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The Inclined Posture (TIP)

Discussion in 'Biomechanics, Sports and Foot orthoses' started by drsha, Mar 25, 2009.

  1. drsha

    drsha Banned

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    The Inclined Posture, The Neoteric Biomechanical Key to Diagnosing Frontal Plane Lower Extremity Imbalance

    {Admin note: This article has been copied from the thread on measuring lld)

    The Inclined Posture, The Neoteric Biomechanical Key to Diagnosing Frontal Plane Lower Extremity Imbalance

    Dennis Shavelson, D.P.M.


    One of the tenets of Neoteric Biomechanics is that the two limbs need to be balanced to each other. The Inclined Posture is a new and fresh paradigm for diagnosing and treating frontal plane imbalances of the lower extremity commonly that have been called “Limb Length Discrepancy until now.

    Deviations in Lower Extremity symmetry on the frontal plane are common, and require compensation by the body to function efficiently. With time, repetitive compensations for asymmetry are pathologic and produce predictable signs and symptoms. When differences in the length, strength and/or structure of a person’s limbs lead to pathologic compensation, the clinical entity is defined as The Inclined PostureTM. A subject has The Inclined Posture until proven otherwise when the clinical signs and symptoms are apparent.

    This paper presents a simple test for diagnosing The Inclined PostureTM (TIP) as well as additional tests and signs that confirm the diagnosis. Treatment options for TIP at the foot/shoe interface are presented, which reduce the need for internal compensation. By controlling TIP we can decompensate its pathological compensations and prevent it from impacting performance and quality of life as we age.


    Neoteric Biomechanics is a new and fresh paradigm for practicing Functional Lower Extremity Biomechanics 1. The tenets of Neoteric Biomechanics include the need to balance one lower extremity to the other when weightbearing. Until now, no organized or efficient manner in which to diagnose and treat what is currently called Limb Length Discrepancy (LLD) has surfaced. The Inclined Posture does not involve itself in the debate over structural vs. functional origin. It simply determines if a subject has made pathological compensations due to the influence of a short leg in closed chain and presents a quick method of compensating imbalance by the use of lifts and platforms at the shoe/foot interphase. It does not prevent skilled practitioners from balancing for TIP internally by lengthening the bones or stretching tight ligaments, capsules and musculotendonous units over time to cure TIP internally

    The Definition and Relevance of TIP

    Human function requires shifts in the center of gravity from one side of the body to the other. Thus, a symmetrical body has the most efficient gait2. Deviations on all three body planes are compensated internally by the body in order to remain centered and balanced3. These compensations tax the system progressively, reduce performance and efficiency and eventually causing degenerative signs and symptoms. Deviations on the frontal plane compensate by making predictable compensatory adjustments in the posture as the body leans to one side. The resultant clinical entity with its signs and symptoms is defined as The Inclined PostureTM or TIP for short.

    The literature points to the fact that humans are not symmetrical3,4. When measured, a person’s two feet are not the same length and width and the muscle mass of almost any region on the left side, is different than that of the right. This paper focuses on the fact that the majority of our population exhibits some amount of variation when it comes to the lengths of our limbs, while functioning and The Inclined Posture deserves early recognition and treatment due to the fact that our population is living longer lives and extending its quality of life.

    The Leaning Tower of Pisa has no internal compensatory mechanism and so its structure has continued to lean more and more over the centuries. Biomechanically, the human race has built in mechanisms such as the ability to shift the spine and hips, tilt the pelvic and shoulder girdles and pronate or supinate the feet in order to maintain our center of balance and erect posture in reaction to postural deviation on the frontal plane (figure 1) 5. Unfortunately, since our ability to compensate internally is limited, leaning forces that make us lopsided often become excessive and if left untreated, symptomatic. This leads to pathology in predictable locations within the postural chain6.

    Clinically, unless the difference in limbs is greater than 1.5 centimeters (the true definition of a limb length discrepancy or LLD), it is difficult to determine its origin and impossible to accurately measure its existence. This means that The Inclined PostureTM is a clinical entity diagnosed by confirming the existence of specific compensatory signs and symptoms that develop in affected subjects as they try to maintain center of gravity and balanced posture over a lifetime.

    The Inclined PostureTM compensates at specific locations of the postural chain when performing specific activities. For example, when standing still, the pelvis tilts downward to the short side and when walking, the short side supinates at the subtalar joint as the long side pronates2. It is important to note that if closed chain asymmetry is present in subjects without taxing the posture, the signs and symptoms of TIP do not develop and by definition The Inclined Posture does not exist. On the other hand, when the signs and symptoms of the inclined posture are present in subjects they reflect the existence of pathology in the postural chain and therefore, by definition, TIP exists. The effects of The Inclined Posture are progressive and degenerative and since it affects a majority of people, TIP plays an important role as a component of many overuse syndromes, postural degenerations, deformities, and performance issues.

    When it comes to limb length, the literature continues to debate two issues; how to measure limb length accurately and what amount of asymmetry needs diagnosis and treatment5,7,8. These questions remain unanswered. We believe this debate diverts us from appreciating the clinical impact when one limb is functioning longer than its mate, even if the difference is seemingly immeasurable. Simply put, if there is asymmetry in a pair of limbs is creating pedal and postural sequelae, it deserves diagnosis and treatment.

    Until now, The Inclined Posture has not been considered as an entity even though there has been active debate about the importance of diagnosing and treating limb asymmetry4,5,7,8. Studies have shown that limb length discrepancies of less than 25 mm are not observed during routine musculoskeletal examinations5. Discrepancies of this level go unnoticed by the patient as well5. Since almost everyone has TIP and less than 4% of the population has a diagnosed Leg length Discrepancy (LLD) actively being treated9, the importance of the inclined posture and its need to be treated is being underestimated.

    In an evolutionary sense, ambulating on uneven surfaces and performing tasks that require uneven function (i.e. going up a flight of stairs) has forced the human posture to adapt to unequal stresses. This adaptation comes in the form of biomechanical and muscular compensation.

    When standing still, a person with The Inclined Posture (TIP) leans towards the short side on the frontal plane in order to maintain an erect posture. When active (i.e. walking or running), this same person functions more long sided, developing a “super” side. An example of this type of biomechanical compensation is the “super” arm, shoulder, and torso that a tennis player develops on the functionally dominant racket side.

    To make things even more complicated, there are concomitant factors that influence how much TIP affects subjects. This means that The Inclined Posture alone does not determine the amount of biomechanical compensation needed or the amount of compensatory pathology that is produced. Some of the concomitants affecting The Inclined Posture are excess weight, underlying biomechanical pathology, activity level, compensatory equipment (i.e. shoes, orthotics), reduced health state, and environmental factors such as inclines in the road. Concomitant influence must be considered because the need for treating TIP increases as the number and magnitude of these factors increases.

    Daily activities, such as washing dishes, waiting on line, or walking about will have a cumulative adverse effect upon the posture when performed lopsided. Add to this the negative effects that a lifetime of play, sport and exercise have when performed lopsided, and you can begin to sense the value of diagnosing and treating TIP.

    Perhaps the concomitant factor influence upon TIP can be better understood if we examine an example. When we talk about TIP being impacted by activity level, we know that when a person walks, maximum heel strike is one times the body weight but when running, heel strike is three times the body weight. This means that functionally, a 5mm TIP difference in our limbs in stance converts to a 15mm TIP when running. This means that additional treatment may be necessary at specific times of exertion. In our example, a small amount of additional heel lift on the short side when the subject is running eliminates the need for internal compensation.

    Until now, practitioners have focused on the chief complaints that result from a posture influenced by The Inclined Posture and treat the unilateral bunion, the long sided knee arthritis, the low back pain and sciatica, as well as the generalized postural aches and fatigue without diagnosing and treating the root problem. Treatment protocols for the inclined posture will prevent many predictable neurological, orthopedic and postural problems from appearing and will assist in the treatment of those that exist.

    Diagnosing TIP: The FEJA Test

    The author has developed an accurate, reproducible test for the diagnosis of TIP called the Functional Equinovarus of the Joints of the Ankle or FEJA Test.

    The test is based upon the fact that functionally, if TIP exists, the long side is compensating to shorten and the short side is compensating to lengthen. Eventually there are soft tissue and adaptive osseous changes, in specific locations, that can be used diagnostically.

    In the functional lower extremity biomechanics (FLEB) literature, Mann and Inman call the ankle joint and the subtalar joint “the joints of the ankle” and located them as the primary compensators of the lower extremities10. These two joints, as a unit, become the first line of compensation and the first areas where fixed changes occur in reaction to the inclined posture. When comparing a pair of limbs, The Inclined Posture exists if there is a relative Equinus deformity between Ankle Joints and a relative Varus deformity between Subtalar Joints, until proven otherwise. This diagnostic test for The Inclined Posture is called The Functional Equinovarus of the Joints of the Ankle or FEJA Test for short.

    The Inclined PostureTM compensates in the sagital plane of the long side ankle joint by dorsiflexing in order to shorten its limb. On the other hand, the short side ankle joint compensates by plantarflexing in order to lengthen its limb. This balances the incline on the sagital plane seen in TIP. In time, soft tissue contractures create a relative difference in dorsi/plantar flexion of both ankles with the short side being plantarflexed (in relative equinus). The Functional Equinus portion of The FEJA Test is performed by forcibly dorsiflexing the ankle joint of both limbs and noting any difference when measured (Figure 2). If the inclined posture and its concomitant factors are enough to cause internal compensation, the side with a relative plantarflexion (equinus) in relation to its mate is the short side until proven otherwise.

    The Inclined Posture compensates in the frontal plane of the long side subtalar joint by pronating (inverting) in order to shorten its limb. On the other hand, the short side subtalar joint compensates by supinating (everting) in order to lengthen its limb. In time, soft tissue contractures create a relative difference in inversion/eversion of both subtalar joints with the short side being inverted (in relative varus). The Functional Varus portion of The FEJA Test is performed by forcibly inverting the subtalar joint of both feet and noting any difference when measured (Figure 3). If the inclined posture and its concomitant factors are enough to cause internal compensation, the side with a relative varus position in relation to its mate is the short side until proven otherwise.

    In summary, a positive FEJA test exists when one limb (the short side until proven otherwise) has both a relative plantarflexion (reduced dorsiflexion) when comparing the ankle joints and a relative varus (increased inversion) when comparing the subtalar joints.
    The REJA test would be reported as a positive test for the short side of The Inclined Posture (i.e. FEJA +, Left). Since the amount of Equinus and Varus are relative, exact measurements are not necessary for a positive FEJA Test.

    The Confirmatory Signs and Tests for TIP

    1. Weighing Scales
    Observe the patient marching in angle and base of gait for 10 seconds and then ask the patient to freeze. The separation of the feet and the angle which they sit determine the angle and base of gait. Trace the patient’s footprints, and in those footprints, put two weigh scales. Then ask the patient to step on the scales. Since TIP causes a person to shift weight to the short side in stance, if the scales do not read the same, the greater of the two readings will be on the short side.

    1. Gait Pattern Confirmatories

    TIP shows predictable changes in gait that reflect the asymmetry in the feet and posture. There is a longer stride length on the long side with a longer foot plant. There is a relative external rotation of the hip and limb on the short side with a greater arm swing when comparing the short side to the long side. There is a relative flatter arch (pronation) when comparing the long side to the short (or a relative higher arcj on the short side (supination).

    2. A Unilateral Postural Complaint, or a bilateral complaint that develops from a one sided complaint. i.e. unilateral Bunion, heel spur, plantar fascitis, ankle, knee and hip arthritis and pain syndromes. Unilateral nerve problems such as sciatica

    The increased work accepted by the longer side with every active step and movement, in subjects with TIP, places greater stress upon the joints, muscles, tendons, and ligaments of the long side. Overuse syndromes and progressive degenerative syndromes attack overstressed locations in the posture with the most force and early. This results in additional compensation in these locations in the posture with early pathology and symptoms.

    For example, when examining the feet of subjects with TIP, the long sided foot performs more work than the short sided foot in supporting and moving the posture. This increased demand exposes any biomechanical weaknesses to overuse and degeneration. Since the long side foot is pronated, more force is applied to that medial column. If other deforming forces such as a hypermobile first ray have predisposed this subject to develop bilateral bunions, a more pronounced Bunion (hallux abducto valgus) deformity develops on the long side. Similarly, the increased pronatory forces of the long side cause additional collapse of the medial arch and compensatory pull of the plantar fascia on the long side. Thus, plantar fasciitis and heel spur syndrome develop on the long side first.

    3. Unequal Shoe Wear Pattern
    With the increased inversion noted at the subtalar joint of the short side, bony adaptation in addition to contactures of the associated musculature, capsular, tendon and ligament soft tissue structures fix the subtalar joint in more varus than its mate. During the heel contact phase of the gait cycle the short sided heel is contacting the ground more supinated and this leads to additional lateral wear of the shoe.
    The additional weight and time that the long side spends in active function in subjects with TIP leads to increased total shoe wear on the long side.

    4. Excess Lateral Column Callus on the short side
    The increased weight on the lateral column as a result of the varus loading on the short sided heel, in gait, results in the existence of a unilateral or a more extensive 5th metatarsal callus on the short side. In Flexible FootTypes, this can also lead to increased callus under the 2nd metatarsal.

    5. Low Back Pain or one side dominated sciatica, A Pelvic Tilt in angle and base of gait, to the short side and/ or A Shoulder Girdle Tilt in angle and base of gait, to the long side
    In TIP, at the level of the pelvis, one limb is functionally (or structurally) longer than its mate. This fact causes a downward tilt in the pelvic girdle from the vertical lopsided towards the short side (figure 1.) This can be measured or “eyeballed” by placing markers on both anterior superior iliac spines (ASIS’s) and noting the presence of the incline (i.e. The Leaning Tower of Pisa). This incline of the pelvic girdle with the short side lower causes L-5/S-1 and L-4/L-5 degeneration and low back pain and radiculopathy. In order to maintain the center of gravity and erect posture, the lumbar vertebrae shift towards the long side and form a concavity. This compresses the lumbar nerves on the long side and leads to compression and eventual sciatica on the long side. The curvature in the spine tapers and becomes less exaggerated as it extends all the way to the shoulder girdle. At the shoulder girdle, the compensatory need to keep the center of gravity causes a tilt with the long side lower.

    6. The Long Sided Foot is Larger, longer and/or wider and reveals an Increase in Pronation when compared to the short side in angle and base of gait.
    The long sided foot accepts a dominant role in stance and in function and performs more work than its mate. Over a lifetime, this is reflected with greater muscle mass, bone density, supportive tissue as well as a widening of the longer foot. This translates into the fact that the long sided foot, in TIP, is larger than its mate both in length and girth.

    As stated previously, the long sided subtalar joint compensates by pronation in order to functionally shorten the limb. This additional pronation places more of the limbs weight on the medial column and drives additional stress into the midtarsal joint. In patients with a flexible forefoot, this force will unlock the midtarsal joint and create a hypermobility in the forefoot that will cause it to stretch and spread. Over time the long sided foot will become larger and wider.

    7. Larger Mass on the Long Sided Limb (i.e. calf, thigh)
    Since, functionally, the long side dominants in subjects with TIP, the compensatory increase in muscle mass, bone density and connective tissue strength leads to the long sided limb developing larger than its mate.

    Measure the diameter of both calves 5 cms below the tibial tubercle to record calf girth. Measure the diameter of both thighs 5 cms above the proximal patella to record thigh girth. The side with the higher measurements is the long side until proven otherwise.

    8. Walking Down Stairs
    Observe the subject walking down a flight of stairs. Due to the compensatory abduction of the short sided hip, the angle of gait will appear windswept to the short side if TIP is present. If it is no t present the angle of gait will appear relatively straight.

    The Diagnosis of The Inclined Posture

    The Inclined Posture exists in a subject when there is a positive fEJA Test and the existence of two or more of the confirmatory tests and signs, until proven otherwise.

    TABLE 1 See Table 1 In Appendix

    Concomitant Factors affecting TIP Syndrome
    1. Excess Weight
    A subject’s weight determines how heavy a body the posture must support and carry. The amount of compensation necessary for a body to overcome biomechanical pathology, including TIP, increases proportionally to its weight. Therefore the more overweight a subject is, the more exaggerated the signs and symptoms of TIP will be.

    2. Environmental Factors
    Uneven terrain causes the need for more compensatory reaction in order to maintain the center of gravity and balance. Increased incline and tilt in surfaces, the hardness of the surface, and even the friction coefficient of the surface play a part in determining how much compensatory energy is needed in order to function on that terrain. Compare the effort needed to run the same distance on a flat straight surface in hot weather to running that same distance up a hill, tilted to the left, in cold weather, when the ground is hard. This comparison can show you the impact of the environment on function and on The Inclined Posture.

    3. Equipment Factors
    Scientists, designers and manufacturers have developed equipment that can compensate for biomechanical pathology, including TIP. These products reduce the impact of TIP by absorbing shock or controlling motion. Running Shoes, foot orthotics and therapeutic socks are just some of the products available.

    Both the quality of the products and the level of wear must be considered as well as the specificity of matching the compensatory need with a products ability to decompensate specific problems.

    4. Functional Foot Type Classification and Treatment

    The feet of every human being can be placed into one of ten groups known as The Functional Foot Types (FFT) 11. FFT classification is based upon the open chain and closed chain positions of the joints in the rearfoot and forefoot of the foot when divided in two by the talocalcaneal and calcaneocuboid joints (the midtarsal joint). Rearfoot position is determined by noting the position of the subtalar joint at its end range of motion in open and closed chain. Fore foot position is determined by noting the end range of motion of the medial column of the foot with the rearfoot neutral and the lateral column at its end range of motion in both open and closed chain. In this manner, the rearfoot and forefoot can be classified as rigid, stable, flat or flexible. Each of the nine Functional FootTypes has its own predictable signs, symptoms, compensations, pathology and treatment. Once classified, every patient can have their foot type decompensated with FFT specific plaster casting techniques and a prescription that is incorporated into a foot orthotic.

    5. Activity Level

    The impact of TIP and its need for treatment increases in direct proportion to the activity level of the subject. The time of performance, the frequency of performance and the intensity of each activity must all be considered. The object of treatment is to maintain or increase activity level while reducing the impact of TIP.

    6. Reduced Health State and/or Fitness Level

    When dealing with quality of life issues there are two distinct factors that determine ones ability to be active. They are health and fitness. It is just as possible to be fit and in poor health as it is to be healthy and unfit. The health state of a subject can deteriorate to the point that it will have a negative impact on compensatory reserves and so if a subject has a poor health state it must be treated simultaneously and the treatment plan for the inclined posture must take health state into account. Simultaneously, fitness level must be determined and if weak it must be treated simultaneously and the treatment plan for the inclined posture must take functional condition into account.

    Treatment for The Inclined Posture

    1. TIP Paddings
    Initially, The Inclined Posture can be compensated by placing a heel pad of one eighth to one quarter of an inch thick in the heel of the shoe on the side showing a positive FEJA Test. Materials can vary but adhesive felt is a readily available option. There should be an immediate improvement of most of the signs of TIP and the pad can be adhered to the shoe or moved from shoe to shoe daily.
    Simultaneously, rearfoot, medial arch and forefoot pads can be adhered to a shoe to decompensate the subjects Functional FootType, if pathologic.
    2. Custom Foot Orthotics
    Custom Foot Orthotics used to treat The Inclined Posture are fabricated in pairs and have three basic components, a semi rigid thermoplastic shell created from an non weightbearing neutral or cast corrected plaster cast for each foot, asymmetric rearfoot posting and/or a heel lift on the limb having the positive FEJA test.
    The semi rigid thermoplastic shell should be fabricated from an non weightbearing neutral or cast corrected plaster cast in order to capture the Functional Foot TypeTM of the subject and the anatomical differences in the two feet.
    The assymetric rearfoot posts should be fabricated in shock absorbing crepe or a similar material and should reflect the neutral position of the subtalar joint of each foot since the short side (+FEJA) will have a neutral position that measures greater in varus than the long side. The thicker rearfoot posting on the short side will add lift to the short side as it compensates for the additional varus deformity on the frontal plane.
    A heel lift fabricated in shock absorbing crepe or a similar material can be added to the rearfoot of the short side (+ FEJA) if the amount of TIP deformity needing compensation is greater than the asymmetric rearfoot posts can accomplish.
    3. Sole Heel Lifts or a Sole Platform Raising The Short Side Shoe
    If The Inclined Posture is excessive (i.e. A Limb Length Discrepancy) and cannot be compensated in the inside of a shoe than a heel lift tapered to the heads of the metatarsals or a platform lift of appropriate thickness can be added to the Outer Sole of the shoe on the short side.


    10,000 years ago, man became civilized and created paved roads, cities, shoes and playing fields to satisfy a desire to expand life and add to its quality. At the same time the medical and physical sciences committed to extend the human lifespan and make it more productive and comfortable.

    The civilized forces of unyielding ground surfaces and hard shoe boxes, when added to the pull of gravity, create an unyielding negative force that challenges our bony and soft tissue structures with every step we take during our entire lives. Genetics and compensatory mechanisms that exist in all of us work to prevent these forces from reducing our performance and quality of life. To these, we have added external equipment to compensate negative forces before they impact our bodies and postures.

    We ask you to imagine “The Inclined Road”. Imagine the cumulative negative forces that would occur in one lifetime, as we took millions of steps, if all of our roads were paved with even the slightest amount of incline to one side. Pelvic tilt, low back pain and scoliosis would develop. Compensatory heel, ankle, knee and hip asymmetry and degeneration as well as muscular and soft tissue compensations would reduce our performance and quality of life. We would be functioning on a lopsided surface. “The Inclined Road” doesn’t exist because as much as possible, our hard, unyielding roads and floors are level.

    Now we ask you to imagine “The Inclined Posture”. Imagine the cumulative negative forces that would occur in a lifetime, as we took millions of steps, if functionally, our limbs had even the slightest difference in length and were inclined to one side. Pelvic tilt, low back pain, scoliosis would develop. Compensatory heel, ankle, knee and hip asymmetry and degeneration as well as muscular and soft tissue compensations would reduce our performance and quality of life. We would be lopsided people. In reality, The Inclined Posture exists in a majority of the human race. Until now, there has not been any focus or energy placed in the direction of diagnosis and treatmentfor The Inclined Posture in order to make people level and remove this never ending deforming force from impacting our performance and quality of life.

    Stimulated by personal experience, the senior author has been studying and teaching about “The Inclined Posture” for more than two decades. This paper is meant to alert the medical and scientific communities of the importance of TIP and its diagnosis and treatment, as we expand our lifetimes and upgrade our quality of life.

    Since examination, diagnosis and treatment for The Inclined Posture is easily accomplished without invasion or discomfort to the patient, we strongly advise that practitioners dealing with the posture as well as the orthopedic, podiatric and biomechanical arts and sciences, become familiar with and take the time to diagnose and treat The Inclined Posture.


    This paper discusses leg length asymmetry, no matter how small and calls the compensatory result The Inclined PostureTM (TIP). Limb length discrepancies less than 25 mm are rarely discussed in the literature yet they are almost universal in functional subjects5.

    Investigators should perform the FEJA test for TIP whenever performing a biomechanical evaluation but especially where deformity, degeneration and symptoms are unilateral or assymetrical.

    TIP exists if there is a positive FEJA test accompanied by two positive confirmatory tests or signs. All cases of TIP deserve treatment. It is our opinion that semi rigid custom foot orthotics with asymmetric extrinsic rearfoot posting and heel lift modifications are the gold standard for treating TIP.

    As our population ages, quality of life issues deserve more and more attention. If you had a table with one leg just a little short of its mates, you could let the table wobble and tilt as you ate on it or you could put a small amount of material under the short leg and eat your dinner in comfort. The diagnosis and treatment of TIP will extend us a more injury free, better performing improved quality of life with less postural breakdown over our lifetimes.
    Last edited by a moderator: Mar 25, 2009
  2. David Smith

    David Smith Well-Known Member

    Re: The Inclined Posture, The Neoteric Biomechanical Key to Diagnosing Frontal Plane Lower Extremity Imbalance

    Dennis you have expanded the technique of fitting a 5mm felt heel lift into a whole program of assessment diagnosis and treatment and called it TIP. It is far from quick and simple as you explained it to be, it certainly is new but its also absurd.
    In my opinion your table leg has severely wobbled and you have TIPPED over the edge into a chasm of confusion and you now require help to extricate yourself. Please take this as constructive criticism and take time to evaluate your own view of yourself before its too late.

    All the best Dave
  3. Gosh what a lot of words to describe something really rather simple.

    Dennis. True or false. The piece could be summed up as follows

    Short leg -> inclined pelvis in frontal plane -> Bad

    Put heel lift or supinate short foot -> pelvis becomes level -> good

    Like Dave points out, I really can't see anything new here!


  4. BTW, watch out for my upcoming article in The Journal of ICGIP.*

    In it i describe how people with viral or bacterial infections sometimes find their body temp rises by a few degrees! THis breakthrough i am calling Raised Actual Thermal Signs, High Internal Temperature. TM (needs an acronym.)


    *i could'nt get it published
  5. Schrodinger's cat has interested me since my student days, twenty odd years ago. If I put Dennis in a room and close the door, does he still exist? Spooner's cat: did he exist in the first place? Answer: who gives a ****?

    No, really, I feel sorry for him, he's come up with (modified is probably more accurate) an idea about thirty years too late when those who really engage in podiatric biomechanics have long since moved on from his taxonomic approach. Another time, another place, hey Dennis?

    You can sell bull**** to some of the people, some of the time; but you can't sell it here today.

    As I quoted just a few days ago: U2 breathe-
    6th of June, nine 0 five, door bell rings
    Man at the door says if I want to stay alive a bit longer
    There's a few things I need you to know. Three
    Coming from a long line of travelling sales people on my mother's side
    I wasn't gonna buy just anyone's cockatoo
    So why would I invite a complete stranger into my home
    Would you?
    These days are better than that
    These days are better than that
    Every day I die again, and again I'm reborn
    Every day I have to find the courage
    To walk out into the street
    With arms out
    Got a love you can't defeat
    Neither down or out
    There's nothing you have that I need
    I can breathe

    Still my gold top copy and there's the paradigm I'm adopting, not your old cockatoo Dennis. Really, there's nothing you have that I need. Shame that you can't reciprocate this line Dennis.
    Last edited: Mar 28, 2009
  6. drsha

    drsha Banned

    Dr. Smith:

    Please send me one of your foam boxes so that you can make me a custom orthotic as promised on your website homepage.

    dennis shavelson dpm
    200 east 72nd street
    NYC NY 10021

    How dare you critique me as an authority of weight!!

    Lots of email success and profits.
  7. drsha

    drsha Banned

    Simon States:
    You can sell bull**** to some of the people, some of the time; but you can't sell it here today.

    Dennis States:
    Perhaps you could do a double blind preliminary study utilizing two subjects that would determine the weight of anything Ph.D. that you say.
  8. I'm guessing you are referring to the preliminary trials of the STJ axis locator that Prof. Kevin Kirby and I had published in JAPMA http://www.japmaonline.org/cgi/content/abstract/96/3/212 . As this was a preliminary study to introduce a new instrument and to speculatively test its validity, a double blind trial should have been completely inappropriate, as anyone with an ounce of research methods knowledge could have told you. Perhaps I could refer you to a basic text in research methods that might help you understand this? This peer reviewed paper included no patents and no pretence, it was just data from two healthy subjects, published in honesty, so that others may take it onwards should they choose. You obviously saw the potential in the STJ axis locator or you wouldn't have sent private messages to me requesting to purchase one (I'll not publish your private messages to me yet).

    As for my PhD, that data was derived from 579 individuals. Power analyses were performed at the time, suffice to say, it was a more than adequate sample. Have you read it? What do you think? It might provide you with enlightenment regarding the methodology required to provide models that are predictive of foot pathology. You can get a copy from the British Library: Spooner, S.K: Predictors of hallux valgus; A study of heritability. PhD Thesis, University of Leicester, 1998. If you need help with any of the longer words, just let me know.

    And your publication record = **** all. Still waiting for one piece of evidence to support anything that you say... I BET YOU CAN'T PROVIDE ANY.


    Not today, thank you. As mother always say's to door to door salesmen.

    BTW Dennis, the more you write, the bigger fool you appear. Carry on...........
    Last edited: Mar 28, 2009

  9. I suspect you'll need to follow the instructions on Dave's website for this. Why do you think posting this here is the right approach? Simple question that requires simple answer, but you'll be incapable of answering this Dennis because... Anyway, I'd like you to make a pair of orthoses for me Dennis, so I can tell you how **** they are, because I'm completely unbiased.
  10. David Wedemeyer

    David Wedemeyer Well-Known Member

    I'd like to cast an early for for post of the year for Simon's response here. I actually projectile voided a swig of coffee all over my desk upon reading this.

  11. David Smith

    David Smith Well-Known Member

    I would be happy to send you a foam box to make you some custom comfort insoles. Just goto my web site and use the contact area to pay £99.95 + P&P to USA £25. Unfortunately I cannot make you Custom Orthoses by mail order only a simple insole as is clearly explained in my web site and hence the price.

    In case you do not understand I have copied below a relevant section of a leaflet sent out to customers NB We are calling then BioTech custom comfort Insoles now.


    All the best Dave

    PS look forward to receiving your order
  12. drsha

    drsha Banned

    Sorry we are so off the subject but I will try to answer your post and state that I only reviwed and copied your website home page. That is what dominates ones philosophy and offers. I never doubted your offer (although simon would say it is a way of making money short of great care).

    I was just being forced by your rage and arrogance to put my shoe onto your foot for a moment.

    The real point, whether cheaper, more available, offering a lower level of care for profit reduces your right to call anything someone else is doing not worthy of a look.
    This reminds me of the docs who shoot down someone elses prior work as less than great get so amazingly angry when their worked is called less than great.

    Simon quoting an article on foot typing that uses two types, pronated feet and normal feet (30 and 5 respectively) that claims that others are at least publishing is so unfair in that The Arena trusts him to suggest valid articles but he is charged with bias.

    I am revisiting my conduct, my approach and my goals to further incorporate evidence. Are you so perfect that you have nothing to revisit?
  13. Actually I cited the article, I didn't quote it. This does raise an interesting point though. The study in question used a dichotomous classification system, we see this elsewhere within podiatry, for example 15 degrees of hallux abduction is commonly used to delineate normality from pathological hallux valgus. Does this mean that a foot with 14.5 degrees of hallux abductus angle functions completely differently to one with an angle of 15.1 degrees? A rearfoot may be classified as inverted or everted, does this mean a foot that is inverted by 1 degree functions the same as a foot that's inverted by 15 degrees? Or differently from one that's everted by 0.5 degrees. Such artificial, binary delineations are problematic as I think Robert has already discussed elsewhere. If we classify people as tall or short we see similar limitations, in reality height, hallux abductus and rearfoot angles are continuous variables and should show something approaching a normal (bell shaped) distribution in the population. As do many foot characteristics. This is a fundamental problem with many foot type classification systems. The question then becomes, how many divisions do we need to accurately categorise a given variable? Hint- depends what the research question is.

    I'm not sure why you see me posting links to articles as unfair though? Many people who use the Arena find links to published articles useful. Indeed, these are the posts which often receive thanks from the membership. Is it unfair that I posted a link to this article specifically, or unfair that I posted links to several articles on foot-type classification? Why do you think this one was unfair and not the others? Or is it, as I suspect, "unfair" that these authors have struggled to carry-out their research and have it published, while you have not?

    As for bias, I merely did a google search on foot type classification and posted links to the research articles, I wasn't selective in which research I posted only in that I didn't post links to websites that didn't report data from research, this was my only bias.

    Why do you think that these articles (or specifically this article) is/ are invalid?

    If I'm trusted to post links to valid articles as you suggest, then that's entirely down to those that have placed that trust in me. I haven't asked for any such trust. I trust that those that follow any links that I post will make their own minds up. I post links to music videos and comedians too, do those that follow these links trust my taste in music/ comedy too? It's in those links I really am being selectively biased.

    IF Dave made an insole for you, would you be unbiased in your evaluation of it? I think not and that was the point of my sarcastic comment regarding your insoles.

    Dennis, one thing I have noticed is the bi-polar nature of your postings here.
    Last edited: Mar 30, 2009
  14. drsha

    drsha Banned

    If I published an article and stated one of my foot types as NORMAL
    you would have DESTROYED IT!
    Fight fair.

    My point is that the fact that you are getting a list from google and not previewing them shouldn't add power to your arguments.
    and I bet your Arena followers think you know them inside and believe in their evidence or you wouldn't suggest them in the first place when that is not the fact.
  15. Yeah Dave, it was all your fault. You're arrogant and angry. Look in the mirror Dennis.:bang:

    Was it unfair the way you went to Dave's website in a misguided attempt to mock and embarrass him here, Dennis? Look in the mirror Dennis.:bang
    Last edited: Mar 30, 2009
  16. If we used the term "not pronated" instead of normal would that change things? If they defined what they meant by the term "normal" would that be OK? How do you know I didn't preview them? For your information, I did. I didn't state that they were good, bad or indifferent in terms of their methodology, I merely stated that they were links to articles on foot type classification that had employed research data derived from studies on subjects. The point being Dennis, that YOU cannot offer any published research data to support your conjectures regarding foot-type classification, can you? Yes or no will do- I won't hold my breath.

    For those who haven't got a clue what we are talking about here, Dennis is referring to a discussion in another thread; this thread:http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=27339

    The world you inhabit is weird Dennis, I don't have Arena followers. The people who read this are generally bright podiatrists with freedom of thought and ability to judge good posts from bad posts, good research from bad. You do them a disservice.

    For the record, the study in question employed the foot posture index devised by Redmond. There are several papers that have been published relating to the validity of this, some positive, some less so. I won't post links to these as I don't want Dennis to think I'm being unfair, suffice to say my "followers" will find them and make their own minds up.
    Last edited: Mar 30, 2009
  17. To be entirely fair, we would have torn it to bits! :eek:

    I think the difference here is that Simon is not claiming to have discovered the next x men style jump in the evolution of biomechanical theory. Dennis is. Claims like he has made, including that other peoples insoles cannot hold a candle to his, require that the supporting evidence be bloody amazing!

    If anyone cares to cast their eyes back over the Arenas more... lively threads they will notice a common thread within these threads (what a veritable tapestry).

    Those who make small claims and support them are admired. Those who make large claims and support them are greatly admired. Those who ask large questions (including about their own work) and approach the discussion with an open mind are applauded (because a good answer is only one post but a good QUESTION stimulates many good answers.).

    Those who are toasted are those who approach with the view that they know best and then act as if everyone else should accept it.

    To be honest, I find all of the ideas which wander in here, like baby rabbits hopping curiously into a foxes den, rather interesting. MASS, Proprioceptive insoles and FFT alike are all fascinating ideas which I'd love to examine. Its just so bloody hard to explore them or take them seriously when they are wrapped in so many layers of exaggerated claims and hyper-defensiveness.

    Its a little like the frustration I feel regarding acupuncture. Enough around it that I find the idea interesting but so obviously not the panacea it is claimed to be. The fluff and fuzz which obscures such things make it hard to find what could be a precious nugget of truth within.

    Perhaps a pearl of biomechanical wisdom is simply a small piece of crap which sneaks into an oyster (the arena) is coated in precious gleaming knowledge as the arena reacts to the irritant and strives to render it tolerable, and finally emerges as something beautiful and wonderful. To much crap, however, and the oyster simply spits the whole lot out.

    Gosh I'm feeling whimsical this evening. Damn, I've spilt allegory all down me now!

  18. cpoc103

    cpoc103 Active Member

    I think the difference here is that Simon is not claiming to have discovered the next x men style jump in the evolution of biomechanical theory. Dennis is. Claims like he has made, including that other peoples insoles cannot hold a candle to his, require that the supporting evidence be bloody amazing!

    Sorry to butt in on this one late, only just read the thread. Am I the only one who can see another emerging Les Bailey type here....


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