Dennis, on another thread, raised a valid and interesting question.
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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.
Regards
Robert
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Simon Posted in reply
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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:-
UCBLs
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...
Regards
Robert -
Robert:
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!
:craig:
"He who is firmly seated in authority soon learns to think security, and not progress, the highest lesson of statecraft". James Russell Lowell
Dennis -
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
Orthoses prescription variables
As for casting Simons got that Covered
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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
Regards
Robert
I mean, c'mon. Its Amercian but it IS gorgeous
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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... -
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.
Thanks,
Nick -
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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.
Thanks,
Nick -
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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.
NickLast edited: Jan 7, 2010 -
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.
Regards
Robert -
:drinks -
P.P.S. Please define: "a pure straight up Root protocol casted orthotic" -
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.
Agreed
How much evidence is "so much evidence"?
Some ;).
:drinks[/QUOTE]
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.
:drinks
Robert -
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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:Attached Files:
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Oh yeah!!!! My new civic hybrid got 40 miles to the gallon on a recent trip. It does corners too.
Regards,
Eric -
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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. -
http://www.youtube.com/watch?v=5B-nU2qj580
For Simon. Enjoy!
Happy New Year! -
Please note both cars American- both cars being driven in a straight line :morning::D -
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! -
For Graham,
Like I said, it got to be German. Here's a bug that wipes the floor with your RAM's 1/4 mile time:
http://www.youtube.com/watch?v=qNXP...60CBE8B6&index=74&playnext=2&playnext_from=PL
Gene Berg used to burn the V8 muscle with a flat 4 -
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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 -
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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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