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What is a "Normal" Foot?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kevin Kirby, Apr 1, 2015.

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    For those interested, Podiatry Today Magazine has just published an article I wrote titled What is a "Normal" Foot?
  2. Rob Kidd

    Rob Kidd Well-Known Member

    Kevin, I have read your short and concise article. In my opinion, you are entirely correct.
  3. drhunt1

    drhunt1 Well-Known Member

    Robb-How is Kevin correct? Do "normal" feet make their way into our offices? Unless they have an ingrown toenail or verruca, probably not. If Kevin is suggesting that some one, or some institution gets a grant to access the general population for a robust, tedious and time consuming study, than I'm all for it. But to suggest that Podiatry data bases be collectively accumulated in order to determine normal doesn't seem like a good approach. Further, one Podiatrists' abnormal may be another one's WNL...so it depends on the viewpoint of the observer, which, at this point, seems to be more subjective than any of us want to admit.

    Like I wrote before on another thread...we don't even have serial radiographs of any one individual patient from 1 year of age through adulthood....no one has taken the time to accumulate that data base which would be quite germane to this topic.
  4. Rob Kidd

    Rob Kidd Well-Known Member

    Let us leave toe nails and warts on one side. And anyhow - toe nail problems are much more common in abnormally functioning feet - but you knew that.

    The issues seem to be these. Firstly, and it has to be said, the Root et all criteria for normality (normalcy is not a word that I use) was laughable at two levels. First, it was ridiculously tight in its parameters. Second, it ignored biology. Kevin mentions certain blood results with a spread of values being considered to be normal - very likely these will follow a normal distribution with nearly all values - perhaps nearly 99%, being within 3 standard deviations of the mean. I know that the proselytisers of the Root normal will run our now and saying it was "ideal" or something similar - but is no evidence at all to support this.

    Second, medicine is not an exact science - actually the whole of biology is not an exact science - evolution buggers it up. One has to accept a human element in the answer to "what is normal?". To use an example from Kevin's letter, if a patient has only 7' of ankle dorsiflexion, yet seems to function normally in respect of any observation that we can make: who the hell are we to say that it is abnormal?

    Yes one can refer to a set of tables as to what is normal, but they will not quote you am isolated value - they will quote a range, between which (if one assumes a normal distribution), nearly 99% of persons should fit. I try not to get personal in any post - but if you looked at my blood chemistry results - questions would be asked about how is is that I am alive at all. And then one has to move into the human side of medicine - normal for whom? This always needs to be addressed, but an isolated value does not come within cooee of it. Maybe that result is normal for them.....................

    Essentially, that describes why I agreed with Kevin's article. If you follow my rants, you will know that I am not scared of disagreeing with anyone - but when was does agree, one should say so. Rob
  5. If you log on to the Podiatry Today website (on the bottom right of this site), there is an interesting poll which asks the following question: Are Root biomechanical theories outdated and in need of replacement?

    Interesting results so far in the poll....
  6. drhunt1

    drhunt1 Well-Known Member

    Robb-if Root had suggested, (or Dr. Weed, whom attempted to teach me biomechanics), that his theory was complete with no further room for growth or expansion, then I would agree with you. But they didn't, did they? I completely understand that science is "a work in progress" and medicine continues to prove former researchers and scientists wrong. What the FDA did to the egg industry in their assault on exogenous sources of cholesterol was criminal, and it wasn't until Dr. Atkins proved them wrong that the FDA finally narrowed the food group pyramid...something that was part of society's learning for over one hundred years. But if one only understood basic biochemistry and the effects of insulin on beta-oxidation, gluconeogenesis,etc., we could've avoided distributing misinformation decade before.

    And that's my point about Root's THEORY....it is a baseline of formation that should be expanded upon, not replaced. Perhaps the real solution to distributing this baseline is simplifying this information for students and practitioners...making the subject easier to understand. This is where I believe animation has a real place in our field. One of the problems as I see it, is the inability of doctors...many doctors to visualize concepts in 3D. But once they see it, it becomes a lot easier to comprehend. Another problem as I see it, is the "dinosaur-like" manner by which we disseminate our information. Conduits for this process are in analog formats, while the rest of the world is light years ahead in digital. Hopefully, there will be a move away from traditional analog formats towards faster, easier and better digital solutions...this will, no doubt, improve our understanding by expediting the process of learning.
  7. Rob Kidd

    Rob Kidd Well-Known Member

    It is late and I am tired. We are halfway to The Flinders Ranges for a couple of weeks R&R. I read your response a while back, and thought to do nothing. Tonight I re-read it; my thoughts are that of a geocentric universe and the response to science by the Catholic Church....................... My advice is to go back to scientific method - modify or chuck out?
  8. Josh Burns, PhD, was one of the keynote speakers at the PAC/PFOLA conference in Vancouver this weekend and gave some great lectures.

    Josh and I got to catch up since it had been awhile (i.e. Chicago PFOLA meeting in December 2006) since I had last seen and spoke with him. I told him about this article I just had published on "What is a Normal Foot?" and, after he read it, he said he agreed with my opinions I expressed in the article. In fact, I was delighted to hear that he has already spearheaded an effort to produce a normative database of reference structural and functional foot and lower extremity variables based out of University of Sydney called the 1,000 Norms Project. You all need to look at this thing that Josh is doing. It's one of the most exciting things I've heard about in some time. Great job Josh!!


    I'm going to see if I can get Josh to comment on his ongoing efforts to truly change the way we look at the foot and lower extremity by the scientific process of gathering data from healthy individuals to determine what type of foot and lower extremity structure and function truly is "normal".... and what is not...at all ages.

    Here's Josh, myself, Freeman Churchill, Jeff Root and Daryl Phillips all enjoying the view of Vancouver Harbour at last night's social event for the PAC/PFOLA conference.
  9. Rob Kidd

    Rob Kidd Well-Known Member

    As you know Kevin, I rarely if ever get personal on arena. However, Josh took a degree conversion course with us in Sydney in the late 1990's. Like all these events, education brings about a permanent change in behaviour. Josh has moved on a huge distance from that I first knew - and bloody good on 'im! A phrase comes to mind - it is a very poor apprentice that cannot surpass the master. I was not his master, but that still applies.
  10. Jeff Root

    Jeff Root Well-Known Member

    All or some of Root's biomechanical theories? Not a well constructed question. I would agree that some of Root's theories are outdated, but certainly not all. Root's structural classification system, casting technique and many aspects of Root biomechanics are a central part of modern day biomechanics. Last week I reviewed Kevin and Eric's chapter in Albert's book and there are a lot of Root related concepts involved.

  11. For those interested, here is a pdf copy of my article recently published in Podiatry Today, "What is a Normal Foot?"
  12. Josh Burns

    Josh Burns Active Member

    1000 Norms Project

    A deeper understanding of human variation is essential. The 1000 Norms Project is a ground-breaking research project currently generating great national and international interest. It involves measuring a range of strength, flexibility, alignment and physical performance indicators of 1000 healthy people aged 3-100 years. An initiative of leading researchers at The University of Sydney, the aim of the Project is to improve our understanding of the physical capabilities of the healthy population across the entire lifespan.

    For those interested, I will be discussing this Project at the Pint of Science festival on the 18th of May in Sydney, Australia: http://pintofscience.com.au/event/mind-syd-mon/


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