MASS - Questions un-answered

Sorry Kevin, once again I disagree (up to a point at least). This has much to do with the point of this thread. Ed claims to be calibrating orthoses in terms of their stiffness characteristics. My contention is that any calibration he may be performing is completely inadequate to explain the complexities of the load/ deformation characteristics of foot orthosis during dynamic function. I think as this thread continues we will show why that is so (if we haven't already).

That said, I agree this valuable information might get lost in the archives due to the title of this thread. Craig can call it...

 

Keep the stuff here but let's add it also to a new thread..eh, Dr. Spooner?...I'm off to work and you probably have a few more minutes before sleepy time arrives?

 

Here's some more. This time we have a device loaded with real data. The device was a real "physical" orthosis and in-shoe pressure data was obtained from me walking on it. In the finite element software I partitioned the upper surface of the model into 6 equal areas and applied the loading obtained from the in-shoe work to the corresponding six areas of the model. The 1st image is at 15% of the contact phase, the second at 50%. It's not ultra-accurate and has it's limitations, but it gives you a rough idea of how things might change throughout gait.

 

Agreed.

 

Takes a very secure man to wear a shirt like that Simon

I have to say I was immensely impressed by those load deformation models. Very sexy.

Linked into this is a somewhat less pure question, WHY is your definition of orthosis stiffness.

From a pure science point of view, the FEA models which simon showed to those lucky, lucky Portugeuse folk are fantastic. One of the concerns I have with defining the whole shebang as "stiffness" is how that data is extrapolated / applied.

The "meh" factor for me with Ed's rig, is that as simon pointed out, it is very much "bench data". The calibration he uses is based (at least in part) on body weight. Body weight is not especially predictive of supination resistance. Thus we have a "sciency bit" which looks relevant, but which has been overextropolated.

I think we all agree that in vitro, there are lots of rather complex elements which affect how the orthotic works (including, but not limited to, those described). I look forward to seeing whatever Kevin and Simon have published, but my worry is that if the whole thing is reduced to a single concept of stiffness, that will be abused by people who have a a vested interest in such overextrapolation.

 

Good photo for your "publicity shot" though. With the obligatory dramatic black and white of course...

 

a) I fink you meant in-vivo, not in-glass as you said.
b) It won't be reduced to a single concept of stiffness, because geometry and friction are important too. And in the discussion of stiffness, you'll get pretty pictures like I've posted here, that show that it isn't a single stiffness.

Why do you think it is "over-extrapolation"? Can we even "over-extrapolate"? I think you just made that up Robeer.

I've asked already, how else do foot orthoses work mechanically other than altering stiffness, geometry or friction at the foots interface? If orthotics work by some other mechanical effect, then I'd be more than happy to include it in our paper? If you think it's not limited to those factors described, then please speak up. The only other ways I can think of that orthotics may work is psychologically or maybe thermally.

 

I'm all over that. E-mail please. I was actually formulating my ideas on zones of optimal leg stiffness (ZOOLS) in that photo.

 

Something to also consider would be effectitive stiffness .

EDIT
I guess I should explain what I´m thinking because it may seems a bit silly when thinking about where the discusion started.

A device stiffness is important to provide a reaction force to the foot, but it also can have a role in elastic energy return, so if we are to think only in terms of stiffness to react to the foot we are only looking at half of the effect of stiffness. I will say, I think because is a classic Mike statement - question

 

I could tell it was something like that. Or possibly serious digestive discomfort. You're rendition of johnny cash on the plane was heart rending.

But then most of the dramatic poses could easily be the toilet face.

 

Or come face? The frightening thing is that I do appear to be turning into my avatar.

 

Spent a couple of hours overnight thinking about this little guys thinking about showing his teeth. :morning:

Say we have 2 different devices .

1 shank dependent EVA

2 shank independent Poly

same stiffness.

Now what we have been discussing is the initial foot - orthotic interface collision and stiffness, geometry or friction, but in the poly device the geometry of the device may have a greater chance of changing if the downwards force from the foot changes ( increases). Now if this occurs due to the elastic nature of Poly we will have a rate on energy return greater than with the EVA device. (?)

and if the above statement is true what another factor in the way an orthotic works be the amount of elastic energy return .?:

 

Mike lets take your two devices and assume we are talking about a single point on their surfaces corresponding exactly on the two devices. Given that you state that the two devices are the same stiffness at this point, if we plot stress/ strain curves for the points with loading within the linear region then the curves will also be identical- right? The slope of the lines will be the stiffness (we already know that this is identical) and the area under the lines will equal the energy stored and again should be equal-right? So, your idea is based on the unloading characteristics and the hysteresis. Will the two devices show differences in their rates of unloading and hysteresis characteristics?

http://en.wikipedia.org/wiki/Hysteresis#Elastic_hysteresis

 

Ok I´ve never heard of hysteresis anyone else who has not heres some reading for you


http://en.wikipedia.org/wiki/Hysteresis

I guess it may depend on how much heat is produced by each device when under load as to the effects of hysteresis - I´m guess then poly may act more like the rubber band and not return to it´s original shape - buts thats a guess.

as for the rate of unloading which is where my idea from I believe the poly will unload faster and therefore return more energy.

 

Why? It's the same stiffness and had the same load applied? Go back to Hookes law.

 

http://en.wikipedia.org/wiki/Hooke's_law

right sorry I of all people should have thought of that :bang:

same spring stiffness, ( the 2 devices) same load on the device will return to the shape it began with at the same time if modeled as a linear spring.

 

Simon and all,
You know, I looked at this thread a while ago when Vern posted the video. I thought that the video answered Graham’s question perfectly so I didn’t look again.

I am glad that others are working on this.

Your criticism is that we are not good enough in our calibration…..agreed. We prototype, test evaluate and improve. To my knowledge we are the only orthotic lab in the world that actually makes an attempt to measure and correlate the amount of force passing through the orthotic with the amount of force that the orthotic offers the body in return.

That should be applauded as a pioneering move.

We are the Wright brothers of orthotic calibration. Of course there will be improvements….there have been on the airplane. We focused a passion to make people better into a very inventive way of getting a first approximation of the amount of resistance an orthotic should supply to resist postural collapse.

One problem that we have noticed is that the loading data is posturally dependant to a great extent. So if we are to accurately do what you are suggesting, then we would have to have the patient measured in MASS posture. So they simply have to get the orthotic before we make the orthotic. It will take some thinking to get that done.

In an ideal world we would have all of the loading data and we would all have access to Pro Engineer, do a complete FEA on every foot and be able to vary the thickness of the orthotic even during the gait cycle to have different effects at different times in the stance phase. Maybe that is the world of the future. I applaud you for trying to get there in one jump.

What we can gather in data on every orthotic is a simple force curve on the plastic.
Not perfect by any means. But if there is a mathematical correlation between the force curve of the orthotic and the correct calibration of that orthotic then it is very useful.

Compared to sticking two fingers under the arch and “measuring” supination resistance…I have no digital readout on my fingers….do you?

As far as your FEA measurements on rearfoot posting….it is what anyone would expect and we have gone beyond that many years ago. We decided, why have a stress riser produced by the end of the posting material?........ Yet more force needs to be applied under the sustentaculum tali to resist early postural collapse and hopefully reduce and delay pronation. We feather a second piece of plastic and heat meld it to the heel cup extending the feathered end of the plastic into the ascending MLA. This is done during fabrication to graduate a thickness (and thus a resitive force) into the arch. This also adds a wider, more stable heel surface without using a crepe material that compresses unevenly causing the heel to round and rock. This is one of the areas that orthoses are gently ground to achieve the calirated force curve.

One thing that we are attempting to determine with calibration is how does the plastic deform under load. Some orthoses deform more between the end of the heel post and the apex of the arch. Others deform more in the forfoot. Curvature has considerable effect on that. Getting an orthotic to flex right is also done in the calibration machine because it allows viewing of the deflection cycle in what appears like slow motion. Thus both a qualitative and quantitative assessment are made simultaneously.

As I have stated before, the warranty information we gather is critical. Specific defect codes....too flexible or too rigid data from warrantees are carefully recorded and analyzed monthly, since we give six months of free modifications and we pay the postage, we usually do see them. They are evenly divided between 0.4% too rigid and 0.4% too flexible. We account for this simply in tolerance. Some patients are the princess and the pea....others cowboy up, as they say in Wyoming.

We give people the very best technology has to offer while always continuing to improve, innovate and engineer better and better technology….but ONLY if it makes people better. This week has been nothing but a series of think tanks. New casting ideas, new reusable media, Point resolutions, milling, use of, and reduction of waste. New education tools. New marketing ideas to help our clients build huge biomechanical practices. Tech support knowledge trees. I have had the best week. That means I haven’t had time to contribute here but……priorities.

Lets see. Argue or Create. Create is more fun, healthier, and gets us from A to B faster….. I will occasionally post….If I read something like this, that sparks my interest.

Thanks,

Ed

 

The medial extension is certainly one of the variables in manufacture that we use.

The calibration is the sum of all the variables in one number. Not perfect, as Simon points out, but useful.

We can fault the Wright brothers for not coming up with the SST on the first try. They must have been idiots. There's no value to what they did. After all they lacked credentials....not a single person on their team had a college degree including them and they had NO peer reviewed published papers. Disregard flight....it must be totally wrong. It will never catch on. They had no right to innovate anyway.

Or did the Wright Brothers take the first pioneering step in the development of flight.

Our calibration is not perfect but we were the first to even try and it did work to a great extent. For all practical purposes we have succeeded and will continue to get better.

What about the variation between steps? Doesn't calibration have to be a magical thing that changes the resistance characteristics of the plastic dynamically and instantaneously, learning and predicting from previous steps. If you've got that, please put it on the market and see if it will fly. If you haven't then you have nothing.....that is the kind or argument you are making about our calibration. Can you produce dynamic FEA cost effectively? What is the cycle time on your FEA? Can it be placed in a manufacturing process...would it survive the environment? dust? etc.

MASS is a commercial success because of our client's experiences with their patients. We keep in close touch with each office that uses us. Each is assigned a Professional Relations Person who gets real time feedback on our product.

Beware, MASS is coming to your country and worldwide soon.

Ed

 

Well there goes another one.

I was really enjoying the discussion . Ed I think that you may have been able to add to the discussion but all you have done in make a infomercial for your product.

Ed I really do think that you could add some to the discussion if you come as a Podiatrist not a salesperson. You may even learn something, you may teach me something - but we will never know if you get the same Ive done this before, I´m better than you, we are the answer.

So this is a request be Ed the Podiatrist not Ed the saleperson might be good for everyone.

Have a nice weekend.

 

The simplicity of calibration is getting the orthotic to deliver a resistive force encourage a change in foot posture or plantar geometry.

In practical terms there is an upward and downward limit of usefulness.

If the orthotic is too weak, too flexible....then the patient reports that the orthotic has collapsed. In simple measurements of arch apex height there is a drop over a much shorter time than expected.

If the orthotic is too rigid. The patient complains of too much pressure in the arch. That is however deceptive. Because a much more common cause of the pain is either tight calf muscles, muscle firing patterns (Preferred Pathway of Nigg), or orthotic is simply too low in the arch. The repetitive impact as the foot drops down and smashes against the orthotic usually is to blame. We recommend a simple "Heel Raise Test" and an orthotic heat adjustment raising the arch to full contact....which usually solves the problem. Rarely, they are returned for re-calibration....but that is free.

So getting the Flex of the device between clinical limits is the goal here....and we do a pretty good job of that with our measurement technique.

Someday we will incorporate FEA data into our manufacturing.....we are moving in that direction...but it will be done in steps. Incorporating each improvement as we develop it. We are getting better and better.

Ed

 

Michael:

When I lectured in the same seminar with Ed a few weeks ago, I sat toward the back of the lecture hall with four podiatry students seated behind me. Toward the end of Ed's infomercial on Sole Supports and how great his company's orthoses were and how terrible all other orthosis company's orthoses were, I turned around to the podiatry students and asked them just one question: "What do you think of Dr. Glaser?" They all responded, "He sounds more like a salesman than a scientist." I gave them a big thumbs up on that short and succinct response and finally said, "That is all I wanted to hear from you students and is the only reason why I came all the way out here to Chicago to give my lectures."

So, Michael, even intelligent podiatry students can see right through Ed and his infomercials that he pays to give around the country on a weekly basis. Ed's only goal is to sell more Sole Support insoles, pad his own wallet, and try to gain some fame for himself and his rehashed century-old ideas by self-glorifying his lab and without actually doing any of the hard work that is required to get his own papers published in peer-reviewed journals.

All this is plainly evident by the discussions we have tried to have with Ed here on Podiatry Arena and which you have astutely noted in your posting.:drinks

 

Already going beyond the need for FEA and calibration. Kind of my Frank Whittle or Werner Von Braun to your Wright brothers, Ed. Don't worry, I am already working with some guys to put these concepts into the market soon.

 

I am using the resources I have, my company, Sole Supports, Inc. to gather data. I am explaining what we look at to make decisions. I am not selling anything. Simon is talking about what he is doing and measuring.....I am talking about what I am doing and measuring.

I am many things. A salesman is one of them. I want to sell the Podiatry profession on the idea that a change in posture is possible and that orthotic calibration is possible and in fact being done.....at Sole Supports. Yes, we make and offer a product that is calibrated. Not to Simon's standard. But to a clinical accuracy that is very effective for doctors to use.

All else is theoretical argument.....which is fine and dandy.....in the mean time we want to actually DO something, TEST something, Measure something, Improve something, manufacture something and yes...sell something which DOES MAKE PEOPLE BETTER.

Please, don't misunderstand, I encourage everyone to dream about better ways to do it. Gotta go...Christmas lunch at school with grandkids....and a patient to Make Better.

That works for me.
Ed

Unfortunately, since we are the only lab that does calibration at all, we are synonymous with the concept. I wish others were offering it. So, when we describe what we do it seems like an infomercial.....unavoidable.

 

to an air-filled bladder. And an air filled bladder isn't a foot, never will be. Ever.:santa2:

 

Hey Ed. Good to see you back on the thread. :drinks

Hmmm. I'm going to take issue with you there. For several reasons.

Based on the name of the MASS device, I think we can agree that we are talking about supinating the foot. Or exerting supination moment. Either way, supinating right?

Now the idea of having an orthotic which in some way correlates to the amount of force needed to have the desired effect (lets say, to supinate the foot), is not a new one.

This was written by Craig in 2003

We agree that this is an important concept.

But, how best to measure this? There must be two elements. How much force is needed to supinate the foot (how hard the foot pushes down to use your terminology) must be matched to the "stiffness" of the device.

Now I know a lot of podiatrists, myself included, who strive to get the "right" stiffness to match the desired force by qualatative estimate. But calibration is more than that. Calibration implies an accurate quantified and measureable value for each factor, which can then be combined.

From what I see, and correct me if I am wrong, you are using two things to measure the amount of force the foot will exert. Foot posture and weight.

However.

The supination resistance test measures how much force is needed to supinate the foot directly. And data in hand (see below) shows that the amount of force needed to supinate the foot, the amount of force the orthotic will be called upon to exert DOES NOT CORRELATE CLOSELY TO EITHER BODY WEIGHT OR FOOT POSTURE.

The airplane we are all trying to build (your analogy) is to match the stiffness of the orthotic to the amount of force we wish it to exert. Many of us are already doing this qualatatively. Your system does indeed make the leap to a quantifiable algorithm. However I would challenge you that based on the data presented in the study below that the algorithm is fatally flawed because the factors measured do not predict the variable in question, that is, how much force is needed to supinate the foot. The measurement of the other side of the equation, the stiffness of the device, is also flawed because a homogenous downforce across the whole surface of the device is in no way similar to a foot acting on an orthotic.

This, to me, is a lot like goniometry. It gives the illusion of science by using quantatative values. What is often overlooked is that this is only as valid as those values are accurate. And, to restate my primary point, the essential element here is supination resistance, not weight. To me, therefore, it has no more validity than a qualatative assessment of supination resistance correlated to a qualatative assessment of orthoses stiffness.

In which case your analogy of the wright brothers is a good one. Yes, it flew. But it was slow, cumbersome, dangerous and in general if you wanted to get from A to B you'd be better off using a horse! Your rig is a beginning. But it seems nowhere near sound enough (for the reasons above) to be used as a clinical tool!


Respectfully
Robert

Noakes H, Payne C :The Reliability of the Manual Supination Resistance Test. JAPMA 93:3, 2003

 

Good point, well made, Robert. This is one of the reasons I think "dynamic navicular stiffness" (DNS) is an important variable to begin to study. If we measure (ideally three-dimensionally, but failing that two-dimensional) displacement of the navicular during gait from the initiation of forefoot loading through to heel lift and map that to loading (lets say we map vertical navicular displacement to vertical loading using a pressure mat) we can plot a load/ deformation curve for the navicular and hence calculate dynamic navicular stiffness (DNS). We can then calculate the orthosis height and stiffness beneath the navicular that should be required to decelerate the navicular and orthosis to equilibrium over a specified distance and/ or time. Simples.

 

I've just written a not too dissimilar paragraph to this at the end of a piece of work I'm about to submit

 

You can't just go nicking my ideas, Ian. You better reference me in this thread. I hope that I at least get an acknowledgement in said paper?

 

Course you do - you know thats how I roll.

P.S. Naturally you said it far more articulately than I did...

 

Try this: "Spooner (2010) suggested that "dynamic navicular stiffness" (DNS) might be important in the design and manufacture of foot orthoses. That the displacement of the navicular during gait, from the initiation of forefoot loading through to heel lift, when plotted against the dynamic loading of the foot should provide a load/ deformation curve for the navicular and hence a measure of the dynamic navicular stiffness (DNS). It should then be possible to calculate the orthosis height and stiffness beneath the navicular that should be required to decelerate the navicular and orthosis to equilibrium over a specified distance and/ or time." You can quote me on that.

 

Awesome. I've just text you about it.

 

The criticism of the calibration is not whether you are good enough at it, but whether you are calibrating the right thing. Does whole orthotic calibration work for all feet?

Now I think I get a better understanding of the reason for your attack on SALRE. (You still haven't commented on my defense on the other thread.) SALRE explains why feet are different. The difficulty of resupinating the foot correlates with STJ axis position. Your methodology treats all feet as the same, but the amount of force required to change posture changes with STJ axis position. So, the supination resistance test is looking in the right place and that non digital read out provides better understanding and better information for making the orthotic than a digital readout of how much an orthotic deforms under equal pressure, in all locations, from a rubber bladder. It matters where the force is applied to the foot.

I like Simons comment about navicular stiffness. It's looking at where force is applied. Although medial heel cup stiffness/ force applied is important too.

So essentially you are making a plastic flat post. If you've looked at shoes that have had crepe rearfoot posted orthotics in them, there is a nice impression of the post in the shoe. They"re not rocking.

Ed, so it's the patients fault if they cannot tolerate standing on high arched devices? Is that what you tell practitioners when they call in saying that their patient can't tolerate MASS devices? So, if it hurts a patient more to wear your device than to use just a shoe, they should just use nothing?

Ed, you are missing out on some customers. If you incorporated SALRE into your thinking you could make more people better.

Eric

 

Thanks Eric. Just picking a point on the foot in my example above. We could say something similar for frontal plane eversion stiffness of the rearfoot, e.g., plot rearfoot eversion angle against loading, calculate rotational stiffness and the required frontal plane orthosis rearfoot angulation and counter stiffness in the orthosis from strike to heel off to obtain equilibrium at the desired point in space and time for this variable. But you obviously get the idea.

 

Simon:

I have a bit of a problem here with your terminology. You are not measuring the stiffness of the navicular bone, but are rather measuring the stiffness of the medial longitudinal arch at the navicular bone. There is a distinct difference and you may want to reconsider your terminology to make it more clear and less ambiguous. Why not "dynamic medial longitudinal arch stiffness"?

 

I take your point Kevin. I was thinking of it as an extension of dynamic navicular drop, which also could be argued to be measuring the displacement of the medial longitudinal arch at the navicular. I'm not precious about names so we can call it whatever seems most appropriate, it is the concept of the test that I am more interested in.:drinks

 

The IDEA of flight does not belong to the Wright Brothers.
They were the first to do it.

I am the first to produce a calibrated orthotic.

A “qualitative estimate” ….does that resemble a WAG.

Ok, I’ll correct you because you are wrong.

We use Body Weight, Forefoot flexibility, and Activity Level.
Postures of the foot and orthotic geometry both have effects.
Using these measured variables we study what works. We know certain variables in manufacture will change calibration readings. Then we asses defect codes to refine how we calibrate. For example, if defect codes for too Rigid increase we may shift the formula slightly. The really big reduction in overall stiffness warrantees occurred when we began to measure and gave up making qualitative estimates.
What other big lab is doing this? Please, let me know who is measuring except us?
I know what the warrantee rates will be in each stage of development of calibration. I lived it…..and am now enjoying very very low warrantees and returns. I think Guido LaPorta covered that in his video.

Putting two fingers under the arch and calling that a measurement…..makes this discussion silly. Criticizing an actual measurement I take on the orthotic and defending a finger pressure test in the same post….now that’s funny.
Actually the supination resistance test does correlate to posture.
Body weight alone as not enough ….. that is why we use three variables. I am sure that there are more, but we need to remain clinically practical.

What we do works. Warrantees dropped. We are a much larger experiment than Craig did in the lab. Ours is a real world clinical gigantic experiment in calibration…..that no one else is even attempting. We are looking down at you from the sky, sympathetic to your qualitative guesswork because we have been there and hey, you have to start somewhere. We have hard numbers to validate our approach. Do we want to give away all of our work to every lab in the world…not really. They should do their own work while we move onward.

If you don’t think that measuring something is a good idea, then keep guessing…..I mean, making qualitative estimates. In the mean time we will continue to develop better and better measurement tools.

I hope that someday someone will come out with something even better. I hope it is us…..we are certainly working on several innovations……like Postural Analysis which was released last month and will be released broadly in Jan.
It will replace the Gib test with a more accurate navicular differential derived mathematically from 3D data of the foot in MASS and RCSP Postures….and calculates an approximation of the % reduction of tension possible with that patient specific postural change.

I spent all day with one of our engineers prototyping and designing new technology for more accurate casting and calibration measurements……a project that has been ongoing for 14 yrs.

Boy, there is nothing more handy when doing research, than to have a plastics lab in your back pocket with a research director, gait lab, research assistants, engineers (biomedical, mechanical, 3D milling, Software, Optics, etc, etc,), a complete machine shop, automation, 3D printing, 3D animation, drafting design, milling, silicone molding, clinical expertise from DPM, PT, cPed and DC’s and to be working with brilliant Phd’s at several universities. Not to mention the software we make available to our engineers like Pro Engineer….. And then to have a TV studio with full time videographer is just amazing. But when you are doing the right thing for the right reasons, success is just a byproduct, a result, a pleasant side effect.

As is lots of FUN!!!

It is hard to compare that, to putting two fingers under the arch and pushing up.
But good luck with that. With a measurement of that accuracy…. I guess there is no real reason to measure anything else or collect data. You can just sit back and criticize what I am measuring…..and make believe that it does not work….when it obviously does.

Someday soon, you will have an opportunity to learn MASS Posture theory and practice and you may decide to try it…..then I suspect you will be singing a different tune. I should expand to England in 2011. Looking forward to a beer with you.
Ed

 

Now isn't that funny. That is exactly what we measure.....Dynamic MLA Stiffness. LOL

Ed

 

No, we have .8% that require re-calibration. So the system is not perfect…but getting better all the time.

So you are arguing that the consistency of your finger placement from foot to foot is so accurate that its qualitative “feeling” is better than digitally measuring how much an orthotic deforms under an evenly distributed load. What about different size fingers, strength of the practitioner, how deeply you place the fingers, the current friction cooeficient between the skin and the fingers, joint stiffness of the practitioner on that day, time of day, state of mind, etc. etc…..the machine has none of those concerns.

Look we tried finger tests and all kinds of hand tests. We had a calibration board early on that our grinders could use to compare with their own hand pressure…. And we had an 8% mis-calibration warrantee rate which reduced by 90% to 0.8% with measurement. I would have a hard time going back to using hand testing but you certainly can continue that.

Sorry, I haven’t read your defense.

The whole orthotic is important, and that is why we apply an even force.

Take them out of the shoe and put them on the table. That is like putting them in a different shoe. Ours can rock after a while too. It is because the medial anterior edge of the plastic, behind the first met, can dorsiflex over time and may need some heat adjustment to bring it back to the ground.

No one is talking about fault. We want to help the practitioner help the patient make the greatest postural change that they can accept. When a practitioner calls in and talks about patient tolerance of the device we have many options to offer. Stretching, slower break in, orthotic adjustment, recalibration and several other options are explored and ultimately the doctor decides what to recommend to their patient. If you are applying a corrective force, the patient will feel it, unless they are numb…..or you are not applying a corrective force, in which case they wasted their money.

I could not ask my clients to waste time drawing any ONE axis on the bottom of the foot, certainly not the STJ axis, and concern themselves with forces on either side of it. It adds nothing meaningful to the orthotic, the treatment, the evaluation, or the results. I tried early on incorporating mods but found them to be superfluous and often harmful. A soft met pad in some instances can be used temporarily to get the patient past the acute inflammatory phase but soon becomes a nuisance and must be removed.

Full contact MASS Posture calibrated orthoses is a better application of rotational equilibrium because it simultaneously takes into consideration all axes and a better re-distributor or plantar force ….. in other words, better at alleviating hot spots (tissue stresses) than flat orthotics with mods.

Whether you are looking through the lens of any ONE or ALL axes of the foot, or Tissue Stress redistribution……MASS Posture is a superior approach.

Ed

 

What? You have all physicians measure the kinematics and kinetics of the medial longitudinal arch of every patients foot that they cast to send to your lab? No. So were talking about something different here, Ed. Is it OK with you if talk about something unrelated to what you and your lab do? The world doesn't revolve around Ed Glaser and his lab despite his MASS.

 

Sure of that are you? What's the definition of "calibrated"? When did you produce your first "calibrated" orthotic?