The Tissue Stress approach to clinical biomechanics

I agree that rigid foot types can have medially deviated STJ Axes and that is very important Eric.

A medially deviated STJ Axis in the presence of a Rigid rearfoot is indicative of a large amount of forefoot pathology in the form of a flexible forefoot FFT.

You would never find a medially deviated STJ Axis in the rigid - rigid FFT.

Understanding the FFT's points you in the direction of where your treatment should be focused. The flexible RF needs antipronatory RF Care, the rigid rearfoot does not.

Remember when taking a FFT, you need both a rearfoot and forefoot exam and it is presented in a Rear/fore FFT that gives clinical information (no rearfoot focus here).

The fact that when one discussing the rearfoot and both the flexible rearfoot and the rigid rearfoot types may both have a medially deviated STJ Axis explains why I don't feel the STJ Axis to be of great import.

IMHO, it is SALRE or TS that fails here and not Foot Centering or FFTing.

Treating a medially deviated STJ Axis with the same anti-pronatory RF skive when it can present in both a flexible and rigid RF Type says to me that you are treating one or both of them inadequately.

No.
Asked and answered (apparently not to your satisfaction I'm sorry to suggest.

Correct me if I'm wrong but none of the evidence you provide, including the infantile evidence that reducing the tension in the plantar fascia reduces forefoot MPJ pain (I bet it reduces RF PF insertional pain as well) is not very profound, impactive or game changing.
Even of greater import, your evidence has nothing to do with the STJ Axis and its clinical import.
Is that the evidence you are missing?

totally your opinion which I insist has no strength for me

asked and answered

I'm not sure I understand your question.
Since labs work by prescription, you must ask each caster and prescriber how they modify their prescriptions foot type-specific.
Do you use a lab that does what it wants disregarding the Rx?

Totally your opinion once again. Not worth very much coming from a poorly evidenced competitive theorist with obvious conflict of interest.

Twisted truth.
I state that TS is pervertedly skewed to the rearfoot because of its overvaluation of the STJ Axis.

Yawn.

I agree but when others point out possible flaws of yours, they are met with bullying, anger and venom. Even worse, when your flaws are pointed out, they are met with censure, dispain and even elimination.

total fantasy......
ask dananberg, root, glaser and williams for examples

This is your biggest LIE and reveals your biased agenda towards me personally that you often deny.
Stupid is not a word that exists in my language and publishing. Total LIE.

DPM's biomechanical education is being systematically reduced in favor of foot surgery. Biomechanics is visulaized by most of the younger podiatrists in America as being controversial with no leaders and no consensus.

The way we deal with each other is the root of that fact.

Being a well trained foot specialist is still my profession and for 40+ years, the last thing I have ever done is call us as a group Stupid.
You should be ashamed of yourself.

Then what gives you the thought that your opinions are so valuable and should be blindly accepted?

Ditto

Dennis

 

Seriously?

DOH!


Perhaps if you post this a 4th and 5th time these conflicting statements will appear less ridiculous? You just make **** up to argue and you can't even get that right. :empathy:

 

Three posts and you still make a complete arse of it; please spare us anymore cr@p old man - sign yoursf into a sanitarium or wherever lunatics take themselves away these days. I'd be happy to make a contribution to your pharmaceuticals providing they were potent enough.

 

Gentlemen please.

This thread is about Tissue stress.

There are plenty of threads on FFT.

Can we keep on topic please?

Eric. Homie. Don't do that. Please. You're encouraging Dennis to carry a good thread off topic.

 

To all:

your personalizations that are often denied as existing, including inviting me to a sanatorium and paying for my meds, will no longer goad me off topic.

This 2006 posting from Craig defines a moment where TS went off on a tangent from which it has never recovered IMHO.

His black/white statement of:
Forces Damage Tissue (True)
Position and Motion do not damage tissue (False)
By denying his 20 previous years of biomechanics and setting a course that obviated the need for position to play a part in biomechanical diagnosis and treatment was an overreaction IMHO.

Position certainly does damage tissue in addition to the fact that forces damage tissue.

To say that our choices must be one or the other and not some custom combination of each for every patient lacks logic IMHO.

IMHO, totally denying the import of position just because STJ Neutral is not the optimal one, is a mistake that I for one, have not allowed myself to make.

Craig et al:
How does this stack up to your postulates on what to do when the evidence we need to proceed is lacking since Eric has admitted that it is lacking?

In debate:
Dr Root made us positionalists even through he discussed and practiced engineering (ask Jeff).
The TSers, following Craig and Kevin have made us engineers treating forces and deny position and motion even though they claim to take architecture into account.
In reaiity:
Todays Rootians do not practice the functional part of biomechanics as much as they could and
TSers do not practice the structural part of biomechanics as much as they could.

Logically, a melding of the two makes common sense and does not obviate the work, teachings or benefits of either.
The Foot Centering Theory of Structure and Function begins with such logic.

Kevin's postulates that started this posting state quite clearly (over and over):

How does a podiatrist use the tissue stress approach when seeing patients? Here is way it should be done:


1. Accurately identify the anatomical structure which is injured or symptomatic.

2. Determine the structural and functional characteristics of the individual's foot and lower extremity.

3. Determine the most likely type of abnormal tissue stress which is causing the pathology within the injured anatomical structure (i.e. compression, tension or shearing stress).

4. Design a treatment protocol to reduce the abnormal tissue stresses on the injured structure and reduce the local inflammatory response so that more normal gait and weightbearing function can occur.


This is certainly very different from the way I was taught to treat patients with foot orthoses (i.e. STJ neutral theory) since this was based nearly solely on trying to get the patient to function in STJ neutral position, with little regard to the injured structure that was being treated.

FFTing is a starting classification system for practicing biomechanics that determines the structural characteristics of all feet which then can be treated functionally by, in the TSers case with TS.

As stated on these pages it is 100% accurate although not very specific eliminating the main problem of Root's classification system that is too specific to be accurate or reproducible.

It adds a 5th postulate to Kevin;s and that is:

5. Determine the location of the area of the foot that is generating the pathological forces (rearfoot/forefoot/both/neither) so that treatment of the structure can be incorporated into biomechnaical care and design a treatment protocol to improve the structural pathology of the injured/weakened/collapsed structure.

IMHO, discussing FFTing is not a deviation from this thread, it a vital addition that needs inspection and appreciation.

or you need another structural paradigm to upgrade or replace Merton's.

Dennis

 

Yet again...

 

You know Phineas and Ferb, right?
You know Doofenshmirtz?
Yep, that'll be the one...

 

:good::boohoo::bang::craig:

 

Dennis - from now on you will have to assume the mantle and sobriquet of Harpic. Just so you kmow.

Kindest

 

Surely Doofenschmirtz?

 

Simon, Mark, Robert et al.....

collectiive giant yawn.

Dennis

 

I'm at a disadvantage having never owned a television for the last two decades. Still use Harpic too. Seriously thinking about ditching the PC now the cretin-infection appears terminal. On reflection, Harpic may "clean round the bend" but it also suggests it leaves things pristine and sweet and shiny. Captain Doofenschmitz it is...