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Theoretical Question #7
If the most common functional foot type is The Rigid rearfoot, flexible forefoot foot type and by definition, the rigid rearfoot has low contact STJ pronatory moments due to the small ROM available in the direction of eversion, this foot types pathology does not respond to treatment reducing heel contact pronatory moments. Rootian Biomechanics (STJ Neutral casting) is not effective in treating this foot type and STJ neutral position is NOT the healthiest position for this foot type to be held in
and
In opposition, excess STJ pronation is the prime etiological factor in Flexible rearfoot type foot pathology because this foot type has pathological pronation moments available that pervert the STJ Axis medially. However, this is a relatively uncommon foot type. This foot type needs its contact phase pronatory moments compensated and Rootian Biomechancs work (albeit not effectively) to treat this foot type.

Accepting the above as factual (I have not recieved ANY opposition to my theoretical questions numbered 4,5 and 6 on other threads in spite of hundreds of Arena Member visits to them) I am making one conclusion and asking a theoretical question.

Conclusion:
Excess STJ pronation is NOT the predominant biomechanical etiology of foot pathology.

Question:
What are the biomechanical etiologies of The Rigid Rearfoot, Flexible Forefoot Foot Type if not STJ pronation?
Dennis

Dennis,

Is it???

Is STJ 'neutral' the healthiest position for any foot type (irrespective of the paradigm one subscribes to) to be held in?? Is this the way any orthoses actually work?? (Clue...the answer is no)

Nothing new here I'm afraid...

Wen, D.Y., Puffer, J.C., and Schmalzried, T.P. (1997) Lower extremity alignment and risk of overuse injuries in runners. Medicine & Science in Sports & Exercise. 29(10):1291-1298.

Cowan, D.N et al. (1996). Lower limb morphology and risk of overuse injury among male infantry trainees. Medicine & Science in Sports & Exercise. 28(8); 945-952.

Kaufman, K.R et al. (1999). The effect of foot structure and range of motion on musculoskeletal overuse injuries. Am J Sports Med. 27; 585-593.

Regards

Ian

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Oooooooooooooo this is gonna turn ugly!

There is SO MUCH about that post which begs to be challenged before we get to the question at the end! Presupposition runs through it like a presumptive running thing.

Is it? I don't see very many rigid rearfeet at all (apart from those unfortunates with triple arthrodesis)! I'm guessing your criteria for a rigid rearfoot is different to mine. What is your criteria for "rigidity" (because I've always thought of rigid as a binary state. There are no degrees of hallux rigidus)

Not sure I follow here either. Are you saying that pronatory moments in the rearfoot are only derived from rearfoot GRF? Because if you are I'd have to disagree! Moments in the Sub talar joint are derived from forces in the whole foot!

Whats the saying? Claims made without evidence can be dismissed without evidence. However I might offer that IF this "foot type" is most common and this claim was true, why are there a plethora of outcome studies showing favourable outcomes?

See above

Who seriously still believes that it is?!

Is it? Does it not depend on the nature of the pathology and the foot in question? I went to a rather splendid talk by an antipodean gentleman (name escapes me) where he presented evidence that degree of rearfoot eversion was not a terribly reliable risk factor for pathology and that supination resistance was much more so!

Again, hard to be sure without knowing exactly what your criteria but I see shedloads!

How does one compensate a moment. Are you speaking of creating supination moments or reducing pronation ones?

So if rootian biomechanics don't work AT ALL in the first type and not well in the second I ask again, how do you account for the success rates in the literature?

I don't.

Sorry. I steered clear of that thread. Consider this to be opposition

Kind regards
Robert

DrSha appears to want a fight or already knows the answers to his questions, or both?

Robert

Isn't that Lithuania? or is that a republic

Dave

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Ian States:
Oooooooooooooo this is gonna turn ugly!
Dennis Replies:
Why ugly?
Can’t we debate as members of the same Arena?

Ian States:
I'm guessing your criteria for a rigid rearfoot is different to mine.
Dennis Replies:
The Rigid Rearfoot Type has a Rearfoot SERM that is inverted and a Rearfoot PERM that is Inverted.
Although the articles illustrations have been removed in this url, this is a good foundational article for you to review and possibly use to foot type a few of your patients.
http://www.podiatrytoday.com/article/7628

Are you saying that pronatory moments in the rearfoot are only derived from rearfoot GRF? Because if you are I'd have to disagree! Moments in the Sub talar joint are derived from forces in the whole foot!
How does one compensate a moment. Are you speaking of creating supination moments or reducing pronation ones?

Dennis Replies:
I have admitted that I am not conversant in moment-GRF and appreciate you correcting me.

Ian States:
If this "foot type" is most common and this claim was true, why are there a plethora of outcome studies showing favourable outcomes?
So if rootian biomechanics don't work AT ALL in the first type and not well in the second I ask again, how do you account for the success rates in the literature?

Dennis Replies:
Because the definition of favorable used for outcomes sets the bar so low that “well placed tissue paper” would have good outcomes as do the devices studied. Stopping pain and subjective reports of “feeling good” cannot compare to preventive, corrective and performance enhancing outcomes.

Ian States:
Does it not depend on the nature of the pathology and the foot in question? I went to a rather splendid talk by an antipodean gentleman (name escapes me) where he presented evidence that degree of rearfoot eversion was not a terribly reliable risk factor for pathology and that supination resistance was much more so!
Dennis Replies:
This statement calls for a foot typing system such as mine since you bring up general points as if they apply to all feet. There ARE FFT’s where supination resistance is key but that is not our current debate.

Ian States:
Again, hard to be sure without knowing exactly what your criteria but I see shedloads!
Dennis Replies:
Maybe this subjective and poorly researched claim is the reason that you feel this should turn ugly.
Can you describe the clinical and biomechanical presentation of these shedloads? Please select at least one of them as a bunion foot as Bunions do not strongly correlate to The Flexible Rearfoot Functional Foot Types.

Finally, I welcome constructive rather than angry opposition. I agree that Rootian failure is well documented and that much of what I am saying is “nothing new”.
However, a new foot typing system, a new diagnostic protocol, a new method of orthotic casting and prescribing foot type-specific creating a new foot orthotic that anecdotally has satisfies a higher standard of outcomes: Maybe that is worth giving an open minded glance to.
Dennis

Dennis,

Read the posts again - whilst I'd love to take credit for those quotes they are infact the good Mr Isaacs' intellectual property...

Ian

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Oooops. sorry I got my names crossed.

Ian Replied to my Posting:
If the most common functional foot type is The Rigid rearfoot, flexible forefoot foot type

Is it???

Dennis Replies:

Ian, if the rigid rearfoot, flexible forefoot foot type is not the most common type in your experience, WHAT Is?

Perhaps this table will help explain The Functional Foot Types to the readership.





Dennis

Attached Images

FFT Table.jpg (69.5 KB, 421 views)

It would also help to have definitions of each of the categories.

Regards,

Eric

Eric:

The Functional Foot Typing System is based upon two positional measurements of the rearfoot and two positional measurements of the forefoot that give diagnostic information about the state of the pillars of the foot and the vault of the foot.

The rearfoot measurements are the subtalar supinatory end range of motion (SERM) position and the subtalar pronatory end range of motion (PERM) position. The forefoot measurements are the forefoot supinatory end range of motion (SERM) position and the forefoot pronatory end range of motion (PERM) position.

The subtalar SERM position is the open chain position the subtalar joint assumes with reference to a bisection of the lower one-third of the leg after applying a strong inversion force upon the calcaneus until it can no longer move. For FFT classification, there are two possibilities (inverted or everted) for the subtalar SERM position.

The subtalar PERM position is the open chain position that the subtalar joint assumes with reference to a bisection of the lower one-third of the leg after applying a strong eversion force on the calcaneus until it can no longer move. For FFT classification, there are three possibilities for the subtalar PERM position — inverted, vertical or everted.

The forefoot SERM position is the open chain position that the first metatarsal assumes with reference to the locked fifth metatarsal after applying a strong plantarflexory force downward upon the first metatarsal from above until it can no longer move. For FFT classification, there are two possibilities (dorsiflexed or plantarflexed) for the forefoot SERM position.

The forefoot PERM position is the position that the first metatarsal assumes in an open chain with reference to the locked fifth metatarsal after applying a strong dorsiflexory upward force upon the first metatarsal from below until it can no longer move. For FFT classification, there are three possibilities for the forefoot PERM position — dorsiflexed, in line with the fifth metatarsal or plantarflexed.

In the FFT system, the subtalar SERM position and the subtalar PERM position diagnose a specific rearfoot type, and the forefoot SERM position and the forefoot PERM position diagnose a specific forefoot type. After determining the rearfoot type and the forefoot type, every foot can be assigned a Functional Foot Type.

In the FFT system, there are four rearfoot and four forefoot types: rigid, stable, flexible and flat. When one plots the four rearfoot types longitudinally and plots the four forefoot types horizontally, there is a 16-box matrix with each box representing a functional foot type (see “Understanding The Functional Foot Typing System” below). Diagnosing The Functional Rearfoot And Forefoot TypesComparing the subtalar SERM and the subtalar PERM positions of the subtalar joint allows one to classify all feet into one of four functional rearfoot types.

The rigid rearfoot type has an inverted subtalar SERM and an inverted subtalar PERM.

The stable rearfoot type has an inverted subtalar SERM and a perpendicular subtalar PERM.

The flexible rearfoot type has an inverted subtalar SERM and an everted subtalar PERM.

The flat rearfoot type has an everted subtalar SERM and an everted subtalar PERM.I

Comparing the forefoot SERM position and the forefoot PERM position of the forefoot allows the clinician to classify all feet into one of four functional forefoot types.

The rigid forefoot type, the forefoot SERM places the first metatarsal below the fifth metatarsal. The forefoot PERM places the first metatarsal below the fifth metatarsal.

The stable forefoot type, the forefoot SERM places the first metatarsal below the fifth metatarsal. The forefoot PERM places the first metatarsal in line with the fifth metatarsal.

The flexible forefoot type, the forefoot SERM places the first metatarsal below the fifth metatarsal. The forefoot PERM places the first metatarsal above the fifth metatarsal.

The flat forefoot type, the forefoot SERM places the first metatarsal above the fifth metatarsal. The forefoot PERM places the first metatarsal above the fifth metatarsal.

Dennis

And outside of it.

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Well quite!

Dennis,

Are you fishing for some peer approaval for your foot typing system? I believe this has been discussed and you are unlikely to receive any testamonials from this arena.

regards

graham

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None of us know what we are doing, but some of us know more about what we are not doing than others!::

Related threads:
Foot type and injury risk
Foot pronation and knee pain

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Be nice to think so! But i suspect it will turn that way about the time I disagree with you.

Oky doky. Thanks for the information on your foot typing system. Most interesting. I understand now what YOU mean by rigid, although I think its somewhat inaccurate from a point of pure pedantry. An STJ which functions in a range which has the calc inverted relative to the leg is accurate, although I will grant you it does not trip off the tongue.

Fair enough.

Hmmmm. Interesting. I would argue that if I was a patient "stopping pain and feeling good" would be the first things on my wish list. "Corrective and performance enhancing would be nice (assumming we know what "correct" is, anyone?) but would be well down on the list. What is the point of enhanced performance if you are still in pain and don't feel good?


True. Lets shelve that one for another day then.

Ah. So When I say that this "foot type" IS common i'm being subjective and poorly researched. When YOU say its NOT you're being....

As I observed before, claims made without evidence can be dismissed without evidence. Show me your data which shows the distribution of rearfoot types and how you overcame the HUGE error inherent to bisection of the calcaneum (never mind the leg), and explain how a foot which falls one degree inverted in perm (on a measurement with at best a 6 degree error according to the literature) can be considered the same as one with a 6 degree perm and treated the same way, and I'll admit your subjective claim is more vailid than mine.

See? Ugly. Told you.

What, all of theM?!

Bunion. Bit vague here. Do you mean an inflammed bursa over a 1st met head, an HAV, HA, HV, SHL, FnHL or an HR? Because the former could have all sorts of causes, not all of them endogenic.

And again. Evidence to back your supposition?

Yes. It is. They ALL are. . Not the first I've seen. Thing is, I mistrust foot typing systems in general for all the vagueries they neglect. I particularly mistrust this one because it relies on binary or trinary observations of a measurement proven to be grossly unrepeatable, even in intra rater trials!

For example. Take your rearfoot types, flexible, stable and rigid. Imagine a foot in which the true perm (loreal, you're worth it) is exactly perpendicular (assuming such a truth could be derived by means of x rays, bone pins or whatever. )

Patient limps in. The first clinican measures it as 1 degree inverted (and i suspect nobody really claims themselves to be accurate on this measurement to within 1 degree) and prescibes as rigid. But he is knocked down by a lorry transporting 6 ton of dehydrated sushi while taking the prescription to the postbox and is put in a coma! (don't worry, he recovers). The patient returns and is re assessed by a clinician of Godlike biometric skill who assesses as perpendicular and prescribes as stable! Sadly his skill is at the expense of his judgement and he is mugged in a dark ally on the way to the postbox by muggers who very specifically steal his paperwork and notes (happens more often than you might think) then subject him to a humilating and unusual assault involving haddock. While he is having PTSD counseling the by now annoyed patient sees yet a third who judges the rearfoot to be slightly everted and though but one degree out declares the rearfoot to be flexible.

Then the first recovers from the coma and the second returns to work with only a slight nervous tic and they have a bugger of a job deciding what type the foot is! After all, 1 degree is all that separates THREE foot types.

Different casting protocol for each?

And thats before we even LOOK at the inaccuracy implied in bisecting a LEG!

Kind regards
Robert
Neither angry, nor closed minded. Just don't think much of your system. Sorry.

There are 10 types of people in the world.

Those who understand binary and those that don't.

Dr. Isaacs stated:
As I observed before, claims made without evidence can be dismissed without evidence. Show me your data which shows the distribution of rearfoot types and how you overcame the HUGE error inherent to bisection of the calcaneum (never mind the leg), and explain how a foot which falls one degree inverted in perm (on a measurement with at best a 6 degree error according to the literature) can be considered the same as one with a 6 degree perm and treated the same way, and I'll admit your subjective claim is more vailid than mine.
Dennis Replies:
As you justly pointed out (not ugly), I have not bisected a leg or a calcaneum for decades and so I had to revisit how I have reported and defined Functional Foot Typing.
All measurements, diagnosis and casting techniques start with "Root STJ and MTJ neutral position" (not the bisection I falsely reported in the past). The inversion/eversion movements andf pronatory and supinatory moments they measure do not change, only the starting position.
THANKS TO ISAAC!!
Furthermore, the slime I mentioned was not to define different posters (or poster types) it was to mention the need to edit the posts of brilliant men and women who flourished their posts with jokes, quips and snide remarks (of which I am one).
The only pure slime type that I have encountered on The Arena is Graham, who I early on stated that I would n9ot dignify with replies (yet he keeps posting on my threads?).
Dennis

Robert States:
Take your rearfoot types, flexible, stable and rigid. Imagine a foot in which the true perm (loreal, you're worth it) is exactly perpendicular (assuming such a truth could be derived by means of x rays, bone pins or whatever. )
After all, 1 degree is all that separates THREE foot types.
Dennis Replies:
You are mixing research dictums with those of a clinician that needs to make a judgement call in order to care for the patient of the moment.
When faced with a patient with an IM of 14, do I perform an Austin or a CBWO. When faced with a 200 lb vs 300 lb patient, how do I decide the dosage of antibiotics? When faced with a patient needing orthotics and not willing to sacrifice style and fit when it comes to shoes, do I reduce the shell thickness, change my posts to internal, add wash to the positive cast to reduce arch height or ???
These are decisions that we make every day based on our foundational knowledge and our clinical experience. The doctor is in the box.
If I am standing on the place where four states meet (in the USA) does it matter what state I am in when deciding if I need a coat to warm me up?
Would a vertical, one degree varus or one degree valgus rearfoot posting (assuming one of your three junctional or cuspid foot types has been misdiagnosed) change much clinically?
In presenting my work, I discuss, for the most part, pure foot types in order to develop a system that has clinical applications.
I could spend a lifetime diagnosing and treating the variations that exist in The Rigid Rearfoot, Flexible Forefoot Foot Types (probably 65% of my practice) but I choose to treat all feet and remain a generalist.
Scanners, post to cast, OTC products, Prefabs and insurance company declarations that viable treatments are not covered until fully investigated all take the doc out of the box.
Root developed a system that upgraded the podiatrist biomechanically for thirty years and stimulated the very work that you perform to prove the errors in it. Please do not one degree me out of the box clinically.
Research sacrifices clinically in order to proclaim its fruit valid. A great doctor uses art and his/her scientific acumen to ad lib and improvise when confronted with exceptional and sophisticated patients in order to provide better care.
In the apples/oranges mix of medicine, am I the apple or are you?
Dennis

Dennis,

I think the forum would engage you more and maybe even consider entertaining your ideas if you just answered questions simply for once and stopped venturing into hyperbole

Cut the waffling and make your point fella

Ian

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Ian,
Stop the minutia and I will stop the hyperbole
and
you should entertain my ideas when they make sense to you irregardless of hyperbole or patents.
and sorry for another hyperbole but if I am a waffler..
(adj. or verb - indecisive; unable to make up one's mind; playing the safe middle ground due to one's own lack of conviction or sense of morality), I hope your other job is not as an english teacher.
Dennis

I can't really crititise there . The sushi lorry probably did not add to the science of the debate....

R

Dennis,

I thought I made myself quite clear in my first reply to this thread - a post which you never responded to... perhaps as it contained actual real life references???

And if the day ever comes that you explain yourself well enough for your 'ideas' to make sense to me then I promise you I will

You are an absolute tool mate.

Peace out

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I like Minutia and Hyperbole. Both can be relevant if used in moderation!

Ad hominems, however, add nothing.

C'mon guys, we're having a good run around here. Lets stick to the points under discussion and not the people having the discussions aye what.

Robert

Feeling the love.

Minutia... Hyperbole... all sounds like Warhammer to me...

Drsha..

I think the main thing that has got peoples backs up is this..

You have started the post with a statement of what is the most commonly found rear foot type, and then gone on to claim a number of other things, including alluding to the root technique of biomechanics (which is outdated and, i believe, known as incorrect) in a forum with some of the worlds top podiatric clinicians and researchers, with out backing any of your claims up. Something I have learned from being an avid reader and occasional poster on this forum is that "a claim made without evidence can be dismissed without evidence", and that everything posted is fair game for questioning, challenging, contention, ridicule and dismissal... if you can't provide evidence to back this stuff up, provide one mother of a rationale or live with the criticism.

So.. were you asking a question or making a statement?? Do you really want to be using rootian neutrals??

I feel tables like the one shown are useful for clinicians (generally not podiatrists) who need a criteria to work from, if they don't know podiatric biomechanics too well, or for research which needs to be able to quantify a level of foot position, however the FPI already has that space.. and besides, i feel that these measurements are useful in a research setting but perhaps not clinically... there are too many variables in each type for it to be of true clinical relevance.

p.s. at the risk of being pedantic... Be careful of your bold type... At a glance your last post reads...

"the doctor is in the box" "take the doctor out of the box"

What are you trying to tell us??

Sam

(I need to ban myself from Pod Arena post pub...)

We may have found a motto for the arena!

I would add only one thing

And stress that ridicule and dismissal, if warrented, should only follow open minded scrutiny and examination. We should all, and i count myself guilty here, resist the temptation to attack new ideas because they are new, just as we should never ACCEPT new ideas without careful and minute scrutiny.

Regards
Robert

PS
I'm stealing this phrase
Mine now.

Sam Stated:
and that everything posted is fair game for questioning, challenging, contention, ridicule and dismissal... if you can't provide evidence to back this stuff up, provide one mother of a rationale or live with the criticism.

Dennis Replies:
well stated and understood.

Robert

Well done Robert, nice entertaining post, I could see you building up to it and wondered how long it would take you to point out to Dr Sha (Le Tan) this blindingly obvious 'limitation' of the Foot helpers, Neoteric biomechanics, FFT, Foot Centring system.

The problem with some people Robert is no matter how much evidence or logical reasoning to the contrary is placed before them, they will never be disabused of their ideas and theories. They have put too much time and effort into the concept and believe with an unshakeable faith that they are right.


E.G. If they support / believe this then what hope

From a web site somewhere on http://www.<!-- BEGIN TEMPLATE: bbco...code_quote --> Foot Helpers, Neoteric biomechanics, FFT, foot centring system, stops you being lazy

Another quote Oh yeah! I'll nip down to M&S (U.S. Insert WallMart) I need Coca cola, a Hoover, some Adidas trainers oh! and a pair of Foot Centrings, ah! but I can't be bothered, I'm too lazy, if only I'de got my Foot Centring earlier. DoH!
I think some focus on what the brand or product is called might be a start

Coca Cola er! the sparkly drinks company err! the neoplasmic imbibacation errr! Quench Satisfying System.

We Demand - AIG managers jailed, Stop the whaling, an end to racism and oh yeah No1, we demand outcomes and a clinical study of Foot Centring, err Neoteric somthing or other thingy.

SCIENCE!! besides the fact that it makes no grammatical sense, anyone with an ounce of scientific understanding you would see the absurdity of this statement.

What is very useful though is when someone (such as our Dearest Roobeer) has the time and energy to put forward those contrary arguments so that others can see the error and are not then taken in by pseudo scientific flannel.

I predict a Dr Sha holiday coming on or an attention diverting distraction in the form of an outraged tirade of waffling about free speech and closed minds and rudeness.

Here's a quote Your Functional Foot Typing system only pays regard to the static, open chain (non-weightbearing) foot posture.

1) How does this translate to the foot function in closed chain (weight bearing)
and what evidence do you have that there is a correlation between the two?

2) What evidence do you have that there is a causative relationship between your arbitrary foot posture classification and specific foot trauma or more distal pathology?

3) Since your system pays no regard to the posture of the rest of the body, open or closed chain, one must assume that you regard this as unimportant. What evidence do you have to show that your definition of correct foot posture will automatically influence correct body posture and improve performance, as you tacitly claim that it will.?

4) What do you mean when you infer that your Foot Centrings are corrective, preventative, posture and performance enhancing? What evidence do you have of this and what evidence do you have that they perform better than other orthotic and treatment protocols?

5) You describe this as a Functional foot Typing system yet you only measure foot posture in open chain. By applying some vague and arbitrary condition i.e. a strong force, applied at some undefined position that causes a certain foot posture of interest.

a)How do these conditions correlate to the conditions applied to the foot in the closed chain situation?

b) Why do you not classify the foot function as your system name would imply?

c) Would it not make sense to classify the nature of the motion between foot postures in the open chain?

d) Even if you did this would it correlate well with kinematic responses from the forces applied to the foot in the closed chain.?

To answer Dr Sah's OP's

Your argument is completely invalid since your conclusion is not a logical consequence of your premise. Both your propositions may be false and at least one is only true if expressed in the terms of its own tautological argument. Neither supports the other and together they cannot support your conclusion. In other word this argument is a total fallacy even if the conclusion is true which is debatable depending on your point of reference and the vagaries of the statement..

Question:
What are the biomechanical etiologies of The Rigid Rearfoot, Flexible Forefoot Foot Type if not STJ pronation?
Dennis

This argument only works within the boundaries of the rules of your theoretical axiom. In other words one has to accept your argument and its rules before one can make any reasonable statement about it. I do not recognise your rigid rearfoot flexible forefoot criteria so how can I make a reasoned judgement about their aetiology. However I would hazard a guess that your question does not reflect the meaning you intended because the grammar is so rubbish.

All the best Dave

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Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception.

Among other things, Dave has intimated that 'traditional" static non-weightbearing measures may not be good predictors of dynamic function. Also several weightbearing static measures also appear poor predictors. Here are a couple of classic examples:
http://scholar.google.com/scholar?hl...-8&oi=scholarr
http://www.japmaonline.org/cgi/conte...tract/84/4/171

However, it is true to say that other static measures have been demonstrated to be predictive of dynamic function:
http://www.japmaonline.org/cgi/conte...tract/97/2/115

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Dennis,

It is not up to me (or anyone) to prove you incorrect - it is up to you to prove to us you are correct. I await the evidence/research.

My problem here is not that you state which foot type you believe is the most common (I can't disagree with your personal opinions/observations), but that you intimate it is the most common foot type across the board. Again I am assuming by 'most common' you simply mean the foot type you see the most frequently in your clinical practice?

As you asked the most common foot type I see in my practice tends to be that which generates enough pathological force within a given anatomical structure to cause pain/injury via the tissue stress mechanism... but I'm guessing thats not the answer you're after...

Ian

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Simon

Thanks for those references,

And I, probably like most podiatrists, look at non weight bearing characteristics of the foot function and more proximal joints. I do not categorise these characteristics, rather I am looking how the quality and range may impinge on the particular condition or pathology presented. Similarly I look at the weight bearing posture of the foot and the posture of the whole body and make judgements about how they may be related to pathology. Finally I look at how the patient functions dynamically and use all those parameters to make some judgement about the design of a treatment plan. Biometrics form an important part of my assessment and evaluation process but they are not neatly boxed and packed into convenient classifications that have imaginary or arbitrary boundaries and conditions.

As Robert neatly pointed out such systems of categorisation tend to have singularities where a value is not differentiable or has several conflicting values for the same point. As a value approximates the point of a singularity the demarkation between two categories becomes less defined due to system design limitations and system error limitations. Also what happens when a certain pathology doesn't match or doesn't respond to the orthosis design for a particular category, where does one go from there.

All the best Dave

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Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception.