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Found this quote in Prof Rhubarbs newsletter. Always a hoot. This month, "Rothbart Proprioceptive Therapy Is A Science Of Miracles". Where does an ego go from being the father of chronic pain elimination? Deification of course!
But anyway, aside from laughing at Brian, I really enjoyed this.
2000 B.C. - "Here, eat this root."
1000 B.C. - "That root is heathen, say this prayer."
1850 A.D. - "That prayer is superstition, drink this potion
1940 A.D. - "This potion is snake oil, swallow this pill
1985 A.D. - "That pill is ineffective, take this antibiotic."
2000 A.D. - "That antibiotic is artificial. Here, eat this root."
I'm sure we could come up with a podiatry version.
1940, The whitman brace "It is made from a plaster model of the foot in a corrected position"
1971, The Root orthotic, "Orthotics do not hold the foot in any position, they improve function"
1995, Tissue stress, "Orthotics don't always improve function, Orthotics change internal forces"
2005, Nigg, "Orthotics can work and can have fantastic effects, but we don't know how they work"
2010, Mass casting "We do know how they work, by capturing a functionally corrected position"
So the question is, why do the "chew this root" therapies keep making a comeback?
I just got back from presenting in Belgium. One of my presentations was titled "the evolution of foot orthotic therapy". Within this presentation I charted the evolution of foot orthoses, from the early pioneers: Royal Whitman- published in 1896 by the way, through to the modern day and beyond.
In researching this presentation, amongst other things, I found that Whitman's devices "worked" by pain avoidance; Percy Roberts used inverted devices in 1916; William Sayle-Creer was taking a tissue stress approach in 1937; George Ogden developed a foot alignment jig and used direct moulding in 1949; Gordon K. Rose was talking about deviation of the STJ axis and using MASS casting in 1958; Root did talk about foot orthoses "working" by aligning the skeleton in 1971: "A foot orthotic must: Maintain the foot near the neutral position while standing, even in the presence of various structural abnormalities of the foot and leg"; composites were used to manufacture the UC-BL device in 1969 and Henderson and Campbell talked about varying the build up of the laminates to modify load-deformation characteristics of the devices; Carlson and Berglund were using free body diagrams to explain the function of foot orthoses in 1979; and CAD-CAM was being employed by 1989.
AND... I didn't even include Swallow's contributions- who was pretty much getting towards "the contemporary approach" and where we are now before Root came along and diverted everyone for 30 odd years. If you get a chance to read Swallow's works that were published in the "The Chiropodist" you'll realise that UK podiatrists were following an approach to foot and lower limb biomechanics based on sound engineering principles and Newtonian mechanics quite nicely, thank you very much for asking... then Root came along and enhanced, yet at the same time stalled our understanding, in my opinion.
The penultimate slide in my presentation was from Ecclesiastes 1:9
"What is that which hath been?
It is that which is, and what is that which hath been done?
It is that which is done, and there is not an entirely new thing under the sun."
Tried to upload a .pdf of the lecture here, but it wouldn't let me. More than happy to share this here, Craig. If not possible, it should be uploaded to the conference website soon, at which time I'll publish a link here.
As for trepanning, I find it useful for sub-ungual hematomas; some other dudes use it for epidural and subdural hematomas, but I wouldn't recommend that for home use.
I recall a lecture I gave many years ago on Thomas Smith Ellis of Gloucester who formulated the tissue stress theory - and a great deal besides. He qualified at Bart's Hospital in 1860 and following an HTA (Horse Traffic Accident) in 1868, which damaged his right foot he studied and published on the subject of "foot biomechanics". A short paper in the British Medical Journal in 1878 described the resting (neutral) position - "The position to which the foot always tends in repose and of the least stretching of the ligaments and most even adaptation of the joint surfaces to each other. This is always found in a mean between the extremes of motion." He published again in the BMJ in 1887 on 'Deformities of the great toe'. Of particular note was his then revolutionary contention that deformity of the 1st MTPJ was not caused by the passive pressure of ill fitting shoes but by the prevention of muscular activity and the mechanical effects of ground reaction forces. His opus magnus was "The Human Foot" published in 1889 which he dedicated to his old teacher Sir James Paget and in which he quashed some of the ignorant beliefs then held concerning the mechanism of the foot. Unfortunately, he took the bad advice of a "well known orthopaedic surgeon of Guy's Hospital" and did not, as he had wished, revise and re-print his book. Had he done so, it is probable that a revised version would be in every podiatrists bookcase today; instead of which he is largely forgotten. Helal affords Ellis 3 lines, Root none, Caillet none, Weinstein none, McGlamry none. Perhaps surprisingly, Kelikian acknowledges him as he deserves: "Practically all important ideas about the function of the forefoot - for that matter the foot as a whole - were formulated by Ellis of Gloucester."
Some of his ideas were, and are, contentious but it will be interesting to see how these may come into fashion when the big wheel turns as suggested by the OP. It is worthy of note that Ellis did not formulate 'proprioceptive theory' and he certainly understood the difference between science and miracles!
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