert:
Tissue Stress micromanages (looks to a fine point of the real picture).

It focuses on the cough, the sore throat, the fever and not the cold.

I could patch up every stress riser that exists within the foundation and structure of my house with bandaids or in addition to the bandaids, I could bolster the rafters (find an Optimal Functional Position), shore up the foundation (increase the size of my beams) or add tie beams (muscle engine training), structually specific by diagnosing its structural and physical weaknesses and imperfections with a prevetive, long term plan.
Plantar fascitis, for me, is a precursor of predictor of underlying biomechanical pathology and for you it is a diagnosable disease or injury.

Different perspective, mine is grander.

Dennis

 

I think that's an inaccurate view of tissue stress theory. It implies that Tissue Stress ONLY treats the plantar fasciitis, and not the aetiology. This is incorrect. If we just pumped it full of steroids without considering what caused the PF then it would be a sticking plaster as you describe.

Tissue stress is just as concerned as FFT with the identification and management of what I'd call the aetiology and what you call the underlying biomechanical pathology. That is a core part of how tissue stress arrives at a prescription.

Tissue stress and FFT both attempt to address the underlying biomechanical deficit which caused the pathology (or, if you prefer, the biomechanical pathology which caused the symptom). Where they fundamentally differ is in how they determine what the underlying deficit actually IS.

 

Robert:

So great to debate you again.

We need to define our terms and purposes.

I would not argue that our definitions must differ so lets define ourselves if we can to give greater purpose to this debate.
It's easy,
let's use etiology for FFT and aetiology for tissue stress.

FFT is an etiological starting platform from which to begin a biomechanical assessment with or without a chief complaint.
It is not a paradigm for care but merely a profiling system that focuses a practitioners EBP to understand the presenting posture and biomechanics of patients as they consider feet from a foot type specific perspective.
It suggests a set of diagnostic and treatment characteristics that are commonly encountered with the patients functional foot type for consideration when diagnosing and treating, no more.

It is used in conjunction with a practitioners diagnostic and treatment paradigm of choice if there is a chief complaint but it can be used without a chief complaint to develop foot orthotic props, training programs and surgical procedures that can be introduced before, during or after a chief complaint coexists.

The paradigm that I choose to use in practice is The Foot Centering Theory of Biomechanics which is based on FFTing utilizing all schools of biomechanics.

There are others which include tissue stress, MASS, Sagital Plane Block, SALRE that may be the treatment focus, by choice, for care.

Summarily, The foot centering theory is a triplane theory rooted in FFTing that in effect, encompasses all the schools of thought's gems and continues to evolve. It is a treatment pasradigm.

My patent is three fold.
1. A foot typing method.
2. A method of previewing the efficacy of the practitioners plan by applying pads to the patients shoes, inner soles or existing orthotics in order to test drive the plan, foot type-specific before proceeding with a custom device.
3. A foot type-specific orthotic that is custom designed, patient specific, with a practitioner in place, to intensify, reduce or eliminate the foot type starting platform from impacting a one on one case (or introduce new ones).

You can tissue stress, subtalar joint axis, foot center, MASS. etc, with or without FFTing but you will get much better clinical and researched results when you start with a Foot Typing.

Summarily:
The Foot Centering Theory of Biomechanics (not part of this discussion) is then the treatrment I advocate but any paradigm can be used after FFTing.

Using Erics coin case of a patient with sinus tarsitis and medial knee pain, the FFTing rules suggest that
rigid rearfoot type .... varus posting
flexible and stable rearfoot .... vertical posting (zero)
flat rearfoot type .... valgus posting

This means that if Eric's patient had a flat rearfoot, I would engage my valgus post and treat both problems (for a starting Rx).

If the patient had a stable or flexible rearfoot, I would apply a vertical rearfoot post with an LLD lift, prn and vault the foot in order to treat the sinus tarsitis on the sagital and transverse planes. I would make my device of thiiner plastic (2mm instead of 4) and I would add shock absorbing topcovers, low durometers of crepe for my posts and possible underfill the arch of the shell with shock absorbing poron or crepe to treat the medial knee pain.

If the patient had a rigid rearfoot I would probably reduce my varus post and add the shock absorbing and LLD treatment, prn as in the stable/flexible group and I would warn the patient that they may need consultation and possible knee surgery if they wished to maintain/upgrade their functional lives.

I would then develop a compensatiory threshold training program for the patient in order to utilize the strengths and weakness inherent in the FFT to use muscle engine power to effect and control moments and stiffnesses reducing my need for ORF's.

In my hands, this would lead to a sinus cure and less chance of compensatory pathology into the knee and possibly the elimination of both BUT in addition, I would be putting the patient in a more optimal functional shell position than STJ Neutral and dramatically reduce the number of ORF's needed but most importantly, I would be taking my patient to a higher place of biomechanical strength and function and never have to introduce to him/her that I may be causing new chief complaints that I will bandaid in the future allowing the patient to accept future weakness, functional disabiity, pain and suffering as a part of my planned care (the part I consider negligent by Eric).

It is for these reasons, goal sets and most importantly, mind set that I believe that TS falls short when considering or treating underlying biomechanical pathology because it has no starting platform before addressing chief complaints.
It begins with the chief complaint and its diagnosis and goals are "pathology specific".

Dennis

 

e·ti·ol·o·gyNoun/ˌētēˈäləjē/
1. The cause, set of causes, or manner of causation of a disease or condition.

So, it appears that you are claiming that foot types are predictive of pathology.
Can one pathology be caused by several different foot types? If so then the foot types are not predictive of pathology.

Why?

First off, are your posts rearfoot, forefoot, or full length.

In my experience, a valgus post will increase pain in sinus tarsi syndrome.

I'm glad that you are finally starting to describe how you change how you make your orthotic for different foot types. So, everyone gets treatment for LLD if they need it. It's independent of foot type. So you don't have to add it in for every foot type. Are there some foot types that get a thinner plastic for their device and others that don't. If so, why?


How does a vertical post and a vault treat sinus tarsitis? In the sagital and transverse planes?

Would all foot types get the shock absorbing crepe post and top covers when the patient has medial knee pain? That's tissue stress.

Again I'm not sure what you mean by varus post. Why would you only reduce the varus post in a rigid rearfoot in a patient with medial knee pain when the literature says that a valgus wedge helps medial knee pain. Why not all foot types?

Can you explain what you meant by this? Is this just a muscle strengthening program? Muscle strengthening is a good idea but, FFT is not needed to use this.

Nice claims. I could claim that when I said abracadabra that I would put the foot in a more functional position and eliminate knee pain at the same time. I could also claim that my treatments don't have side effects, because I never looked to see if they did. Or, if some new pathology developed, I could say that would have happened anyway without the treatment.

Dennis, you have made the assumption that you need a starting platform without proving the need for it. I have serious doubts that functional foot typing will be predictive of pathology. Why should non weight bearing supination end of range of motion be predictive of any pathology in a weight-bearing foot?

Tissue stress can be used to predict who might become pathologic. We have made the observation that posterior tibial dysfunction is correlated with feet with a medially positioned STJ axis. I have also noted that feet that have a partly compensated varus are very likely to get sinus tarsi syndrome. I'd have no problem giving those feet varus heel wedges before complaints developed. I would treat these people with an exact understanding of the logic behind the potential cause of the problem and why the treatment should prevent the problem. Dennis, can you explain why one foot type will get a pathology and another will not? Is the reason that you base foot types on the supination end of range of motion, because it is easy to measure? I don't see why supination end of range of motion has any relation to pathology.

Eric

 

Dennis = BOLD REPLIES

Eric:

 

Presented some data on this at Biomechanics Summer School, Manchester UK (Spooner S.K.: Toward kinetically quantified casting. 25/6/2011). Should be in a position to submit for written publication in the near future.

 

Here you go again Simon.

Is that the same as the research that Dr Payne was going to submit by the end of the summer on FFTing that he knows nothing about that you predicted on these very pages?
Could you possibly get your Podiatric foot out of your mouth on that one?

So lets see.

Like me you have no research that is published in a peer reviewed journal on the subject.

You're so eager to get some that you've lowered yourself to predicting their imminent existense for the future.

Kind of like I can predict future pathology, foot type specific!

and I predict that your research will be short term, small numbers, hypothetical and flawed. but I hope I am wrong.

On the aside, I look forward to reading that when accomplished and I predict that it will fit very well, as much of the literature does, conforming to Foot Centering as a means of controlling ORF's while training muscle engines and that I will add its meritorious pieces to my work.

Dennis

 

As ever I have no desire to discuss anything with you, dennis. Goodbye.

 

Amen. This is precisely why what everyone has been patiently trying to help you realize; FFT and similar reductionist, Doc-in-the-box paradigms are meritless when discussing CFO's. You have effectively refuted your own system and sent it to its timely death, congratulations! :hammer:

 

This thread is in danger of getting unweildy so I'll just pick up a few points.

I'm with Eric here. Whether or not this is true, merely claiming that if I'd treated a patient, it would have gone far better has little validity and does not really advance the debate.

There is a recurring issue here. One can make a few obvious and implied observations about FFT without much more information than we have. Its a typing system. For feet. There are Rx's for certain types of insole corresponding to certain foot types. But the specifics of the system are harder to come by. The patent is public domain but I've not seen much else in the public domain which goes into more detail.

Thus it's no easy for us to make specific observation on FFT without that information. Perhaps in addition to asking us to broaden our education it would be helpful if Dennis gave us the means to do so!

How do you make that to be a lie? I've done all of these things in clinic. Yes, including preventative (I think, one can never be sure what sequallae would have happened). I'm sure others have too.

Dennis makes a very relevant and pertinant point here. I can't speak for the US but in the UK there are a lot of clinicians who lack the anatomical knowledge and expertise to use TS effectively. Not true to say that no one understands it, but certainly true that not everyone does. Foot typing, be it quatrastep, Dennis's version, The old talar made SNA system or even the really old fashioned "high medium low" model, is probably easier to learn.

Dennis believes FFT gives superior outcomes to TS. I believe TS gives superior outcomes to FFT. But that debate is only relevant to those who can choose between them.

A second debate exists for those who lack the motivation, education or aptidude to use TS. I've yet to form an opinion on this, but It's certainly worth considering whether FFT would give better results than the bastardised and oversimplified version of Root which many of our colleagues still use.

This might be a you say potato thing but I think you're wrong there Dennis. So far as I understand it there is little difference between the core aims of FFT and TS, that is to reduce stress in tissues which have been, or which are likely to be, injured, and to improve the efficiency of function wherever possible. That's probably a mission statement we'd both be happy with. I suspect that when formulating FFT you had this concept in your mind.

I'd say the debate is around whether we should use tissue stress ALL the time, or whether sometimes FFT gives the desired outcome (as above) more easily, quickly and consistantly.

 

8-9 months has gone by.

Have you come closer to the publication being submitted as predicted?

Dennis

 

Yes, I've collected more data, presented the ideas at three conferences that I was invited to speak at in Manchester (UK), Valencia (Spain) and Florida (USA) and I am about to submit the manuscript for publication in JAPMA. I've also collected some data on coefficient of friction of orthotic top-covers, which again was presented in Florida and will get written up eventually. I have to prioritise my time as I'm in full-time private practice and have a young family. Right now my priority is in preparing two keynote lectures I have been invited to give, along with my good friend Kevin Kirby, in Flanders (Belgium) in March http://www.arteveldehogeschool.be/elpa/podologie/lustrum/ , I'm sure some of this work will be included in one of the lectures I give there too. Thanks for the interest, yet as I said last September: as ever I have no desire to discuss anything with you, Dennis. Goodbye. Please refrain from attempting to draw me into your callow games. I'm too busy and have no interest in you whatsoever.

 

Your update is appreciated and as we all know, bringing research to harvest as we live out busy and prioritized lives is accomplishment enough.

I am wondering if any of your material is available in its current state and I look forward (usually takes 8 months to harvest in JAPMA) to enjoying your additions to our sciences literature.

I myself, am doing research in what I call Pedal cog, which I have been able to tag to my foot types as the Pedal cog moves away from the direction of pathology.

I would not be able to approach this type of theorizing if not for, respectfully I say it, The Arena and especially you.

Funny but I thought your callow games on the demotivational poster thread with Robert is what brought me to this posting but I guess you think you have stealth protection.

Finally, could you please let me know when you are lecturing in The USA next as I would fight to enjoy your material and to meet you personally as you are at worst, a great representative of our profession for biomechanics as well as being a sensitve father and healer. That's quite different than your Chad persona on The Arena as is mine compared to real life.

:drinks

Dennis

 

The debate for me, is whether or not, without changing your practice habits to start, FFTing your patients would not lead to better clinical outcomes and research than using STJ Neutral or Subtalar Joint Axis (or MASS theory) as cookbook methods for casting and creating your orthotic shells.
Profiling all feet into one of sixteen different functional foot types (at least the 5-6 common ones) as a starting platform would lead to improved custom biomechanical care (wow, did I just remove Quadrastep as viable in this debate?) and research in my expert, textbook and 40 year EBP of biomechanics opinion

I think even the casual observer has been witness to the fact that I stated that I had no real knowledge in engineering and physics when I joined The Arena three years ago. Although admittedly still a novice compared with Simon et al (whom I still am student of) when it comes to these subjects, I have certainly grown to a level of respectability in these fields, by choice.
On the other hand, you are still in diapers when it comes to FFTing, Foot Centering and Compensatory Threshold Training, by your choices.

Dennis

 

God this again? Dennis until you can answers ANY of the questions asked repeatedly of you no one really gives a fat rodent's behind about another of your rants. Answer the questions (if you can), patents mean very little if the end result is invalid.:bash:

 

My question is....when will Dennis ever tire of talking to himself here on Podiatry Arena. Doesn't he realize that we all stopped listening to him months ago?

 

Ian hit the nail on the head some time back:

http://www.podiatry-arena.com/podiatry-forum/showpost.php?p=82662&postcount=22

Ultimately Dennis can be summed up using an analogy of similar adolescent behavior:

Dennis is like that turd one of your college roommates left in the john as a prank; It is disturbing and unpleasant. Everyone is aware of of it but no one wants to take ownership for it much less look at it. It smells up the room and nothing seems to conquer it other than leaving the house entirely and yet everyone is acutely aware that it must be dealt with..

 

Dennis, you really need to figure out how to use the quotes. I appreciate you putting your statement in blue. However, when you click the quote and copy it the blue does not stay. So, below I will try and make Dennis' statements, blue I hope to get all of them and keep Robert's black'

Dennis, your criticism of tissue stress that we wait for pain to occur can be easily ignored by an expansion of tissue stress paradigm. We have said that the tissue stress paradigm is to identify the injured structure, model the stresses on that structure, then design a treatment to reduce stress on that structure and then modify the treatment to achieve the desired outcomes.

We can easily add to the paradigm by saying that there are some measures that we will be predictive of pathology and that we can intervene to reduce those stresses. Specifically, I would predict that a medially deviated STJ axis will be more likely to result in posterior tibial tendon pathology. Those people with more medially deviated STJ axes could be given medial heel skives as a preventative measure. There is a logic to this. (Medial deviated STJ axis leads to a high pronation moment from the ground and the posterior tibial muscle will have to work harder in this foot when compared to a foot with an average STJ axis position.)

This is the problem I have with functional foot typing. No logic has been given as to why typing feet would be predictive of pathology. Dennis would you give an example similar to mine above?

Dennis, all treatments can have side effects. Would you deny treatment of the knee, that the literature has shown to work because you are worried that the treatment might cause STJ pronation? Why not give the patient the choice. Do you prescribe NSAIDs? Less pain in the knee is a better quality of life. You can explain to them to take the wedge out if the foot starts to hurt.

You left out cures hemorrhoids and makes you smarter in your wild claims.
Atrophic? vestigial? What paradigm makes that happen, and how?

Dennis, I invested the time and energy to read your patent and website. You are really crazy if you think I'm going to pay you to tell me more. Dennis, is this your business model? Why should I pay you to teach me biomechanics when you didn't even know the definition of the word until I told to look it up.

You keep making this claim that there is more to FFT than is in your patent, but you can't tell us where it is. You could try and explain it here on the arena. We might take you more seriously if you actually tried to explain the rationale for foot typing.

Dennis, the reason that I don't incorporate FFT into my clinical practice is that you can't explain why it should work. FFT is just a bad version of Root et al foot typing because it ignores the relationship of the foot to the ground.

Dennis, tissue stress gives me a rationale for changing the design of my treatment. You have not given us how foot typing changes your treatment or why you would change your treatment for various foot types.

As far as Dennis has explained, his method is exactly the same as the bastardized Root et al. method. Those that don't try to understand how orthotics work will take a cast of the foot and you send it off to the lab and hope the orthotic that comes back works. They won't care/notice if there aren't any modifications to the orthotic. Although, that is where the pathology specific orhtotics may help. If someone has PT dysfunction then if the lab automatically gives that a medial heel skive then they might do better than FFT where Dennis has said above FFT doesn't use skives.

Dennis, your continued denigration of the rest of the arena is really tiresome. Why do you insult people who you want to understand your paradigm. Bullying us has not won you any converts on the arena. By the way FFT is still in diapers. You have yet to develop the rest of the theory. Why do you type feet? Does your treatment differ for the different foot types? Why? I've asked these questions numerous times because I've wanted to know more about FFT. You could tell us your thoughts on this or you could choose to try not convince us there is anything to FFT.

Eric

 

In Functional Foot Typing the rearfoot, the word rigid refers to "rigidly resisting verticality".

In functional foot typing the forefoot, the word rigid refers to "rigidly resisting being on line with the fifth metatarsal reference point.

Dennis

 

So we're all clear then Yes? OK:dizzy:

"I'm always pleased when I see a fellow scientist reach out for answers to the big questions while rigidly resisting reality because sometimes I feel that it was only me that the burrowing spiders of Hellagain had gnawed their way into my brain, made a nest and have been whispering the secrets of a mystic universe to my mind, which has given up it's rigid resistance to logic on the 5th of September 2011, aah! what a beautiful day of freedom that was."

Dennis will you be the Bluebottle to my nest of spiders, Pleeease, pretty please :butcher:

The Spider and the Fly

Will you walk into my parlour?" said the Spider to the Fly,
'Tis the prettiest little parlour that ever you did spy;
The way into my parlour is up a winding stair,
And I've a many curious things to shew when you are there."
Oh no, no," said the little Fly, "to ask me is in vain,
For who goes up your winding stair can ne'er come down again."


"I'm sure you must be weary, dear, with soaring up so high;
Will you rest upon my little bed?" said the Spider to the Fly.
"There are pretty curtains drawn around; the sheets are fine and thin,
And if you like to rest awhile, I'll snugly tuck you in!"
Oh no, no," said the little Fly, "for I've often heard it said,
They never, never wake again, who sleep upon your bed!"


Said the cunning Spider to the Fly, " Dear friend what can I do,
To prove the warm affection I 've always felt for you?
I have within my pantry, good store of all that's nice;
I'm sure you're very welcome -- will you please to take a slice?"
"Oh no, no," said the little Fly, "kind Sir, that cannot be,
I've heard what's in your pantry, and I do not wish to see!"


"Sweet creature!" said the Spider, "you're witty and you're wise,
How handsome are your gauzy wings, how brilliant are your eyes!
I've a little looking-glass upon my parlour shelf,
If you'll step in one moment, dear, you shall behold yourself."
"I thank you, gentle sir," she said, "for what you 're pleased to say,
And bidding you good morning now, I'll call another day."


The Spider turned him round about, and went into his den,
For well he knew the silly Fly would soon come back again:
So he wove a subtle web, in a little corner sly,
And set his table ready, to dine upon the Fly.
Then he came out to his door again, and merrily did sing,
"Come hither, hither, pretty Fly, with the pearl and silver wing;
Your robes are green and purple -- there's a crest upon your head;
Your eyes are like the diamond bright, but mine are dull as lead!"

Alas, alas! how very soon this silly little Fly,
Hearing his wily, flattering words, came slowly flitting by;
With buzzing wings she hung aloft, then near and nearer drew,
Thinking only of her brilliant eyes, and green and purple hue --
Thinking only of her crested head -- poor foolish thing! At last,
Up jumped the cunning Spider, and fiercely held her fast.
He dragged her up his winding stair, into his dismal den,
Within his little parlour -- but she ne'er came out again!


And now dear little children, who may this story read,
To idle, silly flattering words, I pray you ne'er give heed:
Unto an evil counsellor, close heart and ear and eye,
And take a lesson from this tale, of the Spider and the Fly.

The Spider and the Fly
by Mary Howitt

 

Yawn.

Dennis

 

Eh? How can one resist a position?

I don't understand. Rigid means immovable. By definition does it not follow that it resists ALL positions except the one its in? As in you can't move it into that position?