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At first sight it may appear the French Revolution, Charlie Chaplin, War, Wine and NASA have nothing in common but they do and it is called biomechanics. The term is used more and more in everyday language and has come to mean the study of normal human movement. Patho-mechanics is the technical term for abnormal movement but is often restricted to medical text. At the time of the French Revolution, people, especially poor people, started to matter. The traditional hospitals had been glorified brothels where literally people went to die, usually in great pain and distress. New and increased concerns for the proletariat however meant radical change in health care with the establishment of teaching hospitals. Clinical experts were available to teach as well as practice. In the La Gaze (the beginning of medical specialisation), medics referred to all body systems as biomechanics. Modern interpretation takes rather narrower meaning preferring biomechanics to mean human movement only, but originally this was a term used to describe a complete biological system. Throughout history many researchers have tried to analyse walking but it took to the introduction of cinematography before real insights were made. Even today the strides made in the early 20's and 30's have not yet been surpassed. With the invention of photography frame by frame analysis of walking allowed observation of detail not obvious to the naked eye. The two men most associated with the technique were Eadweard Muybridge and Étienne-Jules Marey and their works are still referred too. Frame by frame analysis helped researchers make special sense of the abnormal human locomotion which had enormous potential for orthopaedic surgery. Anthropometry i.e. the identification system based on physical measurements of the body was created by Alphonse Bertillon a French law enforcement officer. He believed criminals were an inferior species and had physical defects which could be identified by measurement. Not only did he develop the first scientific system police used to identify criminals but also introduced the mug shot and the systematisation of crime-scene photography. Bertillon was the first to include footprint analysis. At is height, anthropometry or Bertillonage as it was known was widely used by French police and in other European countries but it was eventually replaced by fingerprinting. Anthropometry continued to be used by scientists developing growth charts and clothing size systems, and eventually became in common use in sport science. By far the most celebrated person to see a pratical use for biomechanics was Sir Charlie Chaplin who regularly filmed scenes backwards, then to the amusement of millions would show the films unning forward at higher speeds. No one has knows why people find silly walks amusing but the do and made Charlie Chaplin a very rich man and household name. By the fifties, North Americans were conserned at the increasing numbers of wounded veterans returning from Korea then later the Vietnam War. Appalled at the apparent lack of research and development in the science of rehabilitation for amputees and those physically afflicted the public outcry put greater political pressures on the government to introduction of a national rehabilitation initiative. Coincidentally this occurred when North Americans were alarmed at Russian dominance for space exploration. Zillions of dollars were pored into the US aerospace industry and science education in general. During this period it is reported (possibly by Inman?) that on a plane flying to Seattle were two strangers, both on route to attend separate conferences. One was the director for new US Rehabilitation Research and Development Program, the other the NASA supremo. After a few cocktails and the ice broken, they started a casual conversion to pass away the travelling hours. After the introductions the aeronautical engineer rather boldly suggested,
"Do you know if we made aeroplanes like you make false knees then our planes would never get off the ground?”
"What do you mean?" came the puzzled reply".
"You chaps try to replace the knee with something that looks like a human knee whereas we design a plane to defy gravity using the laws of nature."
That was the beginning of a very long and fruitful relationship between the two men and was also the birth of biomedical engineering or modern biomechanics. They agreed to meet after their respective conferences in a city park and one brought a couple of bottles of wine and the other bread. The aeronautical engineer suggested an experiment that with each sip of wine the friends had they should feed the ducks a wine soaked piece of bread. After several bottles of wine, the aeronautical engineers suggested his companion stand and try to walk in a straight line. The effects of alcohol caused the rehab expert to stagger and when he returned to his seat the engineered observed, “Watch the ducks walk.” Despite consuming the same volume for size of alcohol as the men, the ducks continued to maintain a straight line walking.” He asked his friend to explain why the alcohol appeared to have no adverse effect on the duck’s gait. Once they had agreed there was no significant physiological reason it had to be something to do with the body’s centre of gravity i.e the lower the centre of gravity the greater stability. Imbalance through intoxication caused humans to stagger whereas the broadbase of the dase kept them stable throughout. From that keen observation the science of orthoses and prostheses changed to reflect Newtonian Physics and Momentum Physics with emphasis of three and four (time) dimensional analysis. Combined with cinematography, anthropometry, force and pressure analysis, modern biomechanics has been incorporated into sports science and forms a major part of preparing elite athletes for the Olympic Games. Today, biomechanical analysis helps commentators understand the intricacies of movement that are unseen by the naked eye and also assists sportwear designers to manufacture performance enhancing footwear and swim suits, the effects of which are so eagerly awaited by spectators in expectation of record breaking performances.
Re: How Far Have We Come in Podiatric Biomechanics?
Cameron:
Let's not forget the "Father of Modern Biomechanics", Giovanni Alfonso Borelli, who was mathematically calculating the internal forces within the muscles and joints of the body before Sir Isaac Newton's 'Philosophiae Naturalis Principia Mathematica'. Borelli is well known in biomechanics circles but is virtually unknown to podiatrists. He was indeed a pioneer and should be rightfully acknowledged for his considerable contributions to biomechanics as we know it today. Here is a nice review article for all of you who want a little more knowledge regarding the history of biomechanics.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Re: How Far Have We Come in Podiatric Biomechanics?
Hey boys
ITS NEARLY 03AM HERE IN UK AND WERE WAITING TO WATCH JOE CALZAGIE BEAT HOPKINS. mANY PINTS HAVE BEEN CONSUMED PLUS SEVERAL VODJKAS AND JD'S.
Quote:
Another problem with Basmajian's research is that the subjects were sitting when the force to the foot was applied. We don't know whether seated posture somehow changes the activation of the central nervous system in response to loads versus standing, or not.
__________________
ANOTHER PROBLEM WITH THIS PAPER IS THAT ITS JUST RUBBISH. THE GRAPHS SHOW NO BASELINE REFERENCE, THERE IS NO SCALE AND NO CONSIDERATION THAT MUAP OUTPUT MAGNITUDE DO NOT DIRECTLY RELATE TO MUSCULAR FORCE MAGNITUDE,AND THIS IS NOT DISCUSSED, ESPECIALLY WITHOUT A MAX VOLUNTARY CONTRACTION REFERENCE. IT DOESN'T SAY HOW THE WEIGHTS WERE LOADED OR WHAT THE TRUE LOAD WAS. IT INTIMATES THAT THE LOAD IS SOMETHING TO DO WITH THE FUNCTION OF THE LEVER BUT NO MORE. THERE IS NO INDICATION OF CROSS TALK ERROR OR EVEN IF IT WAS CONSIDERED. PERHAPS THE PAIN OF A WOODEN LEVER DIGGING INTO THE KNEE ILLICITS MUSCLE ACTION WHO KNOWS. THERE'S MORE BUT THE FIGHT IS JUST ABOUT TO START SO SEE YA ALL LATER.
Re: How Far Have We Come in Podiatric Biomechanics?
Someone should ring Dave on his mobile... do you thing he will answer now?
I thought it was a strange time for him to be posting- love the dedication though...
__________________
Craig Tanner
Podiatrist ASPETAR-
Qatar Orthopaedic and Sports Medicine Hospital
Doha
QATAR http://www.aspetar.com/
Re: How Far Have We Come in Podiatric Biomechanics?
Quote:
Originally Posted by David Smith
Hey boys
ITS NEARLY 03AM HERE IN UK AND WERE WAITING TO WATCH JOE CALZAGIE BEAT HOPKINS. mANY PINTS HAVE BEEN CONSUMED PLUS SEVERAL VODJKAS AND JD'S.
__________________
ANOTHER PROBLEM WITH THIS PAPER IS THAT ITS JUST RUBBISH. THE GRAPHS SHOW NO BASELINE REFERENCE, THERE IS NO SCALE AND NO CONSIDERATION THAT MUAP OUTPUT MAGNITUDE DO NOT DIRECTLY RELATE TO MUSCULAR FORCE MAGNITUDE,AND THIS IS NOT DISCUSSED, ESPECIALLY WITHOUT A MAX VOLUNTARY CONTRACTION REFERENCE. IT DOESN'T SAY HOW THE WEIGHTS WERE LOADED OR WHAT THE TRUE LOAD WAS. IT INTIMATES THAT THE LOAD IS SOMETHING TO DO WITH THE FUNCTION OF THE LEVER BUT NO MORE. THERE IS NO INDICATION OF CROSS TALK ERROR OR EVEN IF IT WAS CONSIDERED. PERHAPS THE PAIN OF A WOODEN LEVER DIGGING INTO THE KNEE ILLICITS MUSCLE ACTION WHO KNOWS. THERE'S MORE BUT THE FIGHT IS JUST ABOUT TO START SO SEE YA ALL LATER.
BYE DAVE
Dave:
How many research articles from 45 years ago studied the electromyographic activity of the plantar intrinsic muscles under load? How many have since? How many before this article by Basmajian? You must consider that biomechanical studies of the foot in the early 1960s were rare and Basmajian was doing something that no one had ever done before you become too critical of a researcher's work.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Re: How Far Have We Come in Podiatric Biomechanics?
Kevin
Ok I agree I was a little undiplomatic and harsh considering the history, but then I was feeling a little uninhibited at the time, my apologoies.
How ever it is my opinion that when reporting on experiments using EMG it is very important to be presice about methodology. This report leaves itself wide open to critisism since there are only scant details of methods of data collection, processing and analysis, which is so important for the reader to be able to usefully and reliably interpret the work.
The main points are. How did they load the device? was the load perfectly still before reading where taken? Was the load 400lb at the loading point or was it at the knee as a function of the lever * force applied? (it sort of imples that this was the case) At what point did the pressure from force applied to the kee become painful and perhaps cause muscle tension.? Was muscular action required to stabilise the load? Where were the preamps fitted, were there any pre amps? What was the pre amp and amplifier gain. The position, type and gain of the amps can make a huge difference to the output signal. Was there any crosstalk? Was there noise? How was noise and crosstalk eliminated or accounted for in evaluation? Where any filters employed in the electronic circuit or in the data processing? What were the filters? What was the baseline output, How does the output signal relate to muscle activity. How does the signal output relate to signal input. There is an indication of signal output scale where it may be compared with the 200ma timing signal. If one looks at a muscle unit action potential signal (MUAP) and it has a relative scale output of 180ma is that clinically significant. What if the amp gain is 200,000. What does 180ma output = in terms of force? 1N or 1000N who knows. Can force be extrapolated from MUAP magnitude. Generally no it cannot. To get an idea of signal magnitude to muscle force magnitude it is necessary to first have some refrence output, often maximum voluntary contaction is used but is not highly reliable. Muscles tend to give higher MUAP out puts at end range of motion but this may not equal max force output. There are large differences between types of contraction. There was no signal to muscle output referencing reported in this study. In my opinion all that can be extrapolated from this experiment is that there was increased signal output with higher loading. Anything else is supposition and interpretation is based on bias not fact.
Re: How Far Have We Come in Podiatric Biomechanics?
Quote:
Originally Posted by David Smith
Kevin
Ok I agree I was a little undiplomatic and harsh considering the history, but then I was feeling a little uninhibited at the time, my apologoies.
How ever it is my opinion that when reporting on experiments using EMG it is very important to be presice about methodology. This report leaves itself wide open to critisism since there are only scant details of methods of data collection, processing and analysis, which is so important for the reader to be able to usefully and reliably interpret the work.
The main points are. How did they load the device? was the load perfectly still before reading where taken? Was the load 400lb at the loading point or was it at the knee as a function of the lever * force applied? (it sort of imples that this was the case) At what point did the pressure from force applied to the kee become painful and perhaps cause muscle tension.? Was muscular action required to stabilise the load? Where were the preamps fitted, were there any pre amps? What was the pre amp and amplifier gain. The position, type and gain of the amps can make a huge difference to the output signal. Was there any crosstalk? Was there noise? How was noise and crosstalk eliminated or accounted for in evaluation? Where any filters employed in the electronic circuit or in the data processing? What were the filters? What was the baseline output, How does the output signal relate to muscle activity. How does the signal output relate to signal input. There is an indication of signal output scale where it may be compared with the 200ma timing signal. If one looks at a muscle unit action potential signal (MUAP) and it has a relative scale output of 180ma is that clinically significant. What if the amp gain is 200,000. What does 180ma output = in terms of force? 1N or 1000N who knows. Can force be extrapolated from MUAP magnitude. Generally no it cannot. To get an idea of signal magnitude to muscle force magnitude it is necessary to first have some refrence output, often maximum voluntary contaction is used but is not highly reliable. Muscles tend to give higher MUAP out puts at end range of motion but this may not equal max force output. There are large differences between types of contraction. There was no signal to muscle output referencing reported in this study. In my opinion all that can be extrapolated from this experiment is that there was increased signal output with higher loading. Anything else is supposition and interpretation is based on bias not fact.
Respectfully Dave Smith
Dave:
All your points are valid. However, my point about this paper is, how many researchers before 1963 published a paper on the electromyographic activity of the plantar intrinsic muscles during varying loading conditions? Don't you think that a researcher deserves credit for making an attempt to do something that no one has ever done before and then taking the time and effort to get it published in a journal? Doing research is one thing. Taking the time and effort to get it published is a whole other beast. For this reason, I still think Basmajian's article is a classic and is definitely worth taking the time to read for anyone interested in foot and lower extremity biomechanics, regardless of it methodological shortcomings that seem quite obvious from our scientific perspective now over 45 years since its publication.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Re: How Far Have We Come in Podiatric Biomechanics?
Quote:
Originally Posted by Kevin Kirby
Dave:
All your points are valid. However, my point about this paper is, how many researchers before 1963 published a paper on the electromyographic activity of the plantar intrinsic muscles during varying loading conditions? Don't you think that a researcher deserves credit for making an attempt to do something that no one has ever done before and then taking the time and effort to get it published in a journal? Doing research is one thing. Taking the time and effort to get it published is a whole other beast. For this reason, I still think Basmajian's article is a classic and is definitely worth taking the time to read for anyone interested in foot and lower extremity biomechanics, regardless of it methodological shortcomings that seem quite obvious from our scientific perspective now over 45 years since its publication.
I agree, scientific writing has changed a great deal over the last half century. If one reads the papers contemporary to this work that were published in JBJS (let's face it, one of the top journals) you will find numerous methodologies that are equally scant of detail by today's standards. In terms of EMG, Basmajian was THE early pioneer. If you have never read "muscles alive", you should. Brilliant man. In fact I've just ordered a copy as despite reading it, I've never owned it.
Re: How Far Have We Come in Podiatric Biomechanics?
Kevin
Quote:
All your points are valid. However, my point about this paper is, how many researchers before 1963 published a paper on the electromyographic activity of the plantar intrinsic muscles during varying loading conditions? Don't you think that a researcher deserves credit for making an attempt to do something that no one has ever done before
None as far as I can find and research reveals Basmanjian as a highly prolific researcher and writer. He has written many scientific papers and books in anatomy, Physiology, biomechanics, orthotics, and by far the greatest number are EMG subjects.
He has papers dating from 1952 The distribution of valves in the femoral, external iliac, and common iliac veins and their relationship to varicose veins.Surg Gynecol Obstet. 1952 Nov;95(5):537-42. to 1994 Physical rehabilitation outcome measures B Cole, JV Basmajian - 1994 - Williams & Wilkins, with early EMG papers such as Electromyography of two-joint muscles. JV BASMAJIAN - Anat Rec, 1957 - and Electromyography of iliopsoas. JV BASMAJIAN - Anat Rec, 1958.
When taken in the context of this career and if previous papers are read then the paper we are discussing can take on a different light and certainly Basmanjian has been a major contributor to the understanding of these areas of interest. One could understand him not including detail that he has been covered before.
However it would seem he is somewhat of an expert in the area of EMG and even wrote the article Facts vs. myths in EMG biofeedback - Applied psychophysiology and Biofeedback, 1976 - Springer. It would seem reasonable to expect that any paper written by Basmanjian would be more complete in its reporting and not be so ambiguous. Maybe this is a problem with writing for journals where space and wordage is limited and so reports becom truncated. Often to their detriment.
Quote:
and then taking the time and effort to get it published in a journal? Doing research is one thing. Taking the time and effort to get it published is a whole other beast. For this reason, I still think Basmajian's article is a classic and is definitely worth taking the time to read for anyone interested in foot and lower extremity biomechanics, regardless of it methodological shortcomings that seem quite obvious from our scientific perspective now over 45 years since its publication.
I don't believe one can commend a paper simply for breaking new ground if at the same time it is content to let the the content be ambiguous and does not consider its limitations and shortcomings. This may lead to subsequent (perhaps careless or less kowledgeable) readers taking the conclusions at face value and applying them to further research or clinical interventions also without considering the inherent errors, thus compounding the error.
Maybe it could be considered classic in terms of promoting new thinking in the area of interest but at the same time requires to be taken in the context of his other writing and prehaps this should be made more clear in this paper.
Re: How Far Have We Come in Podiatric Biomechanics?
Quote:
Originally Posted by David Smith
It would seem reasonable to expect that any paper written by Basmanjian would be more complete in its reporting and not be so ambiguous. Maybe this is a problem with writing for journals where space and wordage is limited and so reports becom truncated.
Dave:
Welcome to the world of getting papers published in peer-reviewed journals. The author is at the mercy of the reviewers and to the standards of the journal.
As Simon noted, Basmajian's paper is quite typical for this period within the scientific medical literature. All you need to do is read Manter's, Hicks', and Elftman's papers on the midtarsal joint to realize how poorly the methods are reported in these "classic" papers from a similar era. However, like Basmajian's paper, these shortcomings do not make these papers any less important to the history of medical literature regarding foot and lower extremity biomechanics.
I think what is even more impressive about Basmajian's 1963 paper on plantar intrinsic muscle function is how few papers have ever been done on the electromyographic activity of these muscles of the foot. You will probably find that Basmajian's paper is the only paper ever done that has investigated the electromyographic activity of the plantar intrinsics under varying loading circumstances. I would certainly think that we should give Basmajian a lot of credit for his pioneering work in this field, especially in consideration of the near total lack of similar research done in the 45 years since this paper was published.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Re: How Far Have We Come in Podiatric Biomechanics?
Kevin, Simon
Quote:
As Simon noted, Basmajian's paper is quite typical for this period within the scientific medical literature. All you need to do is read Manter's, Hicks', and Elftman's papers on the midtarsal joint to realize how poorly the methods are reported in these "classic" papers from a similar era. However, like Basmajian's paper, these shortcomings do not make these papers any less important to the history of medical literature regarding foot and lower extremity biomechanics.
I agree that the style of that time is very different to today and indicates how we have changed our standards over that time. Is this a good or bad development in your opinions?
Hicks- Mechanics of the foot - SUMMARY
1. The plantar aponeurosis at its distal end is attached through the plantar pads
of the metatarso-phalangeal joints to the proximal phalanges. The attachment is
mechanically very strong.
2. When the toes are extended they pull the plantar pads and hence the aponeurosis
forward around the heads of the metatarsals, like a cable being wound on to
a windlass. The arch is caused to rise because the distance between the metatarsal
heads and the calcaneum is thereby shortened.
3. The toes are forced into an extended position in toe-standing and walking by
the action of body weight, and the arch is caused to rise by this ligamentous
mechanism without the direct action of any muscle.
This paper had a simple format but its conclusions were reasonably extrapolated from the experimental data, unambiguous and difficult to refute.
Basmajian - Role of muscles in foot architecture. - Summary
Simultaneous electromyography of six muscles in the leg and foot in twenty subjects reveals that only heavy loading elicits muscle activity. Loads of 100 to 200 pounds on one foot are borne easily by passive structures (ligaments and bones) that support the arches. With 400 pounds, the muscles do come into play, but even then many remain inactive. The first line of defense of the arches is ligamentous. The muscles form a dynamic reserve, called upon reflexly by excessive loads, including the take-off phase in walking.
The format is similar to Hicks but the nature of the experiment is quite different in that relies on collection and analysis of electronic data of bio-feedback. This requires precise reliable protocols. Although in general terms the conclusion is probably correct the experimental data does not, in my opinion at least, reasonably enable these conclusions to be extrapolated.
Would we allow a paper like this nowadays? Does not allowing such a format restrict our ability to progress? Should we be allowed to make leaps of logic in our experimental conclusions? Do these leaps allow faster progress or confound the scientific method and cloud our understanding?
Just because this paper turns out to have conclusions that represent what we see as correct today does that make it better in retrospect than it was in 1963?
How would you have critiqued this paper in 1963 without the knowledge of today?
Although limited by techology 45 years ago thay were not limited in scientific methodolgy, were they? Has writing methodology (by this I mean the way we format, write and present a paper) evolved into a 'higher' state over that time. Do we innately demand more of a scientist now than then?
Re: How Far Have We Come in Podiatric Biomechanics?
Quote:
Originally Posted by David Smith
Would we allow a paper like this nowadays? Does not allowing such a format restrict our ability to progress? Should we be allowed to make leaps of logic in our experimental conclusions? Do these leaps allow faster progress or confound the scientific method and cloud our understanding?
In my 15 years of reviewing papers for scientific journals, I would easily accept such a paper for publication. Why? Because no one has ever done such an experiment before, to my knowledge. And such experiments may stimulate others to do more refined research in the future. There is no doubt in my mind that this paper should have been published in 1963 and I still think it is valuable for us in 2008.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Re: How Far Have We Come in Podiatric Biomechanics?
Quote:
For those of you who haven't been around this profession as long as I have, I thought it might be helpful for you to become aware of some of the biomechanics concepts that I was taught as a podiatry student from 1979-1983 at the California College of Podiatric Medicine so that you can see how far we have come in the past quarter century in our knowledge of podiatric biomechanics. Some of you other more mature podiatrists, that have also been around the profession for a decade or more, and may have been trained in other podiatry schools in other countries, may also want to contribute to this thread for the benefit of our younger colleagues.
Old Concepts in Podiatric Biomechanics
(circa 1979-1983, California College of Podiatric Medicine, San Francisco, California, USA)
1. Measuring foot deformities such as forefoot to rearfoot relationship, rearfoot varus/valgus allows the podiatrist to best determine how a foot will compensate for those deformities and how best to make an orthosis to prevent those compensations from occurring.
2. A foot is not normal unless it has a perpendicular forefoot to rearfoot relationship, stands with the subtalar joint (STJ) neutral, has a vertical distal third of the tibia, and stands with the calcaneus vertical.
3. The heel bisection and forefoot to rearfoot relationship is easily determined and does not vary considerably from one examiner to another, if performed correctly.
4. The midtarsal joint consists of two distinct simultaneously occurring joints, the oblique midtarsal joint, angulated 57 degrees from the sagittal plane and 52 degrees from the transverse plane and the longitudinal midtarsal joint, angulated 9 degrees from the sagittal plane and 15 degrees from the transverse plane.
5. A functional foot orthosis should always be balanced with the heel vertical since heel verticality is the position that a normal foot has. The only time that a foot orthosis should be balanced with the heel inverted are in cases where the calcaneus is inverted when it is maximally pronated.
6. A functional foot orthosis should never be balanced with the heel everted unless the foot is fixed in a heel everted position such as in peroneal spastic flatfoot or STJ degenerative joint disease.
7. A true functional foot orthosis ends at the metatarsal necks. Forefoot extensions are not necessary to make the foot function optimally with a foot orthosis since placing padding plantar to the metatarsal heads will restrict digital dorsiflexion during propulsion.
8. Pronation occurs frequently in feet since, during standing and walking, the center of mass of the body is positioned medial to each foot which forces feet to pronate.
9. Gravity causes pronation.
10. A foot with a vertical calcaneus in standing and with the STJ in neutral position is the most stable foot.
11. The goal of foot orthosis therapy is to make the foot function in the STJ neutral position.
12. Foot orthoses need to be made of a relatively rigid material in order to be considered true "functional foot orthoses". Soft materials can not be used to make functional foot orthoses, soft materials can only make "accommodative orthoses".
13. A calcaneus that is resting 2 or more degrees everted will continue to pronate to the maximally pronated STJ position during relaxed bipedal stance.
14. A foot with a rearfoot varus deformity will pronate until the heel becomes vertical unless it is supinated by some other influence since the heel vertical position is the most stable position of the foot.
Any other "mature podiatrists" wish to contribute?
I know this is an old thread but I Just wanted to add...I'm not what you would call a 'mature' podiatrist, in fact, I wasn't even born in 1983! But unfortunately a lot of the concepts you outlined are the exact same ones that I was taught. I graduated 2011.
Thank God for this forum!!
The Following 3 Users Say Thank You to MissB For This Useful Post:
Re: How Far Have We Come in Podiatric Biomechanics?
Nice bump Miss B
Reading that list depresses me. Not because we have not moved on, we have. But as MissB points out a lot of this stuff is still being taught.
I fear that those of us who have suffered the epiphany which Kevin alludes to have done our colleagues a diservice. The gulf between the "get its" and the "don't get its" in biomechanics is huge. People like Kevin, Eric, Simon and Craig have moved out ahead... but the pack is still limping along in the 70s as MissBs post indicates.
I don't know the solution.
Oh and MissB? You've made some good posts on some good threads. Time to start posting under your own name I think...
Re: How Far Have We Come in Podiatric Biomechanics?
Quote:
Originally Posted by Robertisaacs
People like Kevin, Eric, Simon and Craig have moved out ahead... but the pack is still limping along in the 70s as MissBs post indicates.
I don't know the solution.
Ask yourself this: if it is perceived that Kevin, Eric, Craig and I (I think you do a disservice to yourself and others here in their omission, btw) have moved out ahead, how have we done this?
I'll give you a clue, it didn't happen overnight, it certainly didn't happen without hours and hours of study and a dedication to the subject that would make Roy Castle proud. http://www.youtube.com/watch?v=GilqqHC0SQ8
"You can have it all, but how much do you want it?" - Oasis- supersonic
Re: How Far Have We Come in Podiatric Biomechanics?
Had a huge crush on Roy when I was 7. Frequently wrote to him to ask if I had beaten the world record on many things, including keeping the largest collection of stick insects...Still have the signed photo.
Re: How Far Have We Come in Podiatric Biomechanics?
Quote:
Ask yourself this: if it is perceived that Kevin, Eric, Craig and I (I think you do a disservice to yourself and others here in their omission, btw) have moved out ahead, how have we done this?
I'll give you a clue, it didn't happen overnight, it certainly didn't happen without hours and hours of study and a dedication to the subject that would make Roy Castle proud.
No doubt! And no disrespect to all the great people I didn't name. I just think the gap is a little wide thats all.
Re: How Far Have We Come in Podiatric Biomechanics?
Quote:
Originally Posted by Robertisaacs
No doubt! And no disrespect to all the great people I didn't name. I just think the gap is a little wide thats all.
I actually think that the number of people with a more sophisticated understanding of foot and lower limb biomechanics is increasing year on year, due in no small part to the activities of those willing to share their knowledge and experience in this field and to forums such as this.
Re: How Far Have We Come in Podiatric Biomechanics?
I think that the word 'dogma' was a bad choice of word on my part (actually I am not sure it ever did describe the views of anyone who was, in any way, involved with the teaching of biomechanics in britain at least). The word got stuck in my head from an earlier posting, as I was scanning this thread. Having gone back to look at it a second time I see that the author had put inverted commas around it.
To know how far we've come needs us to establish a starting 'pont' and and end 'point' (now). As this survey is being carried out in the form of a list (with all its strengths and weaknesses) it would be useful to have a list of contemporary concepts in podiatric biomechanics for comparison with the past and for future comparison.
[B]Contemporary Concepts in Podiatric Biomechanics[/b]
Re: How Far Have We Come in Podiatric Biomechanics?
Quote:
Originally Posted by wdd
To know how far we've come needs us to establish a starting 'pont' and and end 'point' (now). As this survey is being carried out in the form of a list (with all its strengths and weaknesses) it would be useful to have a list of contemporary concepts in podiatric biomechanics for comparison with the past and for future comparison.
To figure where we are now would require a consensus as to what everyone believes now. Some of us may believe in one paradigm and others may believe in a different paradigm. Some people still believe the Earth is flat. The history of progress of science is an very interesting study. Kuhn's on the nature of scientific revolutions is a fascinating read. We will always be in transition.
Re: How Far Have We Come in Podiatric Biomechanics?
Dear Eric,
Nail on the head.
There is no contemporary consensus as there was no historical consensus. I would expect a list of historical concepts to include contradictions, misunderstandings, individual modifications and additions, etc..
If any sense of a consensus emerges in the historical list it should lead to a bit of head scratching. How come we have an historical consensus?
However if it's acceptable to list the historical concepts I would imagine that it's equally valid to create a list of contemporary biomechanics concepts and if it gives a consensus view either the understanding or misunderstanding is perfect or there is a problem?
Re: How Far Have We Come in Podiatric Biomechanics?
I graduated in 2006 and was taught most of what you were taught!!
Everything I use I learned in continuing education workshops (including yours Kevin) and seminars or from reading papers and using my own brain to think through a 3d puzzle.
Unfortunately Root and modified root were not just footnotes to show us where we came from.
I learned that if I wanted full marks on a test for a biomechanics question, or a clinical instructor to approve your orthotics prescription, post to calcaneal vertical. Always. They won't mark it wrong. Always use moderate fill. Well most of the time. If it is a severe pronator then you can throw in deeper heel cup and minimal fill. Maybe a skive. Might actually get you a bonus! Or a severe supinator, then flexible shell with maximal fill. And that's all folks! Because we wouldn't want to over-correct. And 10/10 mark is achieved!
Some PURE GEMS
Orthotics work by controlling pronation (or supination, but we don't really understand how to actually achieve that because it's so rare). Pronation is bad.
High arched/supinated feet are really really rare and only need help with shock absorption (accomodative CFO).
Allow 3 degrees of motion (ie possibly even pronate the foot slightly while casting, or don't fully correct them, or post slightly valgus, we MUST avoid over-correcting, they need to pronate that much to shock absorb)
Don't correct more than 4 degrees.
Only correcting me 4 would leave me still in horrible pain and seeking a below knee amputation as orthotics clearly don't work.
Some colleagues are aghast I do not measure to determine my (rearfoot and intrinsic forefoot only, never to sulcus) postings!
We were taught though bisections were somewhat subjective, they are a qualitative and oh so valuable... see above...
We were basically frightened away from anything but calc vertical to avoid "over-correction" as we might cause an ankle sprain.
The forefoot falls in line if you control the rearfoot, some colleagues are still shocked that I order mortons/forefoot varus/valgus extrinsic posts...
Well, they said they make the foot work around the STJ neutral position. Not in it at least, all the time...
Taught many other bits too, or grazed them in a slightly more modern form.
Re: How Far Have We Come in Podiatric Biomechanics?
Quote:
Originally Posted by Kevin Kirby
Here are a few more of the "facts" I was taught as a podiatry student at CCPM.
15. Since the foot is casted for functional foot orthoses in STJ neutral position and since the foot orthosis is made around a positive cast in STJ neutral position, the foot will function in the STJ neutral position when wearing a functional foot orthosis.
16. Functional foot orthoses work by preventing compensations for forefoot to rearfoot deformities.
17. Functional foot orthoses work by "locking the midtarsal joint".
18. Inverting an orthosis will cause the patient to get bunion deformities since an inverted orthosis will supinate the longitudinal midtarsal joint axis.
19. The plantar fascia cannot add a STJ supination force to the foot since the plantar fascia is not a muscle.
20. Equinus deformities will cause a pronated, flattened longitudinal arch of the foot sometimes and will cause a supinated high-arched foot other times. (Thanks for that one, Eric.)
That straw man, doesn't make anything that you do right or proven for that matter.
Re: How Far Have We Come in Podiatric Biomechanics?
Quote:
Originally Posted by drsha
That straw man, doesn't make anything that you do right or proven for that matter.
Yawn
Dennis, is the reason that you keep coming back to the arena is so that you can learn debate tactics? yawn, straw man ( Straw man, there's an icon we need). How is what Kevin said a straw man argument. Those were all things that were taught at the College where Kevin and I were students. A straw man argument is where you misstate your opponents beliefs and then attack those misstatements. For example stating that tissue stress is a paradigm where we just wait for pathology to happen before treating. That's an incorrect characterization of tissue stress. At least use the criticism correctly.
When will you learn to defend your position and answer questions about your paradigm? That's another strategy that we use. How do you use foot typing to alter how the orthotic is fabricated for one foot type as opposed to another?
Eric
Last edited by efuller : 12th May 2012 at 12:36 PM.
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Re: How Far Have We Come in Podiatric Biomechanics?
Quote:
Originally Posted by efuller
Dennis, is the reason that you keep coming back to the arena is so that you can learn debate tactics? yawn, straw man ( Straw man, there's an icon we need). How is what Kevin said a straw man argument. Those were all things that were taught at the College where Kevin and I were students. A straw man argument is where you misstate your opponents beliefs and then attack those misstatements. For example stating that tissue stress is a paradigm where we just wait for pathology to happen before treating. That's an incorrect characterization of tissue stress. At least use the criticism correctly.
When will you learn to defend your position and answer questions about your paradigm? That's another strategy that we use. How do you use foot typing to alter how the orthotic is fabricated for one foot type as opposed to another?
Re: How Far Have We Come in Podiatric Biomechanics?
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