Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

EBM and Sacketts Empiricism

Discussion in 'General Issues and Discussion Forum' started by drsha, Mar 25, 2010.

  1. God forbid!

    In my view, most religions have developed in order to give us just that - an ordered way of life - a moral code of conduct in which to live. Which is fine, of course, except that it is supported by a superstitious unsubstantiated theory that this code is overseen by an unseen, all-knowing, all-powerful diety who will pass judgement on us at the end of our life. Transgress this code - according to your own religious subscription - and you're doomed; subscribe to it and you will be saved. A simple carrot and stick principle. It could be argued that the construction of such a superstitious theory has merit - perhaps the human race needs an invisible, judgemental guardian otherwise we might descend into chaos and disorder. But equally, we can still subscribe to a moral code of conduct without the need to believe in something supernatural. Good morals and ethics are not the sole preserve of the believers! Perhaps when we have all been implanted with identity chips and the heavens are patrolled by an array of all-seeing satellites operated by some unknown operator with the power to terminate anyone who doesn't subscribe to the current political views and beliefs, God might just be able to apply for early retirement. But would that be real progress?? Until then, I think I might just prefer enlightenment....based on current evidence, of course!

    Anyhow, in the convention of offering supporting evidence, a quote from AC Grayling in a recent article.
    For me, I would wish people to live without superstition, to govern their lives with reason, and to conduct their relationships on reflective principles about what we owe one another as fellow voyagers through the human predicament – with kindness and generosity wherever possible, and justice always. None of this requires religion or the empty name of “god”. Indeed, once this detritus of our ignorant past has been cleared away, we might see more clearly the nature of good, and pursue it aright at last. Synonymous to what we would wish our colleagues would do with promoting the principles of good, effective EBM practice in podiatry and all other disciplines.
     
  2. Yes, I guess we do. And if the religious right would have their way we would further indoctrinate them by introducing the element of "intelligent design" into the biology curriculum. I think that that argument is exactly the same as the argument which says astrology ought to be taught alongside astronomy, or magic ought to be taught alongside modern medicine. It's just simply and utterly inappropriate. It's not part of the same story at all.

    There's no question that children, when they learn history, should learn something about the religious traditions of the past and the contributions they made and the problems they caused. They should certainly learn about these things and part of that of course would have all the many, many different methologies about the beginning of the world and how life was brought about on this planet.

    But that ought to be kept apart from serious science, which has a two-fold purpose. One, to communicate our best understanding of the world as it itself evolves; and the other, to teach disciplined teaching and inquiry and to encourage people to proportion their beliefs and the conclusions that they reach to the evidence that they have for them.

    And if you are going to introduce something like intelligent design into biology classes you're going to muddle those two things together, which is exactly of course what the proponents of intelligent design want and interfere with the process of a proper scientific education.

    Much in the same way as proponents and converts of the mystical podiatric theories would do with their own spurious philosophies. :empathy:
     
  3. David Smith

    David Smith Well-Known Member

    Simon

    I think that your question should be qualified by stating that in both cases all variables must be the same. I think then I already did answer that question earlier, i.e. - Hierarchy (or the level of acceptance) is based on risk and probability.

    Many axioms are generally accepted'truths' but the 'truth' often lies not in its own reality but rather in the level of acceptance by large groups of people or by smaller groups of people accepted as knowledgeable in that field.

    Example, 1) Almost everyone on earth (large group) would accept that the sun will rise tomorrow. There is very little risk in accepting this and the probability of the event occurring is very high based on past experience of billions of people over thousands of years.

    2) Only very few people have the mathematical ability to understand cosmology and the big bang theory and yet as a population, most of us in the world are prepared to base all of our beliefs in our existence on those few scientists and mathematicians theories.

    This may be because we understand the almost irrefutable logic of maths at the level we understand and so assume that maths is always infallible and logical and so therefore must be the mathematician and his theory. This is in fact a logical fallacy (Robert will correct me if I'm wrong in the detail here).

    Anyway we have to believe in some system or other, we cannot believe in nothing otherwise we are nothing ourselves. The probability that these few people are correct is quite low but the risk associated with accepting is also very low whereas the risk of refuting and not accepting these theories is very high, especially if you have nothing to replace it with - Enter Faith and theology.

    Therefore Axioms that have low risk in accepting and high probability of occurring are highest on the scale of hierarchy and those with low probability of occuring and high risk in accepting are lowest on the scale.

    Individual assessment of risk and probability is far less predictable than the corporate one, which is why individuals can be changeable and fickle and nonconformist but groups tend to be far more immutable in character, requiring huge forces of new opinion to change their direction of thought. The larger the group the larger the force required to change them.

    Great question Simon:drinks

    Cheers Dave
     
  4. David Smith

    David Smith Well-Known Member

    Mark

    You wrote
    I'd like to answer that in another thread entitled 'Morality:God Given or Human Invention' in the Break Room.

    Cheers Dave
     
  5. David Smith

    David Smith Well-Known Member

    Mark

    You wrote
    I'd like to answer that in another thread entitled 'Morality:God Given or Human Invention' in the Break Room.

    Cheers Dave
     
  6. drsha

    drsha Banned

    I'm back.

    and you guys and gals say that introducing foot typing takes the thread off the subject :bash::bash::bash: ??

    Robert Stated:
    Dennis, the reason you can't debate this stuff using standard terminology is that as the above statement, and may others you've made indicate (I liked the one about a momentary force) You don't understand it. What is to "not frontal plane pronate"? If an undergrad said that I'd go shout at their Professors.


    In his 2007 lecture entitled
    “Forces, Motion and Outcomes with Foot Orthoses and Running Shoes”, Professor Payne uses the following illustration to depict “rearfoot pronation”.



    If you look at the skin landmarks and the placement of the most plantarly placed marker, it is the misplaced marker and not closed chain RF Pronation on the frontal plane deforming the bare foot. There is actually little to no change in the rearfoot of these this right to left comparison by my eye.

    My opinion is that there is “no frontal plane pronation", no matter how you say it.

    I snidely add that if an undergrad showed me these pictures referring to a pronated foot, I’d shout at their professors. (and I'll stop when you do)

    Summarily, Robert, what are you trying to prove, semantically?

    Dennis
     

    Attached Files:

  7. If you could get some bigger markers and then place the calcaneal marker on the left foot a little more to the lateral side of the skin overlying the calcaneum, you can make this look even more dramatic. ****ing hell I've seen it all now. :bash::deadhorse::sinking:

    Don't even think I'm going to enter into this tripe with you Drennis, i just ****** myself laughing at the picture and couldn't help but post.

    I'm sure Craig, was making a point...
     
  8. drsha

    drsha Banned

    Simon:

    I just love when you talk Ph. D. talk.


    Dennis
     
  9. Well Dennise, when you get yours we'll be able to talk on the same level. Until such time you'll continue to express your jealousy of me in your posts and continue to talk crap.

    Enough said. Bye.
     
  10. Griff

    Griff Moderator

    Dennis, Dennis, Dennis. Swing and a miss I'm afraid fella.

    I'm sure Craig doesn't need me to fight his corner on this - but I actually attended that lecture in 2007 so felt compelled to correct you (I didn't see you there Dennis? Therefore I assume you took the slide from the PDF Craig loaded onto this arena - which I have attached for those who have not seen it).

    This lecture (like the biomechanics boot camps) starts by stating what the historical status quo has been, and then challenges it head on. As Simon correctly clocked - Craig was using this picture to simply make that point. Did that not occur to you when the prior slide was entitled 'Clinical Practice: Evidence based or commonly accepted wisdom'???
     

    Attached Files:

  11. PMSL at Simons post. Laughed tea out of my nose.

    As Ian pointed out Dennis I think you'll find Craig was using irony. But also as Ian pointed out I think he should speak for himself. Someone prod him with a sharp stick.

    Summarily, Dennis, I don't think you understand how the STJ works as a triplanar joint. You remember all that stuff with knitting needles and rubber feet at university. Axes and stuff?

    I've not got long, cos its late and I'm going to Bournmouth tomorrow to do a study day on Saturday, but in brief.

    Ignore, for a minute, the orientation of the axis in the transverse plane. Make it a biplanar joint.

    If the Axis was vertical (straight up) the joint would move entirely in the transverse plane (that is, side to side).

    If the axis was horizontal the joint would move entirely in the frontal plane (rolling around the axis).

    If the axis was at 45 degrees then there will be equal amounts frontal and transverse plane movement.

    Pronation is dorsiflexion (in the saggital plane) eversion (in the frontal plane) and abduction (in the transverse plane). The proportions of each movement depend on the location of the axis. But for this movement to have NO frontal plane component would require the axis to be vertical. Which it palpably isn't.

    Does that make sense?
     
  12. drsha

    drsha Banned

    Robert:

    Thank you for schooling me that the STJ is a triplane joint with an axis that ordinarily doesn't live on any of the pure body planes.

    I read Inman's treatise on "The Joints of the Ankle" published in 1976 six years after I graduated Podiatry College when I assume you were a teenager.

    Who do you think I am??

    I will reword my statement (for someone with blinders on like you et al) to frontal plane pathology is not the cause nor the area of treatment and the picture was selected not to deride the professor (but why don;t you expalin it anyhow Craig), it was simply to point out that the podiatry world is so fixed on STJ frontal plane pathology that it is perverted.

    Another question about the feet pictured:
    Where is the pathology in these feet and how would you treat it if not on the frontal plane of the STJ.
    (maybe on another thread?)

    Dennis
     
  13. Who do I think you are? Oh you tempt me.

    I think you are one of two things. Either you are profoundly ignorant of biomechanics or you are truly dreadful at expressing yourself, so that you APPEAR to be profoundly ignorant of biomechanics.

    Personally I suspect the former. But I could be wrong.

    You said

    This, to anyone who understands even a little about a triplanar stj, is palpably bull****. As I'm sure you agree. And it's also a completely different question to

    isn't it. If you say" there is no frontal plane pronation" how can you possibly expect anyone to know that what you MEAN is "frontal plane pathology is not the cause or area of treatment".

    I'm also guessing your next question is not what you actually mean. Because
    is impossible to answer from a phot of the heel. Could be gout. Could be an ingrown toenail. Could be a mortons neuroma. It's impossible to tell!

    Would you like to reword your illogical question so it makes sense?
     
  14. Robert:

    Do you ever feel like you are :deadhorse: or do you feel like you are :bang: in this discussion of yours?

    Ever want to just :craig: when trying to have an intellectual discussion with certain individuals on Podiatry Arena?

    Good luck, there is a solution for your ills! Do lots of :drinks and then immediately go to the gym and do some :boxing: until you see lots of :pigs: , and the discussion will then flow much more smoothly.
     
  15. Kevin, you always make me :D. You're like my very own :santa:
     
  16. drsha

    drsha Banned

    DITTO !!

    DrSha

    :drinks:deadhorse::bang::boxing::pigs:
     
  17. I see we have moved beyond the need for coherence again. In which case all I can say is "ice cream, due west, sodomy, cola, pineapple Brighton ASICS Lucy ."

    Go on Dennis. I'm itching to know what this persons pathology is. Perhaps look up the meaning of the word pathology first before you answer though to save me having to "school you" again.
     
  18. drsha

    drsha Banned

    Robert Stated:
    I see we have moved beyond the need for coherence again. In which case all I can say is "ice cream, due west, sodomy, cola, pineapple Brighton ASICS Lucy ."

    I found the answer on his website under Biomechanics.

    What are Orthotics

    Orthotics act a lot like eyeglasses. Precisely calibrated devices designed to correct any areas of pathological function and optimise the performance of your body. Like eyeglasses your prescription must be based on an accurate diagnosis of any pathology and an assessment of how your body functions. We do not use the "one size fits all" off the shelf devices many prescribe. Like the reading glasses you may see in the chemist or supermarket these are at best crude devices which may not suit your feet, shoes, or function. Sometimes they even make matters worse!

    Who are Footprints

    At Footprints, we use the latest in clinical diagnostic techniques and orthotic prescription technology. We are not limited to any single "type" of orthotic device, brand, or supplier. Every device is custom made by either spatial marking [/B](using a footprint), Biofoam casting (making an impression of the foot and casting an orthotic to that mould) or the very latest in Laser Scanning and direct milled orthotics. We don't use the same device for everyone because every foot is different. What we prescibe will be no more, and no less than you require!



    What Conditions Can be Treated with Orthotics




    There are many, many conditions which can be treated successfully with orthotics. Almost any pain within the foot, much of the pain which can afflict the joints and muscles of the legs. Often (though not always) back pain has its root in the position of the pelvis and that is much affected by the way we walk. Some have even claimed orthotics can help conditions even further up the body like neck pain and migraine although there is no clinical evidence to support this last!

    Please point out the evidence for the rest of your claims!


    Some of the conditions which orthotics can benefit include:-

    Arthritic or other pain in the Big Toe Joint (or anywhere in the feet)

    I utilized a footprint and the latest prescription technology to prescribe no more or less than what Lucy needed to treat the pain in her neck as well as the pain in her charcot foot cuboid osteomyelitis.

    If I'm selling snake oil and you have the nerve to make the claims that you do over your unproven, no better than OTC orthotics (The Mentz Study) on your website, which of us is an evangelist.

    NECKS PAIN!!
    EVIDENCE!!
    Footprints!
    PAIN ANYWHERE IN THE FEET??
    Prescription Technology??

    You don't know who I am but I know who you are...
    Robert Isaac
    char·la·tan (shärl-tn)
    n.
    A person who makes elaborate, fraudulent, and often voluble claims to skill or knowledge; a quack or fraud.

    Takes one to know one.
    Dennis
     
  19. Oooo dennis, you cut me to the bone.

    What, you don't want to talk about biplanar pronation or how you can tell the pathology by a photo of the rearfoot any more?

    I love your last sentance btw. You call me a charlatan then say it takes one to know one. Did you think that statement through?!?!?

    Looks a lot to me like you're having a tantrum dennis. Changing the subject somewhat. Do you not want to talk about those other things perchance?

    If you like, I could go look at your website and find all the bits on there which are questionable. Is that really the game you're here to play?

    I asked you (again) some valid questions regarding what you claim to know. I think you can't answer them. Further I think that you are getting spiteful too distract attention from the fact.

    Tell you what. Take a breath, get a back rub, roll a joint, or whatever you do to unwind. Then answer a few of my questions and I'll answer a few of yours. Try to be specific though, there is a lot In your post and I don't know what bits confused you. Perhaps "how can one make an effective orthotic from a footprint". Or "what prescription technology do you use". Or "what evidence do you use when you claim to treat neck pain"
     
  20. David Smith

    David Smith Well-Known Member

    DrSha

    You started of a great topic for discussion, you kept from us what was your position but we ran with it. I took the view that your opinion was that EBM was good but difficult for older or more entrenched clinicians to integrate into their practice, however you were one willing to do this. But then you reveal you are not, you just want to shout I'm the best, your all rubbish, my evidence is all that matters Why won't you all see this? With no prompting you return to straw man argument, name calling and nonsense argument. Totally countering your attempt at reasonable discussion. Why did you do this? You didn't need to go there.

    Can you clarify and tell me are you in favour of integrating scientifically gathered EBM into your practice?

    Regards Dave
     
  21. Do you mind? Dennis is avoiding MY questions just now.

    When he's done avoiding mine, then YOU can give him some questions to avoid.

    Wait your turn :D;). Poor guy's only human. He can't ignore everybodies questions at once and ad hominems don't grow on trees. :rolleyes:
     
  22. David Smith

    David Smith Well-Known Member

    OOH err sorry! Our Robert's in attack mode and he wants all the juicy bits for himself, so stand aside and clear a path lads and let the Dog see the man. (save me a rib Robert):D
    I should add LMFHO
    :drinks Dave
     
  23. drsha

    drsha Banned

    I have been in an evidence based biomechanics podiatry practice for over thirty years.

    I utilize the best available evidence when questions arise as I treat individual patients. I integrate the evidence with my clinical diagnostic and treatment skills and foundational knowledge and the patient’s particular needs. In addition I evaluate my results and modify my practice accordingly and I support biomechanical research.

    I practice evidence based when it comes to pharmacology as well but the evidence weighs heavier in this area as level 1 evidence is lengthy and ongoing.

    This means that for all of us biomechanical EBMers, the moment when Dorothy opens the curtain to expose the Wizard in Oz exists.

    We are all Charlatans and I am a bigger man than the rest of you for admitting it as I continue using EBM to try to rise above that title.

    I have no problem with Roberts website but I do have a problem with him (et al) posturing as if he was working from a higher plane of EBM or justification or authority than I.

    As another example, I called Kevin’s Lab (Precision Intracast) weeks ago, saying I was a prospective client and asked what his preferable casting method was for orthotics. The young lady replied that “We prefer a Subtalar Neutral Cast”. Curtain call Wizard Kevin.

    I could do it to any one of you (and you of me) because we are all Charlatans working without Level I EBM to justify our work.

    In his 2009 paper published in The Journal of Foot and Ankle Research, Menz concluded:
    “The development of consensus
    guidelines for the prescription of custom
    foot orthoses using such a technique would
    be a major step forward, and would provide
    a foundation upon which customised foot
    orthoses could be evaluated to the satisfaction
    of both researchers and clinicians.
    Over time, further research may
    indeed reveal that there are subgroups of
    patients and conditions that respond more
    favourably to particular types of customised
    orthoses compared to prefabricated orthoses”.

    My EBM Practice has brought me to a level where I have the ability to type all feet into subgroups for the purpose of treatment and research. I suspect that FFT is teachable, reproducible and useful as a tool in biomechanics when examined but I need proof.

    I have tried Kirby’s Skive, Dananberg’s Kinetic Wedge and Whitman’s (Glaser's) Vaulting and they all have their place in treatment regimens when applied foot type-specific. I do not argue how any of you work because you are helping people passionately and that is a noble task.

    If 1000 subjects were foot typed and 100 of them were selected having the rigid rearfoot, flexible forefoot foot type and its characteristics and they were then tested with a STJ Neutral 3 degree varus RF Post (as in the Redmond Study) and then a custom device (as in Redmond) with a kinetic wedge, I predict that valid level 1 evidence would be produced justifying that care for that foot type. If the same subjects were then tested with the STJ Neutral, varus posted device and a medial Kirby Skive, my prediction would be that no valid evidence would point positively toward the use of the medial skive in those feet.

    What really amazes me is the bias and antagonism that arises when I suggest foot typing (or something else from my work) at appropriate moments and you chastise me for discussing it. Would you expect me to discuss YOUR WORK??

    I will not allow you to degrade my EBM Biomechanics until yours rises above mine with evidence.

    Has any one of you who might agree with Menz and others that a foot typing system may lead to better care and evidence typed one or two people using my system (or considered an alternative system)?

    Currently, biomechanics is faith based and unlike many of you, I am willing to live next door to my neighbors harmoniously as opposed to try to get them to move out of town or worse (do you remember calling my parents mutants?).

    I would like to start a new thread entitled FFT questions where I would field questions from those who wish to examine my work. Any takers?

    It’s been a great 1.6 years as an Arena Member. I am looking forward to more.

    I am not the enemy.
    :drinks
    Dennis
     
  24. Back to Dr Jekyll I see. You must go through clothes like anything? Or is your Mr Hyde the same size and thus able to morphose without rending cloth?

    No point. You never answer any questions. Any time you get one you don't like Mr Hyde pops out in a stream of vituperation.

    Like the ones on LLD. Let me refresh your memory. You said

    Later you said

    leading me to ask

    Which you did not answer.

    And later in the same thread I asked
    you replied

    Which led to an obvious question regarding circular logic. You don't measure lld, so you consider it to be there if you see a certain symptom set. And you believe that symptom set is present in LLD because you have seen those symptoms in long (or short) legs (for 30 years).

    Thats like saying "I know its a cat because it has a tail and I know its a tail because its on a cat.". Its logically inconsistent.

    You never answered that one either.


    Earlier in this thread you said

    Then you changed your mind and said that there WAS frontal plane pronation but that what you MEANT to say was

    Dodging the question again. Which is it Dennis? Are you saying that there IS a frontal plane element but that its not relevant or what?

    Then you said
    I replied
    And you... changed the subject again.

    You persistantly dodge the questions by either

    A: saying we should start a new thread on it,
    B: having a go at the person asking the question
    C: saying its an impossible question to answer because biomechanics is just TOO complex
    D: telling us how great thou art and that we should bow before your manifest EBM greatness.

    Whilst I'm sure you'd be delighted to have FFT threads all over the arena I suspect most people are quite bored of you.

    So rather than have yet another thread for you and I to fight on, how about you take a shot at answering one or more of the questions above from the old ones.

    Oh and here's a fresh one. You keep saying that YOUR practice is Based on EBM. Besides your 30 years of doing what you do, what is your evidence?
    Because if that is all you've got then every clinician over the age of 55 or so is an EBM guru.

    And if you are claiming EBM on the basis of deductive evidence you need to be able to defend your deductions against critisims like the ones above.

    I have a few more, but they can wait.

    Regards
    Robert

    PS, for those playing at home, I'll offer the following odds on Dennis's answer.

    A: 3/1
    B: 2/1
    C: 6/2 on
    D: 2/1 on

    send bets to my paypal account.

    PPS, The difference between us, Dennis, is that as you say we neither of us have level 1 evidence for everything we do... but I don't claim to be able to tell what someone's pathology is from a photo of the back of their heel. Nor to predict what their dynamic function will be based on a static observation. Nor to confidently diagnose LLD from completely unvalidated clinical observations.

    PPPS LOL Dave :D. ruff.
     
  25. drsha

    drsha Banned

    Quote:
    So, to be clear, what does increase pressure under the second met head indicate, a long leg, as per your explanation, or a short leg as per your treatise?
    Which you did not answer.

    Answer: Second met changes are one part of one of the conformatories for TIP. It is certainly low level evidence of a long or short limb as you have exposed. If the short side is in relative varus to the long side and the patient has a flexible forefoot foot type, then added callus would be under the 2nd met of the short limb for those patients. it would not play in other foot types.

    And later in the same thread I asked

    Quote:
    Why do you believe that the long side spends longer on the ground? And why do you believe that this will result in more wear? I'm not saying its not, or that it is, I just want to know why YOU think it is
    you replied

    Answer: The EDG revealed a longer plant time (that's what it did) on the long side consistently. I would assume the modern F-scan would confirm this but have never tested it personally.


    Quote:
    My answer actually is "my experience of more than thirty years".
    Which led to an obvious question regarding circular logic. You don't measure lld, so you consider it to be there if you see a certain symptom set. And you believe that symptom set is present in LLD because you have seen those symptoms in long (or short) legs (for 30 years).

    Thats like saying "I know its a cat because it has a tail and I know its a tail because its on a cat.". Its logically inconsistent.

    I will change “my experience” to "my EBM Based Biomechanics Practice" .

    Earlier in this thread you said
    Quote:
    My opinion is that there is “no frontal plane pronation", no matter how you say it.
    Then you changed your mind and said that there WAS frontal plane pronation but that what you MEANT to say was


    Quote:
    frontal plane pathology is not the cause nor the area of treatment
    Dodging the question again. Which is it Dennis? Are you saying that there IS a frontal plane element but that its not relevant or what?

    Lets try and explain this question using the function of p. longus in gait as a reference. In the rigid rearfoot types, by definition, there is a small amount of eversion available and the foot cannot evert to vertical. There is an inherent ability of these feet to allow peroneus longus to act as a supinator of the forefoot (good) as opposed to being a pronator of the rearfoot (bad). On other planes, these feet may have transverse plane movement of the talus, medially and sagital plane drop of the talus and calcaneus but they there is little evidence for frontal plane treatment of the rearfoot.

    What I am trying to state is that treatment of these commonly presenting feet with frontal plane care is needless (learn from Dananberg) because the pathology, if it exists, exists on other planes.
    What these feet need incorporated in their care is to elevate the talus and place it more lateral (this is Vaulting, learn from Glaser)

    Frontal plane treatment of the rearfoot is imperative in the flexible rearfoot types which are less common (learn from Kirby).

    A Foot Typing System makes sense of it all (learn from Mr. Hyde, sorrry) and enables a skilled practitioner to applies all theories, foot type-specific improving practice.

    Then you said

    Quote:
    Where is the pathology in these feet and how would you treat it if not on the frontal plane of the STJ.

    Answered Above

    Oh and here's a fresh one. You keep saying that YOUR practice is Based on EBM. Besides your 30 years of doing what you do, what is your evidence?

    I have quoted evidence throughout my 1.6 years on The Arena (and my publications). If you were interested in improving your EBM, you would have paid some attention to them, even looked some up, but no, you were too busy being mean and biased by attacking me personally.

    PPS, The difference between us, Dennis, is that as you say we neither of us have level 1 evidence for everything we do... but I don't claim to be able to tell what someone's pathology is from a photo of the back of their heel. Nor to predict what their dynamic function will be based on a static observation. Nor to confidently diagnose LLD from completely unvalidated clinical observations.

    Finally, since you don’t claim to do any of these things and I can, there lies the root of my claim that I am a better EBM Biomechanist than you and if we ever meet in front of a patient together, my claims (or yours) will be tested and verified.
    Oh and yes, when discussing our claims, aren’t you the podiatrist who claims to cure all pain in all joints of the foot and in addition claim to cure neck pain with orthotics in your practice Mr Hyde.

    I have already stated that I am a Charlatan as you are.
    I have already admitted that my evidence is low level and needs to be expanded.
    That puts me on an even plane with the best EBM Orthotic Makers in the world.

    What are you trying to prove with your interrogation of me and my ability to express some of my points well enough when I have admitted my imperfections? Examine my work or don't, it's so simple.

    My statement:
    I would like to start a new thread entitled FFT questions where I would field questions from those who wish to examine my work. Any takers? Does not apply to you because you are not interested in examining my work, you are interested in damning me personally. I dare you to foot type your next patient (what harm can come of it?)

    And

    The Arena has been an amazing source of evidence, logic, organization and theory that I have incorporated into my biomechanics and I continue to thank you all endlessly.

    During that time, you have not proven to me that the foot centering theory, functional foot typing and foot centrings have nothing to offer in return.
    You have more than proven that you hate me personally.

    Does even one of you have the nerve to say that in 1.6 years I have added something to your biomechanical fund of knowledge. Please comment. (Even one "Thank You" would be so reinforcing if you can bear the reprisals).

    Dennis
     
  26. I've only got a minute, I'd love to go into more detail on the rest later, but just quickly

    I did'nt comment on this first time around. But no, I'm not. You were kind enough to quote my website Dennis, read what is says a little more carefully.

    you said
    Based on Me saying

    I didn't say cure, I said treat successfully. There is a big difference, treat successfully might mean simply to make more comfortable. And I Did'nt say ALL the joints of the foot, I said ALMOST any pain.

    And you said

    based on me saying

    I did'nt say I claimed to cure neck pain, I said SOME PEOPLE have claimed orthotics can HELP neck pain. I even went on to qualify that by saying there was no evidence for it.

    I'll come onto the rest later but I thought I'd deal with that one first. Nobody likes being misrepresented or misquoted.
     
  27. As tempting as it is, I don't think I'll extrapolate this view into the other discussion we were having recently! ;) But I agree with your sentiments regarding Dennis. I think I made the observation some time ago that the Shavelson gene pool had a shallow end, but on current evidence it would appear that someone has inadvertently pulled the plug out and condemmed the place as unfit for purpose. Entertaining though, just like his namesake....
     

    Attached Files:

  28. drsha

    drsha Banned

    Robert:

    can't we get beyond the pissing contest?

    I am not questioning whether you can or cannot do the things you claim.

    By stating that htere is no evidence for your neck pain treatment (don't you think that's a Rothbart by itself?) you imply that the rest of your treatments are evidence based (and we know they're not).

    You call me for a lack of evidence yet you cannot produce evidence to support your claims. You are no better then I.

    We are both Charlatans. and
    We are both practicing Biomechanics EBM.

    I answered your question which your snidely claimed I wouldn't, stop pissing on me and I'll stop pissing on you.

    Dennis
     
  29. David Smith

    David Smith Well-Known Member

    Mark
    You wrote
    Schtummm!:cool:

    Dennis wrote in reply to Robert the Hat McVitie
    Really! was it on a secret micro film attached to the pigs wing?

    NO YOU DIDN'T!!! Crikey Dennis you are your own worse enemy.

    Fondest regards Dave
     
  30. Righto then. From the top.

    So you're saying that higher pressure 2nd met indicates a SHORT leg if its a flexible foot and more varus (forefoot or rearfoot) than the contralateral. And presumably a long leg in everyone else?


    I think lawrence alluded to such a study. But you miss my point. The EDG revealed a longer plant time on the long side. How did you know which was the long side? Did you measure before the EDG test?

    If so, and a longer plant showed a longer leg, why not just measure it? If your pre EDG measures were accurate enough to tell you that the EDG long plant was the long leg, then they are accurate enough to use in clinic arn't they?


    Now I'm really confused! Which is it? Or are you inferring that your EBM based practice is synonomous with your experience?

    Either way, its still circular logic unles by EBM you refer to some external evidence source. Do you?


    So what you are saying (stop me if I've misundertood you) is that more rigid cavus type feet don't do so well with frontal plane wedging as floppy ones.

    Or, simpler still, that a rearfoot which is already inverted does not need to be inverted any more with a wedge.

    Seems reasonable enough. Pretty common sense really! I seriously doubt many podiatrists would presently treat an inverted cavus type foot with a varus wedge!



    Um, no you didn't. At the risk of being patronising, pathology is concerned with disease. A particular type of foot is not a "pathology". A tendon rupture is a pathology. The thing that makes the patient say "ow" is the pathology.

    Lets face it, ALL feet fall into one of your foot types. If the foot type is a pathology then ALL feet are, by inference, pathological.

    The only one I can remember you quoting is the Menz study on pre fabs vs root devices for plantar fasciitis... and you misquoted it.

    I'll ask again. Besides your 30 years, what evidence do you offer that your model is better than, for example, Root.


    Sorry, I think this is another one where you've not said what you mean. You seem to be saying that you're a better EBM biomechanist than me because you make more exuberant claims about what you can do?! Do claims make someone a better clinician? If so then Brian is a better clinician than either of us.

    Answered this one

    Simply examining what you claim Dennis. You offer a product / paradigm for us to consider. We must decide whether to accept it / whether it has merit. To do this we must examine it. If we find things we find inconsistant or illogical we will ask you about them. Its not a vendetta or a hate campaign, but you can't expect people to swallow it whole without chewing it first!

    Well if it does not apply to me then go nuts! But again, I'm not interested in damning you personally. Its your work which interests me. Sadly the basis for much of what you say is your own experience which means that we must either take your word for it all or examine you. You set that pace, not us.

    And

    I Don't hate you Dennis (bless yew). I've never met you. I'm sure you're lovely. I just take exception to your work, your claims, your Schizophrenic posting style (you go from being quite reasonable, like now, to really spiteful sometimes) and the frustrating way you do not follow arguments through.


    Thank you. You have added zest to many a dull day, challenged us all to justify our opinions, made me research lots of stuff to make my points (increasing my knowledge) and occasionally even made good points. Whilst I believe that your FFT system adds little to the sum of biomechanical knowledge and has holes you could drive a truck through (thats not you I'm critisising its the model) I seldom check the arena so avidly as when we are having a ruck.

    Feel Better;)

    Robert
     
  31. drsha

    drsha Banned

    Robert:
    Thanks for the Thanks:
    You stated:
    Thank you. You have added zest to many a dull day, challenged us all to justify our opinions, made me research lots of stuff to make my points (increasing my knowledge) and occasionally even made good points. Whilst I believe that your FFT system adds little to the sum of biomechanical knowledge and has holes you could drive a truck through (thats not you I'm critisising its the model) I seldom check the arena so avidly as when we are having a ruck.

    My reaction is that we actually have much in common as to how we think and are principled.

    Your statement reflects an EBM approach to our discussions which I share.

    You have added zest to many a dull day, challenged me all to justify my opinions, made me research lots of stuff to make my points (increasing my knowledge) and very often (not occasionally) made good points. Whilst I believe that your biomechanical paradigm adds little to the sum of CLINICAL biomechanical knowledge and has holes you could drive a truck through (thats not you I'm critisising its the model) I seldom check the arena so avidly as when we are having a ruck-(us).

    Like you, I have answered what I believed to be relevant questions and I have not dignified others that were not on target with a response.
    I have replied to your meanness with meanness (and will continue to do so).

    I will not give you the Level V respect you seem to think you are enabled to (as you should not me) until you prove it (which you in toto, have not).

    When it comes to biomechanics, you are a Charlatan like me (admitting it would give me more respect for you).

    The main difference between us I believe (scientifically) is that I have taken the time to learn your language, examine your points and theories and think them through before deciding they have holes you could drive a truck through (EBM) and you have
    not.

    You have quoted Einstein and so I will as well:

    Any intelligent fool can make things bigger and more complex. It takes a touch of genius - and a lot of courage to move in the opposite direction. Albert Einstein

    Dennis, Dr Sha, Dr Jeckyl/Hyde, Dennis the Menace, Mutant et al.
    :drinks://///// :boxing:

    I look forward to meeting you one day in person, in academia, in competition, in friendship or as enemies as you see fit. I will adjust my personalities and demeanor accordingly as I have done on The Arena.
     
  32. :D

    Ok. Dry, witty, I'll give you that one.

    Although I should point out that I don't claim ownership of a bio-mechanical paradigm.

    You've quoted that before. And as I have quoted before the real trick lies in another quote from the same man:
    I'll learn to live with that ;)

    I thought all this WAS examining your theories! And with respect, I think that you come to the conclusion that we / I have not taken time to examine your model because we / I am not nuts about it. It is possible that we HAVE examined it closely and STILL don't like it.

    See where I think we're different is contained in the definition of the word charlatan (which, BTW, is a stronger one than I would have used.)

    The skill or knowledge we might argue. Without baseline such argument would be meaningless. Which leaves us with the claims. Who makes the most elaborate and voluble claims? In your own words Dennis

    But we digress. Lets talk about evidence, as we seem to have reverted to the pissing contest you mentioned earlier. Again. Bad habit of ours.

    If you will induge my nationalistic tendancies, lets refer to the English rankings.

    Ok. I'd say (and please anyone else feel free to jump in here) that we mainly live in Level D, with occasional excursions into level C. Particularly in terms of "based on first principles."

    So we're both trying to work off first principles and bench research agreed? Within that we can break it down to are the respective models (tissue stress / FFT)

    :- Consistent with first principles? (newtonian physics)
    Consistent with bench research? (such kinetic and kinematic data as we have)
    Proof against critical appraisal? (which is what we're doing right now)
    Consistent within its own paradigm?

    For me, these are the best we can do in terms of EBM. Expert opinion is common as muck from anyone with a new idea or who thinks they have the next big thing because expertise has no entrance exam and the title is often self conferred. Homeopathy, to take an example close to my heart, has many an expert claiming it works, but is not consistent with first principles (like that a water molecule can "remember" a complex molecule it once saw). That is contrary to accepted principles of chemistry and physics. Removing a painful corn on the other hand, though it is not backed by an RCT of patients who had a "sham enucleation" is consistent with the principle that not walking on a lump of hard skin is better than walking on a lump of hard skin.

    So. If we agree that neither can claim much more than level D evidence, the greater claim to being EBM compliant lies with

    The model most consistent with first principles
    The model which stands most robustly to critical appraisal
    The model most consistent with bench research
    The model most consistent within its own paradigm

    So, fresh question to you dennis, if you feel the above are fair criteria for a model being evidence based (because we are talking about the best MODEL not the best INDIVIDUAL), how do you justify your repeated (nay voluable and elaborate) claims to being an "EBM biomechanist". What bench research can you point to? How well do you feel FFT has done in terms of critical appraisal? How to you reconcile the circular logic I have highlighted within your paradigm (the use of measurement in identifying LLD). How is your model based upon first principles?


    Regards
    Robert
     
  33. Atlas

    Atlas Well-Known Member

    We have ignored half of Sackett's 'recipe' for too long. Kids come out of university being able to quote mountains of research, but really struggle with practical clinical problem solving. Try and find a pure bonefide practitioner, who carries more weight than a paper-clip at a teaching university (Podiatry & Physiotherapy) in Australia?


    We have salivated over EBP, at the expense of RBP (results-based-practice). Now trial-and-error has become an anachronism.


    We talk about modern medicine, and advances etc., but I question how far we actually have come. Is the EBP-manicured modern practitioner that much better than the relics of the past? I doubt it. They had little diagnostic help. They thought on the ground more. They had less inhibitions (taping lasted more than 20 minutes in those days):deadhorse:)




    Ron Bateman
    Physiotherapist (Masters) & Podiatrist
    Melbourne Australia
     
  34. I'd tend to agree that the practical, on the ground, pragmatic skills are what makes a good clinician rather than an encyclopaedic knowledge of research. But can that sort of thing be taught? Or is it learned through experience and (I think this is a big one) clinical mentoring. Do universities make Good podiatrists or equip people with the skills to BECOME good podiatrists?

    I don't know how it rides in the Southern hemisphere but here a student is lucky to see a couple dozen quality biomechanics cases as an undergrad. Its just not enough to develop "trial and error" knowledge.

    The problem with RBP is that our methods of monitoring results are so horribly subjective. Hence people who believe in crystal healing, reiki, and homeopathy. This is the more comfortable approach. For me, the emphasis on Ebm rather than Rbm is a wholesome thing because like it or not, we all have an instinctive urge to revert to Rbm and an instinctive mistrust of EBM.
     
  35. drsha

    drsha Banned

    A sheep sticks his brave head from outside The Arena Herd!
    Where have you been?
    and where are your compatriarts?

    Ron:
    Have you ever functionally foot typed a patient or two to see where it gets you clinically?

    As a PT I ask you a theoretical clinical question:
    What if our goal was to take feet and using orthotics. motor control and manual therapy, teach P. Longus to power and leverage the 1st ray into the ground in closed chain strongly enough to overcome sagital plane pathology?
    Would that be a clinical advance?

    “If you hate your parents, the man or the establishment, don't show them up by getting wasted and wrapping your car around a tree. If you really want to rebel against your parents: outearn them, outlive them, and know more than they do.”
    Henry Rollins
    ;)
    Dennis
     
    Last edited: May 3, 2010
  36. drsha

    drsha Banned

    Robert, the Prover Stated:
    If we agree that neither can claim much more than level D evidence, the greater claim to being EBM compliant lies with

    The model most consistent with first principles
    The model which stands most robustly to critical appraisal
    The model most consistent with bench research
    The model most consistent within its own paradigm

    So, fresh question to you dennis, if you feel the above are fair criteria for a model being evidence based (because we are talking about the best MODEL not the best INDIVIDUAL), how do you justify your repeated (nay voluable and elaborate) claims to being an "EBM biomechanist". What bench research can you point to? How well do you feel FFT has done in terms of critical appraisal? How to you reconcile the circular logic I have highlighted within your paradigm (the use of measurement in identifying LLD). How is your model based upon first principles?

    DrSha The Carer Replies:
    Just as debating which of us has better clinical skills/outcomes, I prefice this posting by stating that a discussion about which of us has poorer (or better) level V evidence to justify our practices has no value to our readers or our patients.
    They are both "Expert opinions common as muck... because expertise has no entrance exam and the title is often self conferred" as you have previously stated.

    From the outset, I bowed to your knowledge and EBM skills as to which of us should be more valued when it comes to evidence. You are very important as one facet of EBM based biomechanics practiced (EBP).

    I have never argued your approach, the difficulty of your chosen passion or the fact that EBM is what separates those who are committed to EBM from those who “can put tissue paper into shoes to help people".

    Because I am not a physicist or an engineer and do not possess the time or the foundation to examine evidence in order to determine its validity, bias and level, I need you to do that and then I can decide after your input, as the clinician, whether it is worthy of impacting specific patient questions and my practice protocols.

    You "convert the abstract exercise of appraising the literature into the pragmatic process of using the literature to benefit individual patients while simultaneously expanding the clinician's knowledge base." (Bordley DR, 1997) for biomechanics (me).

    I have dedicated my EBM practice to clinical outcomes as I use my experience, the patients unique needs and the available evidence to practice Podiatry.

    I am a Podiatrist and a clinician utilizing the evidence as best as I can to serve my patients needs.
    You are a scientist, physicist and engineer practicing Podiatry.

    In your world, evidence trumps empiricism (at any level), in my world patient needs and care trumps the evidence (Until proven otherwise).
    And I hope we both agree that neither you or I or Spooner has proven otherwise.


    I believe that focused clinical work enables me to offer better patient care (with your help) and I suggest that my work, when and if you examine it will foster better evidence for biomechanics.

    Robert: I agree with your distaste for calling us all Charlatans (I exaggerated to make a point).

    When it comes to biomechanists, we are Evidenced Based Charlatans (EBC’s) using level V evidence. The day our evidence proves the sum of our collective theories worth applying into practice will be the day we both dream of.
    Why aren't we working together?

    To answer your question:
    I will publicly admit that you can lay claim to being more EBM compliant than I when you are ready to proclaim me more clinical and patient compliant than you.

    Dr Sha, The Carer

    PS: TIP is totally hypothetical since there is no evidence at any level with clinical relevance.
    I introduced it in a separate thread, at a much later time than The Foot Centering Theory, FFT or Foot Centrings.
    Please stop using it to critique of my evidence based work as it is not.

    I believe that LLD will never develop useful evidence on its current path and that TIP therefore, is the best EBM we have for LLD.
     
    Last edited: May 3, 2010
  37. Double bind. You say empiricism trumps evidence UNTIL PROVEN OTHERWISE. And how can it be proven otherwise if not by research? That's what evidence IS.


    Pragmatic example. The way I learned biomechanics used a lot of forefoot varus extensions. I would have confidently told you that based on experience it was a good mod which worked well. Then I was exposed to evidence (low level extrapolation from first principled but external evidence none the less) that they could be harmful. I stopped using them and switched to other things and you know what? Empirically, outcomes improved.

    I thought you wanted to move on from the pissing contest? This isn't about you and me. If anything it's about ebm vs empiricism. Or possibly about whether fft is ebm compliant. But a page of your self agrandisement is tiresome and irrelevant.

    with respect, that's bollicks. Leave alone the fact that you don't know anything about me, we're all podiatrists (well most of us). We're both in full time clinical practice. The difference between us is not what we are but how we argue.

    I'll bet you would! No dice. Because:-
    1- this is back to you vs me and as I keep saying it's not about you and me.

    2- You make a catagory error that evidence is muturally exclusive or alternative to clinical and pragmatic expertise. It's not. Evidence compliance and patient compliance are the same thing. That is, ebm exists for the sole purpose of establishing the best patient care.

    Regards
    Robert
    ps. Happy to leave Tip alone. Although I will, in parting, say that by your own testimony you based tip on lld so if one is suspect they both are.

    So let's move on to fft by all means. Save me looking through all the types dennis, do any of your foot types demand a lateral (valgus) rearfoot wedge with or without a valgus forefoot wedge?
     
  38. drsha

    drsha Banned

    Robert Stated:
    So let's move on to fft by all means. Save me looking through all the types dennis, do any of your foot types demand a lateral (valgus) rearfoot wedge with or without a valgus forefoot wedge?

    Reply:
    The answer is yes.
    and
    Why save you through looking at all the types (since you have really never looked at them before)?
    DrSha
     
  39. Because I don't remember every word of every document I read? And I'm on my iPhone and can't readily access the information on your prescriptions.

    Ok. Which foot type? I'm going to go out on a limb and guess it's the inverted rearfoot inverted forefoot. Is that right or are you gonna make me give up my evening copying and pasting your information? Tiresome but I can if I must.
     
  40. NOT rigid rearfoot types
    Ok, I give up. Spent half an hour trawling your online information and I can't find which foot type you recommend valgus heel wedging for. Put me out of my misery, when does neoteric biomechanics recommend the use of Valgus rearfoot wedging?

    Holy hell, its hard to discuss your model when you are so reluctant to give out information as to what is in it!! Its like being asked what you think of a painting you're not allowed to see! Could you PLEASE give me a straight, simple and unequivocal answer to the question in bold? Preferably in 2 or less sentences?
     
Loading...

Share This Page