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Understanding of 'Root' mechanics makes it easier to understand todays theories

Discussion in 'Teaching and Learning' started by mike weber, Jun 15, 2009.


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    While some maybe still using Root mechanics as their base of foot assessment.

    Im wondering what or if people have thought if they were a student again if understanding new research is easier to understand because of knowledge of root mechanics.

    ie Root: here is the normal foot, measure detect difference treat.

    now: there is no normal look at axis, motion, joint stiffness use patients symptoms as guide to tissue stress etc.

    So I guess I´m asking the biomechanics teachers and anyone who has an option. Would they teach Root mechancis to students at the start of biomechanics (say 10-15 % of the course ) learning so understanding of todays mechancis is easier to understand.

    I can see some +ve as the practical aspect of a root biomechancial assessment is great skills for new students with using hands and eyes.

    it gives many students advantage of thinking thru the process and get greater understanding as to why that theory is wrong and how the new theory works better etc.

    -ve it can be confusing to learn to be told that its wrong.

    what are your thoughts.

    Michael Weber
     
  2. Graham

    Graham RIP

    Re: understanding of root mechanics makes it easier to understand todays theories

    Michael,

    Might be interesting to know what is currently being taught in the schools around the world. While there are a few eminent thinkers/teachers here in the arena they don't teach at all the schools. My experience is that the majority of biomechanical education is still "Root" based with some exposure to the "new theories" but not necessarily much experience in the clinical application.

    Craig may know more about this. My thoughts are that an unbiassed, scientific and clinical approach would be to teach the pros and cons of all the theories, including Root.
     
  3. Re: understanding of root mechanics makes it easier to understand todays theories

    When I was teaching undergraduates full-time, this is exactly what we did. One of the assignments was to "critically evaluate the contemporary theories of podiatric biomechanics".

    BTW, students used to hate the idea of having learned something that is full of flaws earlier within their education (they used to get Root shoved down their throats in year two as the "gospel truth" by another lecturer, only to have me lead them to the realisation that life's not that simple in year three). Students are generally lazy, they want to know what the need to write to pass their exams and assignments. Unfortunately, they learn to play the game and write what they think each lecturer wants to here. Lazy, but smart.

    Do I think that understanding Root first makes understanding other theories easier? No.
     
    Last edited: Jun 15, 2009
  4. Ann PT

    Ann PT Active Member

    Re: understanding of root mechanics makes it easier to understand todays theories

    I have been teaching other Physical Therapists about biomechanical evaluation and fabrication of orthotics. I started with Root and Weed because it seemed like the foundation should be taught first even though I don't use their measurements when designing orthotics. I went on to teach other theories of foot function. I follow more of the tissue stress model when designing orthotics but I can't get my students to stop thinking about the STJN measurements and trying to make sense of those with the orthotic prescription. I think teaching Root and Weed has made it more complicated for them and now I think I wish I hadn't started there! I think I regret teaching something but then saying I don't use that information to design the orthotics!

    Ann
     
  5. Re: understanding of root mechanics makes it easier to understand todays theories

    I find it interesting (and slightly amusing) that this is seen as "the foundation". What makes this "the foundation" rather than just another historical perspective? In the UK at least, people were using foot orthoses before Merton Root was born. If it is an historical, why not start at the beginning? And, why not cover other contemporary theories to Root?

    Incidentally, I had a call from a colleague and good friend to make some devices for one of her patients recently, she said something like "my patient has got some devices, I don't know how to describe them, but I haven't seen anything like them before." They turned out to be Rose-Schwartz menisci type devices. Now, this is not meant to disrespect her, as I clearly don't, but it seems that her "foundation" didn't start with anything pre (alternative to) Root either. Who's fault is this? Partially mine, because I used to teach her;), but in my own defence, she only had me for a year and a half.:D She didn't get the third- interesting year with me:cool::cool::cool:. The point of this anecdote? When did the history of podiatric biomechanics begin? With Root- certainly not, as I'm sure the great man would agree. Were there no other contemporaries of Root that took a different approach? Certainly not. So what makes Root the "foundation"? Perhaps, if we look outside of the USA and even the UK, we will learn of other pioneers that have had profound influence upon podiatric biomechanics in their own countries. France? Spain? Germany? Denmark? I'm sure each of the countries have got their own "big knobs".:D

    Me? My "foundation" was Root (thankfully, I just learned what the teachers wanted to hear and didn't get it too in-grained in me- students are lazy but smart- for all my ex-students- I was a student once too- I knew what you were doing BTW). I guess because that was seen as the "best" most coherent theory at that time. SO............. why not teach that which appears to be the "best" most coherent theory at this present time as the foundation?
     
    Last edited: Jun 15, 2009
  6. pgcarter

    pgcarter Well-Known Member

    Re: understanding of root mechanics makes it easier to understand todays theories

    I spent 6 years teaching undergrads at Latrobe in Melbourne about orthoses design and fabrication and making links between function, biomechanics and patient assessment. I used to take some advice form Craig Payne and follow the content of his lectures, but found it very useful to talk in terms of a set of paradigms (multiple lenses) through which to view human gait function. We began with an older book called "Human Walking" Rose and Gamble? I think it was, the memory is hazy. Root stuff was presented as a historical perspective that was an early effort at a "unified field theory" of gait and still had some merit from a clinical perspective.We covered tissue stress, sagital plane, Kevin Kirbys' ideas, the basic physics behind orthoses design features. A real stew pot full of ideas seasoned with a bit of clinical experience which appeared to mature over time into a set of tools to use in a clinical setting.
    regards Phill Carter
     
  7. Re: understanding of root mechanics makes it easier to understand todays theories

    Why confuse them with the inconsistencies of subtalar joint neutral theory in the first place?! Here is what you should teach podiatry students:

    1) teach them the basics of physics and biomechanics, including terminology;
    2) teach them the foot and lower extremity segments and what normal and abnormal alignment of these foot and lower extremity segments should look like;
    3) teach them normal and abnormal walking and running kinematics and gait examination techniques;
    4) teach them the concepts of subtalar joint axis location and its effects on the kinetics of gait and the production of injury;
    5) teach the concepts of rotational equilibrium in each joint of the foot and lower extremity to allow them to grasp the concepts of tissue stress theory, orthosis therapy, injury production and how foot orthoses/braces mechanically heal injuries, prevent injuries, and optimize gait function;
    6) teach them the function of each muscle, each set of ligaments/fascia and each joint of the foot and lower extremity during weightbearing activity, and
    7) teach them the most common mechanically-based injuries of the foot and lower extremity, what abnormal forces/moments are responsible for the injury and how to reduce those abnormal forces/moments to heal the injury.

    This partial list of teaching tasks should allow the average podiatry student to function quite well clinically without needing to confuse them initially with subtalar joint neutral biomechanics as advocated by Root and colleagues. However, I would think that including Root theory as a historical lesson may be helpful for them, but should not be dogmatically taught to students as the only theory of foot function/orthosis therapy (like the way we all were taught biomechanics at the California College of Podiatric Medicine in that Root theory was the only theory and only way to make "correct" foot orthoses, with anyone questioning Root theory being viewed as a heretic).
     
  8. gez

    gez Member

    Re: understanding of root mechanics makes it easier to understand todays theories

    I was taught Root biomechanics at university as being correct. This was only five years ago. We were taught subtalar joint axis location, tissue stress and sagital blockade theory in one two hour lecture entitled "the alternative paradigm"

    It has taken me five years post graduate reading (much on this web site) to get up to speed on current thinking and theories.

    I agree with Kevin, Root biomechanics should be taught as a history lesson. More empasis should be put on learning ideas like SALRE and the diagnosis and treatment techinques that accompany this idea.
    I cannot see the point in teaching something as a "foundation" which is now widely regarded as being incorrect. A poor foundation does not make for a strong building.
     
  9. Re: understanding of root mechanics makes it easier to understand todays theories

    say we take the Midtarsal joint.

    If we teach the one axis theory Nester et al are we heading down the same road at Root mechanics.

    Research says that there is movement between the cuboid and navicular and therefore 2 axis is exact science. So should we teach about the Navicular and Cuboid Midtarsal joint axis even though there is no clinical detection method of the 2 axis.

    Michael Weber
     
  10. Re: understanding of root mechanics makes it easier to understand todays theories

    In a word, yes. In a few more words, students need to be empowered as critical thinkers, as this is what will ultimately help them to be useful clinicians. I used to discuss Nester's research along with various other models of the midfoot, but I also used to discuss the most sophisticated research on these joints and highlight the ideas and concepts of "modelling". In fact, when I'm invited to speak these days, I usually end up talking about this.
     
  11. Re: understanding of root mechanics makes it easier to understand todays theories


    Michael:

    I think you are missing the important points of Nester's work. Nester showed that one midtarsal joint axis can only be used to describe the motions of two segments relative to each other and that two midtarsal joint axes cannot exist simultaneously to describe the movement of the same two segments. Nester also showed that the midtarsal joint is a moving axis (not fixed in space as Root et al claimed) and made the important biomechanical point that motion determines the axis, not that the axis determines the motion. We need to teach our students the best knowledge that is available. I do agree with you that students should be taught that the every foot joint has a moving axis but that we have no way of detecting these motions accurately in some cases, unless pins are embedded into the bones.

    One of the real problems is that many individuals that teach podiatric biomechanics are not up to date on the latest theories probably since learning something new would mean making extra effort. In addition, since these individuals would need to spend more time making up new lectures, they tend to want to lecture on the same material year after year.
     
  12. Re: understanding of root mechanics makes it easier to understand todays theories

    I guess thats the problem that Ive been getting at with some of my posts with out comming out and saying it. Been playing devils advocate to see what response there is out there on PA.

    Will spend summer digesting a little more of Nester et al work.

    Glad Midsommer. ( happy summer solstice ) A Swedish and other nordic countrys tradition which means you spend the day drinking, eating while the sun does not set( if your north enough) and you get to dance around a midsommer tree to hope for a good crop in the fields.

    ahh new traditions when you move countries

    Michael Weber
     
  13. pgcarter

    pgcarter Well-Known Member

    Re: understanding of root mechanics makes it easier to understand todays theories

    Each successive generation has a different set of ideas and word useage, we have all discussed and thought about trying to get widely accepted definitions of terms and now we are moving into the more complex sphere of discussing whole paradigms and their relative merits and clinical usefulness. No two witnesses at a trial ever say the same thing about even simple events, so our chances of actually accepting one version of such complex ideas is pretty slim. If we say the Root Neutral concepts are a thing of the past, and no longer correct, I would question our ability to define "normal" just as strongly. I am sure there is a spectrum of normalcy into which many of us fit, but who has drawn the boundaries? and where are they? or should we just accept one persons version in the same way that for many years Roots version was widely accepted?
    regards Phill Carter
     
  14. pgcarter

    pgcarter Well-Known Member

    Re: understanding of root mechanics makes it easier to understand todays theories

    As far as teaching goes, when I was studying and teaching I used to think that by the time anything actually made it into a text book it was already history, and that in a clinical profession things are always evolving faster than people can write, edit and publish texts, and that students can barely afford them anyway. This does not mean that this form of informational history should not be taught. I've always believed that what we are trying to teach is "clinical perspective", an amorphous ambiguous (spelling?) idea that is in fact really difficult to teach. The new practitioner does need to understand where the older ones have been and are evolving from, and the profession needs some degree of continuity and consistentcy, in Australia at least I believe we suffer PR problems stemming from the rapid evolution of training and sphere of practice. I am not suggesting we should hang onto ideas and practices that have been shown to be just plain wrong.
    regards
    Phill Carter
     
  15. Lawrence Bevan

    Lawrence Bevan Active Member

    Re: understanding of root mechanics makes it easier to understand todays theories

    I totally agree with everything on Kevin's list for undergrads.

    One devil's advocate question though: In the brave new post-Root world, what would be the preferred casting technique and what position would the foot be in ?
     
    Last edited: Jun 18, 2009
  16. Re: understanding of root mechanics makes it easier to understand todays theories

    It would vary, depending upon the individual, their presenting problem and the "goals" of the orthosis to be produced from it. Pretty much as some of us already do.;)
     
  17. Re: understanding of root mechanics makes it easier to understand todays theories


    Lawrence:

    I like the Root supine neutral position suspension casting process as a basis by which to further modify the shape of the foot during the casting process and as a method by which to better achieve the goals of foot orthosis therapy for my patients (as Dr. Spooner also mentioned). During negative casting of the foot, I may lower the medial longitudinal arch (MLA) of the foot, I may raise the MLA, and/or I may put the foot into either subtalar joint neutral or somewhere around the neutral position depending on what I am trying to accomplish with the orthosis.

    I was taught that there was only "one way" to properly cast the foot to get a "functional foot orthosis" while I was being indoctrinated in Root theory at the California College of Podiatric Medicine. That is a myopic approach and even seems silly to me now 29 years later. As experts in foot orthosis therapy, we should be modifying our negative casting process to achieve the optimum mechanical effects from our custom foot orthoses for our patients....not casting all the feet of all our patients in the same position regardless of the pathology and the peculiar lower extremity function of each of our patients.

    As an aside, I don't care much for foam-box "casting" since the foam-box method seems to slightly widen the heel cup shape of the foot and doesn't allow me to visualize the all-important plantar aspect of the foot while the casting process is being performed. In addition, contrary to what a few self-promoting podiatrists believe, maximizing the height of the MLA in foot orthoses is not the panacea for all foot problems. Very few feet needs to be supinated excessively in order to achieve optimum gait function and symptom resolution.
     
    Last edited: Jun 18, 2009
  18. Lawrence Bevan

    Lawrence Bevan Active Member

    Re: understanding of root mechanics makes it easier to understand todays theories

    I only ask because the OP was suggesting that Root et al theorems provided a backdrop to other concepts and thus grounded students.

    Kevin posted a list of more preferential things to be educating undergrads and this makes total sense. However I thought this would make a paradox when it comes to the moment of casting with the inevitable question "why do you do it that way?" i.e. what is STJ neutral and why are you using it?

    Can we describe the default casting process without using the phrase "neutral position"?

    How about :

    1 grasp the 5th digit.
    2 orientate the 5th digit so that it is in line with 5th metatrsal.
    3 using 5th digit dorsiflex/abduct the 5th ray to resistance.
    4 using the 5th digit/loaded 5th ray move the foot through it's range of motion until the lateral border of the foot is straight, where possible.
    5 hold position until plaster/STS sock set.

    Pointless semantics?

    The "neutral position" with the MTJ "locked" is a good casting position - it invaribly makes a comfortable, effective orthotic. If you have ever supinated the MTJ during a cast you will know the reason for trying not do so!

    But we also know that the theories used to describe why this cast is good are not correct, that the MTJ doesnt lock, the "neutral" position isnt exactly that. However when it comes to casting we still take "neutral" position casts!



    L
     
  19. Re: understanding of root mechanics makes it easier to understand todays theories

    Lawrence:

    I never said get rid of the concept of the subtalar joint neutral position or get rid of neutral position casting technique. For clinical purposes, these are good ideas and should still be taught. I have always said that I didn't agree with all of Root et al's theories on orthosis therapy or their theories on foot function, but did like their subtalar joint neutral casting technique as the preferred method to begin to show students how to make good impressions of the feet for custom foot orthoses.
     
  20. Cameron

    Cameron Well-Known Member

    Re: understanding of root mechanics makes it easier to understand todays theories

    Michael

    Good question. It is difficult to not include Root et als work in the current curriculum simply because the whole concept of foot orthoses is based upon the stjn position.

    As an academic I always had issue with courses which upheld the teaching of first principles and inductive thinking yet would present podiatric biomechanics (a la California circ 70s) as sacrosanct. Cognitively this would be analogous and the juxtaposition would suggest a weak academic program. To be fare vocational degrees do walk a tight rope between theory and practical aspects of the job so the pattern is not uncommon in many similar degrees.

    Personally when I was responsible for teaching biomechanics I started with gait analysis and fact schemata relating to kinematics, kinesiology, anatomy and anthropometrics. Only later when required to train students in foot orthotic manufacture did I introduce the theories surrounding the stjn paradigm and foot function.

    In summary my approach was to teach what I could prove first then develop into problem solving based on contemporary theory.

    what say you?
    toeslayer
     
  21. Re: understanding of root mechanics makes it easier to understand todays theories

    For myself I think it was harder for me to grasp the systemic approach to biomechanics having been taught Root. Took quite a bit of "deprogramming".

    I think this is more a critique of how we learn / are taught than the Root paradigm itself. The model has much to recommend it when taught as a model. However all too often it is taught as dogma, something I'm certain its founders never intended.

    If we learn of foot mechanics, forces, tissue stresses, anatomy and such like FIRST and are only then taught of the models (including Root) we are in a position to as Simon put it "critically evaluate the contemporary theories of podiatric biomechanics". However all too often students, and I count myself as one of these, are taught Root as Dogma and then told to critically analyse it without having been given the tools with which to do this!

    I had a student with me recently who expressed this very frustration. Root was taught as true, then smugly critiqued as inaccurate. The result was a confused student who wanted to know what the RIGHT answer was.

    So, if we take "todays theories" to be the rather more free form systematic approach which rides on the back of an understanding of mechanics and bears on its shoulders the assorted paradigms then my answer to the OP would be resoundingly NO. Its like being taught to make a loaf of bread then expected to know how to grow wheat. Far better to learn the principles which underpin ALL the models THEN go ahead and study those models.

    That said I would still put Rootian biomechanics first on the list of paradigms to learn after the mechanical grounding has been laid. Rootian biomechanics is a wonderful cart, but not if it is placed before the horses.

    Regards
    Robert
     
  22. Re: understanding of root mechanics makes it easier to understand todays theories

    Robert:

    Regarding your suggestion for putting "Rootian Biomechanics" first on your list, how many of Root's eight biophysical criteria for normalcy do you agree with? In addition, how would you explain, using Root biomechanics, why a lengthening osteotomy of the calcaneus (a Young procedure) would cause a decrease in pronated position of the foot? Also do also agree with Root biomechanics that most foot orthoses should be balanced with the heel vertical??
     
  23. Re: understanding of root mechanics makes it easier to understand todays theories

    Biophysical criteria for normalcy = 0. I think the "treasure" in Root is within the idea of holding the STJ in neutral. Root suggested we could "hold" the subtalar joint in neutral with our orthoses. This is not true and not a good idea either. However, if we can limit the excursion of the subtalar joint so that it functions more closely around the neutral position and reduce the extremes of excusion, this should limit the medial and/ or lateral deviation the STJ axis and reduce the peak pronation and/ or supination moments about it. If tissue stress theory holds water, this should be a good thing= zone of optimal stress (ZOOS) :cool:

    Perhaps this is why neutral position casting prevails...
     
  24. Re: understanding of root mechanics makes it easier to understand todays theories

    I think that Root's idea that there must be a position within the range of motion of the subtalar joint (STJ) that he called "neutral position" was really the brilliant idea. I have a problem with his tautological definition of "neither pronated nor supinated", but I think Mert Root really did the best he could to bring order to the relative chaos within podiatric orthopedics/biomechanics during his earlier years.

    It would have been wiser for Root to define the STJ neutral position simply as the position within the subtalar joint (STJ) range of motion from which there is twice as much supination range of motion as there is pronation range of motion, and left it at that. By the way, neither Root, Weed or Orien said it was OK to use talo-navicular joint (TNJ) congruency to determine STJ neutral position. TNJ congruency is someone else's idea of finding STJ neutral position since Root et al knew this was more a finding of midtarsal joint rotational position than STJ rotation position. This idea of TNJ congruency being STJ neutral probably started with Sheldon Langer, DPM, from Langer Labs, on the East Coast of the US when he lectured on casting throughout the country in the 1970s.

    We have such a better knowledge now of foot and foot orthosis function than Root and coworkers had, that it is hardly fair to criticize Root and coworkers too much for what little they had to work with, research-wise. I have a problem with those who continue to teach the innaccuracies of Root's theories without having given much thought to those ideas that challenge his theories or without having taken the time to read the recent research literature. My other problem is those who seek to make names and money for themselves by claiming that their orthoses are superior to all others because they use different casting methods or shape their orthoses differently using outdated architectural terminology. If Mert Root were alive today, I'm sure he would be much harder on these individuals than I have ever been.
     
  25. Re: understanding of root mechanics makes it easier to understand todays theories

    Simon:

    Root certainly advocated casting the foot in STJ neutral position, but also advocated balancing nearly all orthoses with the heel vertical, which meant balancing them close to the STJ maximally pronated position. How does that make sense??
     
  26. Re: understanding of root mechanics makes it easier to understand todays theories

    Dear Darth Kirby

    1. None. Or rather I think that the whole concept of normalcy is deeply flawed

    2. I couldn’t.

    3. Hmmm, this one is trickier. If you asked me whether most of MY foot orthotics are made this way then resoundingly no. However I consider the thousands of people making and issuing orthotics who do not have the inclination / time / ability / see the need to take the harder path of the "systematic" approach and I wonder if given the simplicity accessibility and success rate of doing them this way is this such a bad thing?

    Perhaps I'm mellowing

    I take your points. You know how I feel about the Root model in general. However my comment was not "which of the models is best", rather "which I would teach first." Therefore, to paraphrase you,

    1. Which model of foot function is most recognised outside of podiatry?

    2. Which model of foot function do you think the majority of the profession is using today?

    3. Which model of foot function has the most outcome studies to justify its use?

    4. Which of the significant models of foot function was developed first chronologically (Ok, Kapandji pipped Root by one year with the 3 arch model but I REALLY hate that one.)


    Regarding the neutral position, its fascinating that one of the most profound underpinnings of biomechanics has such different definitions! In particular the 2:1 ratio position which would mean the neutral position could change with tightening / loosening of soft tissue support structures. By this definition a TEV foot could have a neutral position massively inverted and foot with a surgically fused STJ (in any position) will be fused in neutral (again by definition). The "neither pronated nor supinated" definition is, as you say, tautological and therefore pretty much useless.

    As Simon has quoted Ole ben, "many of the truths we cling to depend on our point of view!"

    Regards
    Galen Marek
     
  27. Re: understanding of root mechanics makes it easier to understand todays theories

    The Young procedure for flatfoot lengthens the lateral calcaneus thus adducting the forefoot relative to the rearfoot which creates a greater amount of metatarsus adductus in the foot. This increases the STJ supination moment arm for the medial metatarsals and decreases the STJ pronation moment arm for the lateral metatarsals, with a net effect of increasing the external STJ supination moment from ground reaction force acting on the forefoot (Kirby KA: Subtalar joint axis location and rotational equilibrium theory of foot function. JAPMA, 91:465-488, 2001.) Root et al's theory did not account for this transverse plane effect of foot shape within their theory.
     
  28. Re: understanding of root mechanics makes it easier to understand todays theories

    Within the foot we still have a ´neutral´postion , but the hard thing for new students is to understand that it is individual and it´s called equilibrium/balance.

    As they can not detect it as Root ´neutral´makes it the challenge, which I beleive Root mechanics is still hanging in. Because if you really think about it having all feet working the same way goes against everyother medical science. Even identical twins are slightly different because of enviromental factors so why do we think the foot should be the same for 4 billion plus people.

    Anyway I was looking thru my old papers and came across this, does anyone remember the calculation method for STJ neutral.

    Total rom (inversion,eversion of calc ) /3 * 2 = inversion from neutral

    then to work out stj neutral would be Neutral STJ position = Calcaneal Inversion- Inversion from neutral.

    ie calc inversion 24 calc eversion 12 =total rom 36

    36/3 * 2 = 24

    stj neutral = 24 - 24
    equals 0

    Just though I would share

    Michael Weber
     
  29. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    The mindset of any theory or approach can block one to understanding any other theory or approach. We see it all the time here on Podiatry Arena.

    Its similar to a consverative never agreeing with a liberal on a whole range of issues. Its simply a matter of the 'conservative' or 'liberal' world view or "lens" that blocks understanding of the others point of view.

    The teaching and learning of clinical biomechanics and its clinical application has to be done in a way to avoid those mindset traps. It has to prepare the student to appreciate all sides, so they can be analytical in when confronted with new information, and not be blocked or dismissive of new information because of the mindset of the particular 'world view' or mindset that they have.

    Its a challenge to know what and how to teach the student to best prepare them for this. I wrestle with it a lot. At the Boot Camps, the first day is spent on what I call a systematic approach to assessment that draws on many theories and approaches (without being explicit as to the theory). The theory comes into it later on the 2nd day. However, it could be argued that the systematic approach I take, is nothing more than just another theory ....
     
  30. wes_d

    wes_d Welcome New Poster

    Hi guys!

    I'm new to this site and have spent hours reading with great interest. I am very keen to learn/understand current and new theories and their integration into practice. I am graduating next week, and although I have a passion for biomechanics, as a recent graduate I have found the numerous theories confusing to come up with a consistent paradigm for treating.

    I slipped into podiatry as a disenchanted chiropractic student, and as a sufferer from lumbar back pain, I saw a podiatrist who gave me orthotics which miraculously cured my pain and enabled me to continue distance running pain free, convincing me podiatry is the way forward. The orthotics I had assumed my foot in stjt neutral, and I feel much more stable with better posture, thus I can see the root theory works, as taught in university. I have bilateral pes planus and a non existent MLA, and when walking bear foot I feel out of "alignment", at a undergraduate level the root theory makes sense, a limb in neutral seems mechanically efficient compared to a limb overpronating. Author's also report that 70% of the population overpronate and this is normal. I have read the work on the tissue stress theory by Mcpoil and Hunt and other articles on the theory, at uni. we were enlightened with bits of other theories, but predominantly taught root.

    I found it more confusing when on placement, different podiatrists would use different theories and practices, and some would criticise others, no-one had a universal theory or treatment protocol, everyone was different - more confusion. I always had difficulty understanding root, as the foot is a dynamic structure passing through stjt neutral so why would you want to fix the foot in that position, but the alternatives seem to be confusing. I have read some of Valmassey, Michaud, Root and other articles in search of the definitive answer. The tissue stress theory makes sense in the studies on PF for example, but for lower back pain etc I find the integration into clinical practice hard to understand.

    I have read about the Precision Intricast Newsletter Books, they sound great but volume one is out of stock, I was wondering what advice you would give and what you did as new graduates? I am striving to understand and be able to treat biomechanical problems in the best manner possible, but find a lot of the theories conflicting.

    Great site by the way and an invaluable source I feel, I look forward to reading in the future.

    Sorry for the long post,

    Kind regards,

    Wes
     
  31. Griff

    Griff Moderator

    Hi Wes,

    Don't worry about finding a definitive answer - its not that there is a right and wrong. Its many theories all of which have parts people like and people dislike. By no means do you have to pick one and subscribe to only that - most of us tend to use a bit of a mix of paradigms depending on what makes sense to us or what patient is sitting infront of us at the time

    Read, read and read more. Come on here on a daily basis. Read all the legendary articles from Kevin Kirby, Eric Fuller, Craig Payne, Simon Spooner, Howard Dananberg etc etc. Get yourself on as many courses as possible (do not miss the boot camp). Talk to as many colleagues as possible. Be willing to not know the answers. Have fun.

    Ian
     
  32. Wes:

    You can have access to nearly all of my papers at http://www.box.net/shared/z9vvdj6lt8

    Even though my first book is not currently available, my second and third books are currently available.

    Good luck with your reading and be sure to ask questions here on Podiatry Arena if you need help. I wish that I had a resource like Podiatry Arena when I was a podiatry student.
     
  33. Hi Wes,

    here is my advice for you as a new grad the learning really begins....

    read

    question what you read

    read some more


    try some treatment options on friends and patients



    think about results

    think again

    read again

    always keep an open mind every patient is different even if they have the same symptoms

    Michael Weber
     
  34. wes_d

    wes_d Welcome New Poster

    Hi guys,

    Thanks for the advice! I have been reading lots, I have a couple Biomechanics summer school folders that I am reading which is providing very useful, and I will definitely attend in the future.

    I have also ordered volume II of the newsletters, so look forward to reading those!

    I am starting to get a feel for it, I think an open mind and avoiding a dogmatic approach which is so often the case is the way forward!

    Many Thanks,

    Wes
     
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