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Wellness Biomechanics vs SALRE

Discussion in 'Biomechanics, Sports and Foot orthoses' started by drsha, Sep 21, 2012.

  1. drsha

    drsha Banned

    Members do not see these Ads. Sign Up.
    This was posted by Dr Sha, Eric Fuller and David Wedemeyer on another thread that and was too off thread so I thought I would start a new thread to allow the other to go back on subject.

    Originally Posted by drsha

    Eric:Doesn’t this mean that if some feet have medially positioned STJ Axes and some feet have laterally positioned Axes that SALRE plays no importance clinically when working with “High Arched Feet”?

    So every patient with a medial STJ Axis gets a medial skive and every patient with a lateral STJ Axis gets a lateral heel skive? Very reductionist and cookbook, kinda like FFTing?

    We need to define “High Arched Feet”. Are they possessing a high navicular sag or FPI? Do they have a high arched profile for the Wet Test?

    Or possibly, are you referring to their STJ Neutral position which is in varus (inverted)?

    In either case, I am wondering if you are considering the forefoot pillar when making your rearfoot posting position skives?

    Dr. Wedemeyer helps explain the SALRE concept of why some high arched feet are frontal plane pronated and some frontal plane supinated. (if he is talking about the same “High Arched Feet as you are Eric, if not, please re-define states:
    Please, either Eric or David, show us an x-ray of a high arched foot with a medially deviated STJ Axis from your records which I am sure you both have taken in practice.

    My interpretation is that David is trying to state is that those feet with an inverted or supinated rearfoot on the frontal plane when attached to a pronated forefoot on the sagittal plane (the rigid forefoot FFT’s) maintain a lateral subtalar joint axis on the frontal plane and that other rearfeet with an inverted or supinated rearfoot on the frontall plane are attached to a supinated forefoot on the sagittal plane (the flexible forefoot FFT’s) and that this forefoot type perverts the STJ Axis of their otherwise high arches medially on the sagittal plane into collapse.

    These medially deviated STJ Axis feet are not high arched, they are in fact collapsed because of their forefoot pathology that SALRE pays no attention to.

    They respond better to sagittal plane correction of the rearfoot and forefoot supination obviating the need for rearfoot frontal plane skiving.

    Because FFTing examines both the rearfoot and the forefoot to determine pronatory/supinatory pathology and not just the reartfoot as in SALRE,
    The rigid rearfoot/rigid forefoot functional foot types have a laterally displaced STJ Axis and the Rigid rearfoot/Flexible forefoot functional fopot types have a more medially displaced STJ Axis depending on the level of rigidity and flexibility on a patient to patient basis (a practitioner of biomechanics is needed here to make that decision using EBM, experience and foundational training).

    The STJ Axis just like the STJ Neutral is moot, the functional foot typing is diagnostic and provides a direction and location for clinical care.

    Yes it does, due to SERM-PERM testing.
    In response, how does SALRE translate to the foot on the ground in weightbearing, or STJ Neutral, or MASS or fill in the blanks________?

    Functional Foot Typing, like Root STJ Neutral or SALRE are open chain parts of an exam that must include a stance and gait eval in closed chain conducted by a biomechanically oriented practitioner.

    The foot centering pads (the middle of my three patented points…..functional foot typing, foot centering pads, foot centering orthotics)) are tested and adjusted in closed chain. Then the FFT and closed chain information is applied to the casting and prescribing of the foot centering, one patient at a time.

  2. Zac

    Zac Active Member

    Why are we here again? Surely Dennis you know your theories are not accepted by many/most here & they have been discussed ad nauseum. Why go through this again. Why not find a board/blog where you can discuss your theories with people who are supportive/interested. I mean that genuinely - why come back knowing that what you write will be so heavily challenged & nothing changes ie. you continue to believe your theory, most others here believe something different.
  3. drsha

    drsha Banned


    With regards to this thread, what do you believe?

    Are you not interested in critiques of what you believe or only in rejecting the thoughts of non believers that challenge you? I thought you were scientists?

    Are there high arched feet with a medially deviated STJ Axis?

    Please slow me just one on x-ray.

    On the aside:

    The most telling thing about your post is when you state:

    I am interested in learning from your challenges which is what has happened to me for three wonderful years now as I participate on The Arena.

    I learn little from those who yes me to death.

  4. Yes, Dennis.
  5. J.R. Dobbs

    J.R. Dobbs Active Member

    Yes, Dennis
  6. Zac

    Zac Active Member

    Dennis, my post was a genuine comment about why write exactly the same things I have seen you write for years, knowing you will get exactly the same response. I do think it is good to come on here & present different ideas & challenge & be prepared to be challenged. I think that is very healthy & helpful. But the response from people (with FAR more knowledge than I) has not changed. I don't think they are closed minded people, they just do not accept your theories & that doesn't appear to have changed at all.

    And yeh, it was nice to be thanked, but only because I think it highlights what I'm saying.
  7. Zac:

    You are amazing!....you have hit the all-time record for Podiatry Arena of 15 "thanks" in less than a 48 hour period!! You must have said something that everyone agrees with!;)
  8. drsha

    drsha Banned

    Your post was well appreciated and replied to.

    Please ponder, from the nil, the possibility that, other than the opinion of the same small group that do not represent all members of The Arena (as stated by Dr Kirby) that "do not accept my theories", you have never offered me any evidence to get me to change my course. To the contrary, more evidence is surfacing that seems to verify Foot Centering.

    All who visit The Arena know what would happen if they came forward and opined that anything that I penned here had some value. Does Oblivion come to mind? I remember when Robert was demonized as a Dennis Lover.

    I have asked the group to reveal its evidence (December will be upon us in a few months to see what evidence you have produced in 2012) and you have provided poorly constructed, weak and low level products that force you to maintain an agenda that sends those who offer opposing views to oblivion before actually investigating them.

    Let's use a foot typing analogy.

    The world is flat vs. world is arched (round) in the 1400's.

    We know where the gold standard, poorly evidenced opinion stood. At the edge of a flat world that they promoted as if evidenced and we know how they treated dissenters.

    Where would we be today if the vaulted scientists that theorized a round world fell prey to their bullied attempts to quiet them?

    “The ideal country in a flat world is the one with no natural resources, because countries with no natural resources tend to dig inside themselves. They try to tap the energy, entrepreneurship, creativity, and intelligence of their own people-men and women-rather than drill an oil well.”
    ― Thomas L. Friedman, The World is Flat: A Brief History of the Twenty-First Century

  9. David Wedemeyer

    David Wedemeyer Well-Known Member

    Dennis 17 thanks to Zac' post says a lot. In this case it is you, not us. Attack SALRE all you like but keep in mind it is not the only method the majority of us use to determine what modifications we will use for a particular patient. You need to reread Kevin's seminal paper on the STJ axis and rotational equilibrium and quit attacking it just because it is Kevin's work. Zac's post is proof others see right through you. You don't want to learn, you want to preach and comparing yourself to the great scientists of the past is comical and arrogant.
  10. I AM a Dennis lover. I wish I had even half your tenacity, your entrepreneurial instinct, your imagination or your self belief. I truly do!

    But I just can't see your theories as being even Internally consistent, and debating with you is a lot like pushing treacle uphill with a fork. On a hot day. Wearing boxing gloves. In the rain. With a live stoat in your trousers.

    And it is ground we've gone over so many times. The definition of insanity is to do the same things and expect a different result. That's why you get no takers for a debate any longer Dennis, it's all been done before.

    The tragedy here is that there is probably some value to theconcept of foot typeing as a pragmatic system for those who lack the knowledge or inclination for anything more profound. On this basis I could be persuaded to see a role for it. But all the time you promote it as the acme of biomechanical excellence, one cannot take it seriously.

    It's a lot like comparing KFC to a Michelin star resteraunt. I LOVE kfc. It's convenient, quick, tasty and does the job (much as fft I suspect). But to Market it as better than scallops fried in olive oil with proscueto crudo and served with sweet potato and a lemon dressing is just never going to work!

    There are more biomechanical kfc consumers than foodies, why not shoot for that Market?
    Last edited: Sep 23, 2012
  11. drsha

    drsha Banned


    After much has been said as diversions from the title of this thread.

    1. Can we define "high arched feet"?

    2. If SALRE has "high arched feet" with either a laterally or medially deviated STJ Axis and I must assume since somewhere between the two is normal or optimal, some feet with a normal or optimal STJ Axis, what clinical use or need is there for measuring or considering ones STJ Axis when it comes to high arched feet?

    3. Does the same lateral-normal-medial STJ Axis range exist for "flat feet"?

    Can anyone show us an x-ray of a high arched foot with s flexible forefoot and a medially deviated rearfoot as described by Eric and David? My experience with these patients is that their feet are less then high arched and I need to be convinced that Eric's high arched foot exists in reality and not just in his mind.

    No promotions, foot typing or centering, no profit motive to my questions.

    In response to your opinion that compares me and KFC, SALRE, for me, just doesn't make much internal sense.
    yet you keep repeating it and TS and.... over and over again.
    Debating with you is a lot like pushing treacle uphill with a fork. On a hot day. Wearing boxing gloves. In the rain. With a live stoat in my trousers.

    The tragedy here is that there is great value to Evidence Based Biomechanics if only it existed to the level of excellence that you aspire it. But it doesn't.
    On the pretense that aspiring for it equates with it existing, you have yourselves positioned as the judges of what is the "Acme of Biomechanical Excellence" here on The Arena by your own invention and incestuous validation and without the validation of all of us who eat at KFC's.

    Maybe we are both serving middle of the road comfort food and neither of us is cooking up gourmet or fast food or maybe, if we work together, we can open up a great restaurant that everyone can imitate to the delight of all until the evidence surfaces and we can go gourmet?

  12. 1. No. It will only ever be relative.

    2. SALRE offers no "if X then Y" because as has been said many times before, its not a treatment protocol, its a model. It also involves no normal or optimal positions, the closest is an "average". But thats not the same as optimal. You might treat people with different sizes of lumbar brace based on their height, but you wouldn't call anyone normal or optimal height.

    3. One of the areas I disagree (respectfully but profoundly) with Kevin is that I think "flat feet" should be dumped from our lexicon as being far too vague. But that aside I suspect there is probably a correlation between a more medial than average axial position and feet with lower than average arch profiles. But I've seen feet with very low arches and very lateral axes.

    What a horrible thought, Only one restaurant? Nonono!! There has to be a place for both. With my conciliators hat on we may have to accept that not everyone has time or inclination to cook Gourmet, and you may have to accept that some people don't like KFC. My example was carefully chosen, I never said that one was better than the other.
  13. RobinP

    RobinP Well-Known Member

    What you are stating in your point 2 above is where you are not talking on the same level as the people with whom you disagree. It is a fundamentally flawed statement.

    Why does there have to be an optimal?

    Why is it so difficult to accept that sub talar joint axis is just an imaginary line that is different at every instantaneous point within the gait cycle?

    Why do you seem to conveniently not understand that SALRE is a concept that allows the practitioner to use mechanical principles

    Why do you constantly compare your prescriptive functional foot typing theory with the non prescriptive concept of SALRE. They do not need to be compared. They share very little common ground and can exist exclusively of each other

    We all understand this. You want a black and white answer when there simply isn't one. There is no great conspiracy here
  14. drsha

    drsha Banned

  15. RobinP

    RobinP Well-Known Member

    Dennis, you could not have answered with a more devastatingly perfect demonstration of exactly what I am talking about. Here's a clue. The fundamental flaw in your thinking is the word optimal.

    Just as a point of note, I was never taught Root mechanics. I, despite reading several times still do not get why one would use foot typing, particularly your brand of it and SALRE is not something I am hugely bothered about in open chain, other than as a theoretical concept to explain to patients
  16. David Smith

    David Smith Well-Known Member


    Your query and quest for optimal position is illogical. It is like asking where is the optimal place for a bus to be on its route and then stating, with a superior air, that my higher ideal searches for that place.

    That place doesn't exist except in a given circumstance and at a particular time of interest i.e. like when your waiting for the No. 36 bus to arrive as scheduled at your stop at 7.45 then that is the optimal place for it to be at that time for the circumstances described.

    There is an optimal route but it is not fixed either e.g. that might be the shortest route between all the stops but on the other hand it might be quicker and easier and less of a nuisance to others for it to use the road. other examples are available on request:empathy:

    regards Dave
  17. drsha

    drsha Banned

    Could you please explain why?

    Optimal is used in the biomechanics literature in many, many ways.

    Optimal Correction for Scoliosis
    Optimization of skeletal configuration: Studies of scoliosis correction biomechanics
    Optimal fixation.
    Optimal ROM.
    Optimal Posture
    Optimal Functional Performance for Golf and other sports.
    Optimal Operating Range
    Optimal flight in ski-jumping.
    Optimal car driver's seat and optimal driver's spinal model.
    Optimal Stroking Style in Swimming
    Biomechanical modeling and Optimal control of human posture
    The Biomechanics of an Overarm Throwing Task: a Simulation Model Examination of Optimal Timing of Muscle Activations
    Static optimal estimation of joint accelerations for inverse dynamics problem solution
    Musculoskeletal parameters of muscles crossing the shoulder and elbow and the effect of sarcomere length sample size on estimation of optimal muscle length
    Cadence and exercise: physiological and biomechanical determinants of optimal cadences--practical applications

    to mention a few.

    What is flawed with aspiring to or approaching an optimal custom casting position for orthotic shells to replace the fictitious STJ Axis or Root's STJ Neutral Position other than you printing it?

  18. David Smith

    David Smith Well-Known Member

    And further to this, what Robin is trying to point out to you is that if you think that there is an optimal position for bus to be on its route then fair enough. But you can't then say that it is wrong to theorise that the best place for a bus to be is at the right place at the right time because it doesn't describe and agree on a single optimum place to be all of the time. The two ideas are mutually exclusive, one can't be used to disprove the other. Its like saying my recipe for jam is is the best and your recipe for custard is no good because it makes rubbish jam.

    Regards Dave Smith
  19. drsha

    drsha Banned

    Correct me if I am wrong Dave but in EBM, we are sitting in front of a patient with specific needs that deliver unanswerable questions that need to be addressed by us as best as we can, correct?

    The patient you describe is waiting for the No 36 bus (obese), to arrive as scheduled (wants to run marathons) at 7:45 (has underlying foot type-specific biomechanical pathology and one leg shorter than the other) and wants to know the optimal place for it to be (wants his/her heel pain to end) at the time for the circumstances described (wants the best functional life, performance and fitness I can offer).

    If there is an optimal route, I will continue to spend my life looking for it for that patient.

    The excuses you make to me (and your patients I assume) for seeking a method to replace your current one which doesn't acknowledge that there may be (is) an optimal route for the No 36 bus for your patient will lead your transportation system to be in well debated shambles.

  20. David Smith

    David Smith Well-Known Member

    Dennis I feel that I must correct your since your wrong, if my patient had a penny farthing with EBM headlights and was short of a pound then his picnic would be less one pork pie and I would definentely search with all my effort and expertise to sort out the optimal pickle route for his perambulation biomechanically.

    If you excuse a method of wrong doing just to optimise you peripheral routes then that's up to you but for me there is no EBM there at all and I don't acknowledge your method of sub optimal posturing as architectural or structural without any evidence to back it up at all biomechanically or EBM Vaulted over the moon Neoterically speaking.

    Good luck Dave Smith
  21. drsha

    drsha Banned

    I have no problem with your opinion of Wellness Biomechanics.

    Now what is your opinion of SALRE?

  22. efuller

    efuller MVP

    Why do you think that there is one optimal position? Why can't there be a range of optimal positions?

    The answer to that question lies in the definition of optimal. What task is it optimal for? Which anatomical structure are you trying to optimize? The most optimal position for the fifth metatarsal may be horrible for the first metatarsal. Dennis if you are looking for the optimal position, you should define what optimal is. What criteria would you use for optimal. Is it the best position to get a picture of the skin lines on the bottom of the hallux?

    I'll bet each of those optimal things has a definition. Best stroke in swimming would make the swimmer move the fastest. Best ski jump would be where the jumper goes the farthest.

    Do you want to put the foot in the best position to prevent plantar fasciitis even if the patient doesn't have plantar fasciitis? etc.

    The assumption that casting the foot in a position will put the foot in that position when the patient stands on the orthotic made from that cast.

  23. efuller

    efuller MVP

  24. RobinP

    RobinP Well-Known Member

    Optimal is subject specific. I didn't read through the whole list above - I got the jist - safe to say that they will all be limited to the subject which they discuss. For example, optimal ROM will be quite different for the joints of an Olympic gymnast than it will be for average Joe

    Dennis, you can aspire to cast someone in an "optimal "position all you want. Bear in mind, however that you cannot maintain this alignment in weight bearing ambulation even on a flat surface, never mind differing terrains, footwear and demands on musculature.

    You also seem to make the assumption that providers of foot orthoses must
    1. take casts to make foot orthoses
    2. rely on some ill defined position in which they always cast in order to fabricate an orthoses

    I do neither of these and I know that there are a great many on here who feel the same. Again, you can aspire to these things. I don't really care but I would question why you have a need to find an optimal alignment

    Imagine for one moment that you know know nothing about STJ neutral theory, SALRE and foot typing. Also imagine that you have an injury of some description. Now, imagine that you have a friend who also has an injury but it is sore in a different place. What is logical about making an orthosis to treat both injuries that is based on a single, predefined "optimal" position. If I saw a doctor who did this, I would be seriously worried
    Last edited: Sep 26, 2012
  25. drsha

    drsha Banned

    I have right here on The Arena and elsewhere.
    1. Optimal functional position is the position that a foot is in the day that bone growth has ended unless there has been Juvenile Tie Beam Expansion.
    2. Optimal functional position is the momentary position that I can put a patients foot in as they live their lives that make inhibited muscle engines trainable.

    But none of them could respond to your ad nauseum demands for a definition that you are comfortable with or one that supports your beliefs and dictums TOTALLY!

    Summarily, none of them are definable as you ask. Each of these "optimals" are dynamic and you would fall on your face making the same demands of their "optimals" as you are doing here.
    The swimmer when taught his/her best stroke would become a better performer and would then be capable of developing a new best stroke.

    You, Eric, want optimal to be everlasting when I am looking to change it with ORF's and MERF's and an optimally positioned shell.

    That means that you just don't understand that the human body is capable of being stressed in a manner that leads to improvement or "correction. The tissues are stressed with moments that cause the affected structures to strengthen, lengthen, contract or weaken in a positive manner due to TS.

    In the same way that TS can produce symptoms, it can produce positive change.

    Summarily, TS, when harvested positively is the mechanism that the body uses to get stronger, perform and prevent symptomatology from developing.
    This TS should and could be fostered

    TS when allowed to cross the pain, deformity, degeneration and overuse thresholds produce the symptoms that you wait for with your hands tied behind your back.

    Which is a more logical progression?

    I use TS for the good of mankind, you use it to treat symptoms even if it promotes further problems (applying pronatory RF moments to treat medial knee pain is bad for most feet).

    In effect yes but I am not practicing symptomatically as you do.

    You are treating and thinking chief complaint pathology specific and I am thinking foot type pathology specific.
    For each patient, the presenting complaint in TS terms is the weakest link in the postural chain. Treating that will only promote the next weakest link to fail if you don't treat the natal biomechanical pathology. That starts with a foot typing of some kind until you show me a better way. I am treating the precursors that if and when you admit to doing, destroy your theories.
    You make an orthotic for a chief complaint, I make an orthotic for life.

    Isn't that the assumption we all make when castiing. You and I both. Are you saying that we don;t need to cast?
    You are really losing me here, groping at "straws man".

    Which is more logical.
    Allowing the foot to degenerate and collapse and then cast that collapsed foot in STJ Neutral or SALRE neutral?
    Trying to put that collapsed foot in a less collapsed position to try to prevent future symptoms or improve perfomrance or quality of life as a practitione rof biomechanics?

    Wellness vs Get Sickness or Get More Sickness?

    Simmarily, TS theory for symptoms, for me is the tip of its useful iceberg, TS for correcting underlying biomechanical faults is the iceberg I have trademarked as Wellness Biomechanics.

    How do you compare that to SALRE, the topic of the thread?


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