Prescribing Orthoses: Has Tissue Stress Theory Supplanted Root Theory?

Wrong again hunnybun, wrong gender, wrong continent, just plain wrong. Try again. You really are an ego-maniac.

 

Jeff

In summary, anyone who is tying themselves down to any particular theory or system is doing themselves and their patients a disservice by not availing themselves of all the tools that are out there.


Why then haven't you responded to my clinical assessment of bio-fluid mechanical loading?

 

So now I'm J.R. Dobbs :bash::dizzy::bash:

 

I don't condone some of it. He is his own man and will have to choose how he interacts with others here. But I do feel it is beneficial to have the perspective of a DPM from the U.S. who isn't totally pro TST to counterbalance Kevin and Eric because I believe that Kevin and Eric are the exception to the rule here in the states. I think their comments could give podiatrists on the PA that reside in other countries the false impression that TST is broadly accepted here. It is not.

DPM's have a much different and broader scope of practice than non-DPM podiatrists. I don't profess to know exactly how podiatrists practice in all other countries, but the surgical, radiological and pharmacological education and training amongst other things create a significant increased educational demand on DPM's and as a result, biomechanics doesn't get the same emphasis as it might in podiatric training in other countries.

What you are not picking up on is that I have on several occasions admitted that we need changes in the practice of biomechanics and foot orthotic therapy. I'm not suggesting that change is unnecessary. I'm simply trying to point out my concerns with the runaway freight train that is TST.

Kevin started this tread with a question. In Kevin's own words, TST has not totally replaced "Root Theory" because some of the terminology, techniques and theories that are used in the practice of TST can be traced back to "Root Theory". So we have successfully answered Kevin's question, no TST has not supplanted Root Theory.

Biomechanics and the practice of foot orthotic therapy can be practiced in many different ways. If we want what we do to be accepted by the general medical community, we need to have better defined methods, techniques and practices and the science to back them up. We are far from that point in time. Hopefully having opposing opinions will expose some of the flaws and help lead to better methods. I continue to learn from the discussions here on the PA and my thinking continues to evolve. That is why, in spite of some of the BS, I continue to follow and contribute on an as available basis.

 

Jeff


Biomechanics and the practice of foot orthotic therapy can be practiced in many different ways. If we want what we do to be accepted by the general medical community, we need to have better defined methods, techniques and practices and the science to back them up. We are far from that point in time.

I don't understand why you would say this, I've been telling you about a bio/fluid technology that I've been using for over 20 years

 

Debate requires opposing opinions Jeff, Daryl and yourself have provided that. What we don't need is someone who:

Not my words.

Or someone whos:

Again, not my words.

Which leads to colleagues saying:

I wouldn't go there if I were you, Jeff because as you said

Do you know about post-graduate and for that matter undergraduate podiatry training outside of the USA, Jeff?

Agreed.

In the meantime, I'm now someone else, apparently.

 

I know most don't get the surgical training that is required in the U.S. I'm not criticizing non U.S. trained podiatrists. In many ways I like the model because so much attention here is focused on surgery that a lot of other valuable podiatry skills and techniques get pushed aside as is the case with biomechanics. In the states to become a DPM requires a four year undergraduate degree (after 12 years of primary education), three to four years of podiatry school and then a three year residency. So it takes about ten years of college and residency before a DPM can start a private practice and those who go into private practice are becoming fewer by the day. Many DPM's now work for institutions that in many cases, don't provide foot orthotic therapy. Practitioners like Kevin depend on these institutions for referrals. More and more of those patients are also being referred to orthotists and pedorthists for foot orthotics.

 

It's not about the number of years, it's about the academic level, Jeff. As one of my colleagues stated a study was conducted in which the academic rigour of a DPM was equated to that of an undergraduate diploma here in the UK. I think one of the key differences is the study of research methods and critical reading which I think the courses outside of the USA place far greater emphasis upon. Thus, non-DPM trained podiatrist are often far better placed to critically evaluate opinion and research.

Europe wide, I think it is imortant for you to recognise that your father's books were not big sellers and as such very few podiatrists within central Europe had even heard of them until we started to lecture there. In the UK, the dominance of neutral theory has long since passed. I think that just as you perceive Kevin and Eric to be bucking the trend in the USA, your fathers work is no longer considered, by the majority, to be the most appropriate model of practice here.

Anyway, I got a paper to review for a journal, some lectures to write for South Africa and an alter ego to assume on top of working in full-time practice, and manufacturing all of my own devices and those for some colleagues too.

 

QUOTED BY SIMON

It's not about the number of years, it's about the academic level, Jeff. As one of my colleagues stated a study was conducted in which the academic rigour of a DPM was equated to that of an undergraduate diploma here in the UK.

Then how come you are so dumb about science based ideas??

 

Without getting into the side debate

I do wonder or a point - how much have the Pods in the states have been looking or reading on the lastest in Biomechancis anyway?

Because if as I thin Jeff wrote when asking some Pods about TST they looked like Deer in headlights. Tissue Stress was 1st mentioned what 3 decades ago ( might be less ).

and yes it might mean that in the states Kevin´s original question/statement might be that for US Pods TST has not replaced Root.

But maybe a better 1st question might have been have you heard of Tisuse stress theory in Foot and Leg biomechanics?

This for me is important, because if people arn´t reading and learning continuously maybe the profession needs to take a look at what is happeneing.

People can pick and choose whatever they want , but to not look is very frightening for a profession going forward

 

Really? No thanks.

 

Really? No thanks?????

quoted by Mike Webber:


People can pick and choose whatever they want , but to not look is very frightening for a profession going forward

This is why you're an idiot Simon!!

 

Jeff:

I don't "depend" on any institution for referrals. I get referrals from all over Northern California (and sometimes from other states) from previous patients, running shoe stores, chiropractors, physicians, other podiatrists, in addition to a number of physicians who work in industrial medicine clinics and in health maintenance organizations. If one source of referrals diminished, then that would be fine since, after being now in private practice for 30 years, I have done very well for myself and my family. In fact, I could step away tomorrow from podiatric practice and do very nicely, thank you. However, quitting now after 30 years probably not be a good thing for me or my patients.

Even though I enjoy podiatric practice for the most part, I still don't like being talked about in a fashion that makes me out to be somebody I am not or my podiatric practice something that it isn't.

I for one, would like to see this thread closed to further discussion and cleaned out so it can be read by others in the future without all the name-calling. Enough is enough.

 

I think Ray Anthony, his book The Manufacture and Use of the Functional Orthosis and his Rx Labs may be primarily responsible bringing the "Root" approach to Europe. I believe, and correct me if I'm wrong, that Ray also started the Biomechanics Summer School seminar series. Then, if I'm not mistaken, Langer Labs became a key player in influencing podiatry there.

 

Kevin

I for one, would like to see this thread closed to further discussion and cleaned out so it can be read by others in the future without all the name-calling. Enough is enough.
___________


You accused me of making things up and doing everything I do FOR THE MONEY! You also associated my product with snake oil.

Is that acceptable, rather than name calling?

 

Kevin, I didn't mean to imply anything other than the fact that many podiatrists, orthotists and pedorthists in private practice get a significant number of referrals from podiatrists at institutions whose policies prohibit them from prescribing orthoses. I know you get a lot of referrals from Kaiser (many of my friends have been referred to you by Kaiser DPM's) so the only reason I mentioned you by name is to give credibility to my claim. I didn't mean to offend you and I'm sorry if I did. I know other DPM's who rely on those referrals as it is an important source for new patients.

 

Craig is on a flight at the moment so won't have seen all of this. I'm going to lock the thread until he can get to this and decide whether to re-open it or not.