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What do you use besides Root protocol?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Robertisaacs, Jan 7, 2010.

  1. Members do not see these Ads. Sign Up.
    Dennis, on another thread, raised a valid and interesting question.

    When someone comes up with a new idea they tend, directly or indirectly, rightly or wrongly, to compare it to Root / Langer standard protocol.

    Such folk are often accused, again rightly or wrongly, of attacking a straw man in the sense of "the car I designed is better than the model T Ford you are driving so it must be time you upgraded" (when nobody is actually in model T fords any longer.)

    So Dennis asks, not unreasonably,

    Fair Question. So, bearing in mind that Root protocol covers assessment as well as prescription, what do YOU use which is NOT Rootian / Langerian.

  2. Simon Posted in reply

  3. Since the position in which the foot is cast is only a small part of what goes toward making the insole I would add:-

    Cast modifications
    1st met depression / cutout, anything from clipping the corner to a full J cut.
    PF Groove
    Varied amounts of arch fill / removal / medial expansion / medial reduction
    Medial heel skives (of course)
    Heel spur cavities

    Insole variation.
    Root calls for a 2/3rds length poly prop (or similar) shell with variable amounts of posting / wedging. In addition I routinely use:-

    Mortons / reverse mortons extensions.
    Gait plates
    High / low medial flanges
    EVA Shank dependant
    EVA Partially shank dependant
    Varied densities of EVA
    Plasterzote over EVA laminates
    "simple" insoles (which are sometimes flippin' complicated!)
    Striker mods.
    Therrox shells (sort of a cross between EVA and polyprop)
    Varied top covers for increased or decreased friction

    That is off the top of my head. I personally tend to find that using materials like EVA and Therrox allow me to make insoles with higher flanges and heel cups and less arch fill on the cast (and thus closer shaping to the cast contour) without the complications of irritation.

    However the most fundamental area in which my practice deviates from Root Canon is in the assessment. Being for the most part a "tissue stress" thinker my prescription starts with the Diagnoses and associated mechanics and works from there, rather than toward a "normal" value or formula. For example, if we have two patients, one a 7 stone pensioner and the other a 20 stone warehouse worker doing 20 hour shifts, both present with Plantar Fasciitis and are biometrically identical in terms of RSCP, NSCP, Forefoot / rearfoot relationship etc, A Root protocol will have them treated the same. Not being so constrained I will provide a hugely different prescription for each.

    And on...

  4. drsha

    drsha Banned

    While I do agree with most of the language you utilized to start this thread, I feel that you used an unacceptable amount of poetic license when defining those of us making foot orthotics when you state:

    "the car I designed is better than the model T Ford you are driving so it must be time you upgraded" (when nobody is actually in model T fords any longer.)

    The foot orthotic industry and most of the dispensers of foot orthotics are not only in model T's, they are claiming that their model T's are model 2010 7 series BMW's!
    "He who is firmly seated in authority soon learns to think security, and not progress, the highest lesson of statecraft". James Russell Lowell

  5. While Robert and Dennis go at it with their baggage from battles gone past. Simon started some orthotic prescription variable discussions in the orthotic consen project thread.

    Here what I wrote

    There is 2 post it one so if it seems a bit messy sorry.

    Orthoses prescription variables

    As for casting Simons got that Covered

    But should impression taking for orthotic be included and therefore form box and Foot scanning should be included.
  6. Sorry about the poetry. I am a whimsicle soul.

    I guess the question of whether we are in Model T's or BMW 7 series (i'd have gone for a 2009 Ford Mustang or Aston martin Vanquish myself but each to their own) can only be answered based on how fast it goes, or to put it another way, success rates.

    That, however, is not the point. The point is that you don't know WHAT we're all driving. Perhaps our bmw's are akin to the model T in performance, perhaps not. But given that we're all in different cars one can't really compare the new vehicle with the model T alone.

    In fact, given the lack of performance data for the vast majority of our vehicles, one can't properly compare ANY of them. Which is why to say that the new car is better than ALL others will never be a supportable statement.

    However, I digress, and have spilled allegory all over the thread. What say you to the methods other than root that Simon and I have put forward?

    Oh and regarding
    I'm afraid that not having time or inclination to justify themselves to you does not mean they are Avid fans of neutral suspension casting. But if anyone wants to come on and say they only ever use Root technique you can consider that a vote for your side of the debate!

    I mean, c'mon. Its Amercian but it IS gorgeous
  7. American = doesn't go round corners a develops the same BHP from a 6 litre that the Germans get out of 1.8 litre:dizzy:. Give me an Audi R8 (V10) any day.

    Attached Files:

  8. I overtook one of those on the a249 last week. It IS a pretty car and will do corners.

    Bit... Teutonic though. I'll take my chances with the American muscle mentalness.

    Makes a nicer noise as well. And runs on barn owls as well as petrol.

    Unless you were being metaphorical...
  9. N.Knight

    N.Knight Active Member

    I can't understand the why it is so important to use a neutral cast non wt bearing, when as soon as the foot wt bears it changes completely, yes I cast, use the foam box method most semi wt bearing.

    I am a recent UK grad, I understand that Root et al work was pinnacle at the time (I was not even born for another 8-10 years), times progress we progress, new theories are made, I think the ting to remember is that every pt is a person and a certain degree deformity does not need a certain wedge. Yes I still sue root form time to time, but not all time, I like to keep my options open and open to new idea to improve my knowledge. I am still learning it all.

    In clinic, I try and keep my orthotics as simple as possible.


  10. Jeff, this pod must be a right pain in the arse! ;) Spell checker might be the way forward, Nick.
  11. That'll be the point then.:morning:
  12. N.Knight

    N.Knight Active Member

    Hi Simon,

    I did type it in word, the mistake didn't show as there was no spelling error. I proof read my post before posting, I hate using my dyslexia as a excuse, however when I read back I always miss stuff like that, most common is does and dose. I have a programm on my pc to help, however I am on my laptop at present.


  13. My heart bleeds.
  14. N.Knight

    N.Knight Active Member

    I can see where you are coming from with regards to software and money it is a waste of money and far too much of tax payer’s money spent, I never asked for anything just took what was offered to me and what I believe would help. Sometimes yes it is me been lazy, however everything I post on here I proof read and type in word, I apologies for any grammar errors made. It is only me that is makes look bad at the end of the day.

    Last edited: Jan 7, 2010
  15. Not so bad as those who don't post at all in my book! Takes guts for a new grad to join in :drinks.

    Lost me there. What's the point of what now?

    I think its a valid point. Not wanting to drag it back to the old foam vs POP debate but a non WB neutral cast bears little resemblance to the cast uses to make the orthotic. Needs medial expansion, lateral expansion, arch fill...

    Lets be honest they get pretty homogenised at the "cast correction" stage.

    Perhaps that's why we have so much evidence that a pure straight up Root protocol casted orthotic does not attenuate symptoms significantly better than a pre fab. One of the "pearls of wisdom" on the thread of the same name was that the orthotic shell is only the frame upon which the prescription is then applied. I think there is some truth there.

  16. The point is that using a Rootian protocol, the idea is to capture the foot in it's "uncompensated" position, hence it is performed in neutral non-weightbearing. The assumption of the weightbearing cast being that the foot doesn't change position from that which it has been captured in during the course of a step? The point being that using a non-weightbearing technique it is easier to manipulate the foot into the positions you desire than trying to fight against a weightbearing foot.

    The assumption being that the weightbearing cast is better, Robert? I've recently reviewed a paper for JAPMA which is of significance to this discussion- but unfortunately, I can't discuss it yet. At what point during gait does the foot morphology best correlate with the weightbearing cast? Are you adding/ removing any plaster on the weightbearing positive cast? How do you manipulate medial / lateral longitudinal arch height and forefoot to rearfoot relationships on a weightbearing positive? How do you achieve intrinsic forefoot/ rearfoot posting on your weightbearing casts?

    "You can't get there from here"- REM. Comparatives between pre-fabs and Root devices has nothing to do with weightbearing devices versus Root protocol, Robert. Is there any evidence that Root protocol casted orthotics do "attenuate symptoms significantly better than a pre fab"? Moreover, is there any evidence that weightbearing casted orthoses do "attenuate symptoms" significantly better than a Root protocol orthoses? How much evidence is "so much evidence"?

  17. P.S. What studies are you referring to here?

    P.P.S. Please define: "a pure straight up Root protocol casted orthotic"
  18. The assumption being that the "uncompensated" position is better? Is the foot designed to work best "uncompensated"?

    Course not. The foot has no single "position" during gait. Which raises the question of whether we should be shooting for any of the morphologies it adopts or indeed anything else. As you have educated me before, insoles don't hold, they push.

    I'll give you that. Balanced against which with a NWB the lab has to guess at the soft tissue spread.

    Hell no. Pro's and cons to both ways. Both can work and both can be borked.

    Flag it when it comes?

    I seldom (not never) use fully weight bearing casts but i'd guess just before heel life. Just a SWAG.

    You mean me personally? I rarely do plaster addition on a foam cast, preferring to directly modify the foam. I tend to find that using three pint pressure I can get the medial arch and FF RF where I want them without too much trouble. Lateral arch I tend to remove on the negative unless I specifically want one.

    How do you achieve intrinsic forefoot/ rearfoot posting on your weightbearing casts?

    Rearfoot intrinsic by modding the Positive. Forefoot by casting the forefoot inverted then pressing it down in the negative afterward.


    I don't know of any.

    How much evidence is "so much evidence"?

    Some ;).


    I think you misunderstand me. I'm not saying that WB or Semi WB performs better than non wb, nor that it is closer to some "magic shape". I'm asking how significant the precise morphology of the NWB cast is considering the amount of "correction" it goes through to get to the insole. And I'm not sure it matters any more. The "right!" shape is the one which exerts sufficient ORF in the right places to get symptom relief / improve function whilst still being tolerable to the patient. The morphology of the foot, in any position it is passes through during gait or into which we contort it, is IMVHO only a starting point to getting to this shape for the device.


  19. Historical assumption. Maybe though, if the zone of optimal stress for the STJ is around neutral, then trying to "hold it" near to that zone might be a good thing..

    So, do we need "casts" at all? Insoles are inert, they can't really "push" (pushing to me is an action) they can only react to the forces applied to them.

    Not if you measure it in-vivo and put it on the prescription form.

    Of course.
    When your heel comes to life;)? What position is the STJ likely to be in at this point?

    "Three pint pressure"? Would that be Robeer? Modifying foam- hmmm, you can only push down, not pull up. So you never remove plaster in the medial longitudinal arch?
    Lost me on the last bit.

    I don't misunderstand you, Robert. I'm just playing the game.
  20. Graham

    Graham RIP

    I'll stick to my 5.9l, 6cyl turbo diesel Dodge RAM 2500. Sports performance computer & chip. 950hp. This year the twin tubo's with straight pipes for a meagher 1700hp.

    You'll be "Rooted" to the spot as I leave you in my dust!:hammer:

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  21. efuller

    efuller MVP

    Oh yeah!!!! My new civic hybrid got 40 miles to the gallon on a recent trip. It does corners too.

  22. Eric, you just said that out-loud. Hybrids are something that gardeners do in green-houses.:D Can I take it from this that you're not a petrol head who has to wipe a tear from his eye every time he hears the sound of a big block V8?
  23. efuller

    efuller MVP

    No, I'm quite schizophrenic when it comes to cars. My other car is a Lexus GS 430 that our family inherited from my father in law. The only problem with it is that the v8 is too quiet.

    I enjoy the feeling of being pushed back into the seat in one car and I enjoy the gas mileage gauge hovering around 50 in the other car.
  24. Graham

    Graham RIP

  25. Yeah cool. I like the big cloud of black smoke coming out of the RAM! Yeah baby. No fair fight though -he running laughing gas.

    Please note both cars American- both cars being driven in a straight line :morning::D
  26. Graham

    Graham RIP

    The quarter mile originated from the British and French settlers. They wanted to race horses like they did in Europe but it was too dificult to clear the land for the mile oval. So they cleard a straight quarter mile. Thouroughbreds were too slow at this short sprint distance and hence the "American Quater Horse" was created.

    By the time the Yanks built an oval they changed to horse to a NASCAR. With their left hand drive they could only go around left corners!!!

    You still can't beet F1 or Lemonde for real racing though!
  27. Graham

    Graham RIP

    I agree. Audi A3 diesel is out next year in Canada. Then I'll retire the RAM to the drag strip. Once the warantee is off the Audi I'm sure we'll find some toys to plug in for a sweeter ride!
  28. Here a little Australian love for you From TopGear. The aussie ute and friends .

    Excuse whatever language thats put on the screen. Aussie ute top gear
  29. I'd strongly recommend the Audi S3 (I have one of these as my daily drive- I had to give up the Audi TT when Grace was born). This is my weekend fun bus:

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    • bus.jpg
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  30. To be fair there ain't NOTHING gonna go round corners at the moment! And my crapmobile can drift on snow with the best of em.

    Pull in, wait for the back to go out, opposite lock and hard on the accelerator. A moment of freedom and poetry!

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