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Are Root Biomechanics Dying?

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  #31  
Old 6th April 2009, 01:43 PM
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Default Re: Are Root Biomechanics Dying?

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Originally Posted by Jeff Root View Post
Kevin, sorry for the delayed responses but I have been away at the Midwest Podiatry Conference. I think you may have missed the essence of my point. Without using a standarized method of bisecting the distal third of the leg and without bisecting the posterior aspect of the heel, how do you know if the foot is supinated or pronated or if the heel is inverted or everted? What is your frame of reference? If you reject Root's biophysical criteria for normalcy and do not subscribe to his methods of biomechanical evaluation of the foot, then what non-Root method do you use to determine if the foot is supianted or pronated?

Jeff Root
www.root-lab.com

Jeff:

Hope you had fun at the Midwest Podiatry Conference.

In my article, I pointed out that the subtalar joint (STJ) neutral is a poorly defined position of the subtalar joint, it is tautological, can't be reproduced from one examiner to another and thus makes scientific investigation of the foot using STJ neutral or of "deformities" that are based on STJ neutral measurements, as advocated by Mert Root, DPM, lacking in reliability.

We simply don't need STJ neutral position since it does not need to be used to evaluate feet. We could eliminate neutral calcaneal stance position and just measure relaxed calcaneal stance position relative to how far from the STJ maximally pronated the STJ is resting in while standing. This is what the Maximal Pronation Test does that I invented and first described back in 1992 (Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992). We used this Maximum Pronation Test as a more reliable indicator of STJ position in our latest foot orthosis study (Javier Pascual Huerta, Juan Manuel Ropa Moreno, and Kevin A. Kirby:Static Response of Maximally Pronated and Nonmaximally Pronated Feet to Frontal Plane Wedging of Foot Orthoses. J Am Podiatr Med Assoc 2009 99: 13-19).

We could also use Tony Redmond's Foot Posture Index which does not use criteria that use STJ neutral position to determine how pronated or supinated a foot is. We could map out the STJ axis which doesn't rely on STJ neutral postion. We could use the Supination Resistance Test which is another test I invented and also first desribed in the chapter that Don Green and I wrote from the 1992 DeValentine book. We could use Eric Fuller's maximum lateral column eversion height test and/or the Hubscher maneuver to evaluate the forces and motion of the foot. None of the above tests need STJ neutral position in order to evaluate the foot.

By the way, Jeff, what is the definition for subtalar joint neutral position that you are currently using? This would be a great way to discuss the many problems with the STJ neutral position.
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Last edited by Kevin Kirby : 6th April 2009 at 05:19 PM.
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  #32  
Old 6th April 2009, 03:42 PM
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Default Re: Are Root Biomechanics Dying?

Quote:
Originally Posted by Kevin Kirby View Post
Jeff:

In my article, I pointed out that the subtalar joint (STJ) neutral is a poorly defined position of the subtalar joint, it is tautological, can't be reproduced from one examiner to another and thus makes scientific investigation of the foot using STJ neutral or of "deformities" that are based on STJ neutral measurements, as advocated by Mert Root, DPM, lacking in reliability.

We simply don't need STJ neutral position since it does not need to be used to evaluate feet. We could simply eliminate neutral calcaneal stance position and just measure relaxed calcaneal stance position relative to how far from the STJ maximally pronated the STJ is resting in. This is what the Maximal Pronation Test does that I invented and first described back in 1992 (Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992). We used this test as a more reliable indicator of STJ position in our latest foot orthosis study (Javier Pascual Huerta, Juan Manuel Ropa Moreno, and Kevin A. Kirby:Static Response of Maximally Pronated and Nonmaximally Pronated Feet to Frontal Plane Wedging of Foot Orthoses. J Am Podiatr Med Assoc 2009 99: 13-19).

We could also use Tony Redmond's Foot Posture Index which does not use criteria that use STJ neutral position to determine how pronated or supinated a foot is. We could map out the STJ axis which doesn't rely on STJ neutral postion. We could use the Supination Resistance Test which is another test I invented and also first desribed in chapter from the 1992 DeValentine book. We could use Eric Fuller's maximum lateral column eversion height test and/or the Hubscher maneuver to evaluate the forces and motion of the foot. None of the above tests need STJ neutral position in order to evaluate the foot.

By the way, Jeff, what is the definition for subtalar joint neutral position that you are currently using? This would be a great way to discuss the many problems with the STJ neutral position.
Kevin,

Can I assume that you are no longer using subtalar joint equilibrium theory since there is no evidence that it can be reproduced from one examiner to the next? How much variability is there in the placement of the line drawn on the plantar surface of the foot from one examiner to the next? Is there any difference between experienced and inexperienced examiners? Craig, where's the study on that one?

What definition are you using to objectively differentiate (quantify) a medially, average (or is it normal?), or laterally deviated STJ axis? I will give you my definition of STJ neutral once again, after you answer that question for me.

You contend that we don't need STJ neutral to evaluate feet yet you continue to use the concept of forefoot varus, valgus, forefoot supinatus, etc. That seems hypocritical. For example, if you have a forefoot supinatus and you pronate the foot, the inverted forefoot to rearfoot is reduced or gone. Unless you use STJ neutral to determine the presence and quantity of forefoot supinatus, how can you determine if the patient has a forefoot supinatus? There are many clinical benefits to using STJ neutral as a basis for comparing feet. While you may advocate discarding them, many practitioners do not. Regardless of your preference, you will continue to need the concept to communicate with others until you can develop or adopt a foot classification system that replaces it. As an example, how many surgical procedures require an neutral position x-ray as a basis for calculating osseous surgical intervention? Since the angular relationship of the osseous structure of the foot changes with positional changers of the foot, which of the alternative systems that you mentioned above will allow x-rays to be taken that are clinically more useful than the neutral position files used today? Random position surgical intervention? Not on my foot!

Some people might advocate getting rid of speed limits because 1) there is variability between speedometers, 2) no one actually follows the speed limit, and 3) no one can agree on the best speed. So the solution is to remove all speedometers from cars. But what is a better system?
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  #33  
Old 6th April 2009, 08:37 PM
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Default Re: Are Root Biomechanics Dying?

Quote:
Originally Posted by Jeff Root View Post
Without using a standarized method of bisecting the distal third of the leg and without bisecting the posterior aspect of the heel, how do you know if the foot is supinated or pronated or if the heel is inverted or everted? What is your frame of reference? If you reject Root's biophysical criteria for normalcy and do not subscribe to his methods of biomechanical evaluation of the foot, then what non-Root method do you use to determine if the foot is supianted or pronated?
Quote:
Originally Posted by Kevin
In my article, I pointed out that the subtalar joint (STJ) neutral is a poorly defined position of the subtalar joint, it is tautological, can't be reproduced from one examiner to another and thus makes scientific investigation of the foot using STJ neutral or of "deformities" that are based on STJ neutral measurements, as advocated by Mert Root, DPM, lacking in reliability.

We simply don't need STJ neutral position since it does not need to be used to evaluate feet. We could eliminate neutral calcaneal stance position and just measure relaxed calcaneal stance position relative to how far from the STJ maximally pronated the STJ is resting in while standing. This is what the Maximal Pronation Test does that I invented and first described back in 1992 (Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992). We used this Maximum Pronation Test as a more reliable indicator of STJ position in our latest foot orthosis study (Javier Pascual Huerta, Juan Manuel Ropa Moreno, and Kevin A. Kirby:Static Response of Maximally Pronated and Nonmaximally Pronated Feet to Frontal Plane Wedging of Foot Orthoses. J Am Podiatr Med Assoc 2009 99: 13-19).

We could also use Tony Redmond's Foot Posture Index which does not use criteria that use STJ neutral position to determine how pronated or supinated a foot is. We could map out the STJ axis which doesn't rely on STJ neutral postion. We could use the Supination Resistance Test which is another test I invented and also first desribed in the chapter that Don Green and I wrote from the 1992 DeValentine book. We could use Eric Fuller's maximum lateral column eversion height test and/or the Hubscher maneuver to evaluate the forces and motion of the foot. None of the above tests need STJ neutral position in order to evaluate the foot.
Jeff:

You asked me a few questions which I believe I answered. I only asked one question of you.

Quote:
Originally Posted by Kevin
By the way, Jeff, what is the definition for subtalar joint neutral position that you are currently using?
To which you replied:

Quote:
Originally Posted by Jeff Root
Can I assume that you are no longer using subtalar joint equilibrium theory since there is no evidence that it can be reproduced from one examiner to the next? How much variability is there in the placement of the line drawn on the plantar surface of the foot from one examiner to the next? Is there any difference between experienced and inexperienced examiners? Craig, where's the study on that one?

What definition are you using to objectively differentiate (quantify) a medially, average (or is it normal?), or laterally deviated STJ axis? I will give you my definition of STJ neutral once again, after you answer that question for me.
I would appreciate an answer to the only question I asked of you, Jeff, (i.e. what is the definition for subtalar joint neutral position that you are currently using?) if you want me to continue this discussion with you.
__________________
Sincerely,

Kevin

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Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

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**************************************************
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  #34  
Old 6th April 2009, 09:44 PM
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Default Re: Are Root Biomechanics Dying?

Quote:
Originally Posted by Kevin Kirby View Post
Jeff:

You asked me a few questions which I believe I answered. I only asked one question of you.

I would appreciate an answer to the only question I asked of you, Jeff, (i.e. what is the definition for subtalar joint neutral position that you are currently using?) if you want me to continue this discussion with you.
This conversation is not worth continuing since you are unwilling to acknowledge the weaknesses of your own theories and since you are attempting to dismiss the limitations of your theories but are more than willing to discredit the theories of others. This horse was dead years ago!
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Old 6th April 2009, 09:47 PM
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Default Re: Are Root Biomechanics Dying?

Quote:
Originally Posted by Jeff Root View Post
Kevin,

Can I assume that you are no longer using subtalar joint equilibrium theory since there is no evidence that it can be reproduced from one examiner to the next? How much variability is there in the placement of the line drawn on the plantar surface of the foot from one examiner to the next? Is there any difference between experienced and inexperienced examiners? Craig, where's the study on that one?

What definition are you using to objectively differentiate (quantify) a medially, average (or is it normal?), or laterally deviated STJ axis? I will give you my definition of STJ neutral once again, after you answer that question for me.
Kevin, what was your answer?
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  #36  
Old 7th April 2009, 05:12 AM
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Default Re: Are Root Biomechanics Dying?

Kevin Stated:
The Maximal Pronation Test does that I invented and first described back in 1992 (Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992). We used this Maximum Pronation Test as a more reliable indicator of STJ position in our latest foot orthosis study (Javier Pascual Huerta, Juan Manuel Ropa Moreno, and Kevin A. Kirby:Static Response of Maximally Pronated and Nonmaximally Pronated Feet to Frontal Plane Wedging of Foot Orthoses. J Am Podiatr Med Assoc 2009 99: 13-19).

We could also use Tony Redmond's Foot Posture Index which does not use criteria that use STJ neutral position to determine how pronated or supinated a foot is. We could map out the STJ axis which doesn't rely on STJ neutral postion. We could use the Supination Resistance Test which is another test I invented and also first desribed in the chapter that Don Green and I wrote from the 1992 DeValentine book. We could use Eric Fuller's maximum lateral column eversion height test and/or the Hubscher maneuver to evaluate the forces and motion of the foot. None of the above tests need STJ neutral position in order to evaluate the foot.

This is a great and timely debate. I predict that it will turn personal and ugly as Kirby's arguments and skills are shown to have many of the same flaws as he denounces others with. At some point, The Administrator will close the thread as he does with all opposing threads whether meritorious or not. I am calling this symptom complex "Arenaitis".

Dennis Debates
I have no argument that these evaluaton and diagnostic techniques you and your colleagues have invented represent one possible direction for consideration as uogrades and expansions on diagnosis and evaluating feet biomechanically but have they led to any advances in treatment?
Have they expanded, upgraded or changed your casting technique for creating an orthtoic shell?

Your lab pictures and those that I have seen you post on The Arena of your orthotic shells seem to be generated from a Root Suspension technique which you then Rx with your inventions?
If so, what difference does it make cinically if you use Dr. Roots fallable strategy or your fallable strategy? I think that is Jeffs point and it deserves an answer, not a dodge.
If not, please describe the advances in casting a foot orthotic negative cast that your inventions, terminology and research have fostered as I will be glad to incorporate them into my treatment plans.
Dennis
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  #37  
Old 7th April 2009, 09:34 AM
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Default Re: Are Root Biomechanics Dying?

Can I play?

Quote:
If you reject Root's biophysical criteria for normalcy and do not subscribe to his methods of biomechanical evaluation of the foot, then what non-Root method do you use to determine if the foot is supianted or pronated?
I think that there is an error in considering a foot to be pronated or supinated in terms of describing "a foot". Depending on where one defines neutral the more recent Mc poil and Cornwall data (1994?) suggests that

A: the foot is never in a static position, passing through most degrees from a bit pronated to maximally pronated twice in each stance

B: the foot never actuall passes through neutral while WB!

I think to describe a foot as pronated or supinated is like describing a person as seated or standing. It describes what they are doing this second not what they are.

One can see what a foot is doing. One can derive what is creating excessive tissue stress. One can attempt to push the foot in such a direction as to attenuate same. Whether that foot in static WB is described as pronated, supinated, rigid or flexible or 23.6675 degrees for the rotation of the planet does not change what it IS. Its all just how we describe it! Semantics if you will.

[quote]Can I assume that you are no longer using subtalar joint equilibrium theory since there is no evidence that it can be reproduced from one examiner to the next? How much variability is there in the placement of the line drawn on the plantar surface of the foot from one examiner to the next? Is there any difference between experienced and inexperienced examiners? Craig, where's the study on that one?

What definition are you using to objectively differentiate (quantify) a medially, average (or is it normal?), or laterally deviated STJ axis? I will give you my definition of STJ neutral once again, after you answer that question for me.[quote]

Kevin is, of course, uniquely qualified to answer this question. Its a good one too, for all the kinematic and kinetic data on wedges, posts and different types of orthotics i've never seen a kinematic OR kinetic study on the effect of a Medial Heel Skive vs a medial heel post. I'd love to.

I think there is an issue of inductive vs deductive evidence however. SALRE is a model based on deductive reasoning rather than inductive evidence, as indeed is the Rootian model. The latter has been subjected to much inductive testing and provided some mixed results with it. SALRE, as a model, would be harder to test because it is not a fixed protocol.

However I think there is a fundamental difference between the potential unrepeatability of finding an axis and that of bisecting a calc which lies at the core of the difference between SALRE and the Rootian model. The line of the axis is not used as a quantified variable in the prescription of an orthotic. SALRE is not a formula for how to prescribe an orthotic, rather a model of how to think WHILST formulating a prescription. For me axial location is a gross measurement for a gross modification. I'd not be confident in my intra rater repeatibility of finding an axis. I WOULD be confident in distinguishing a foot with a very medially deviated axis from one without. The bisection of a calc, by contrast, makes an incremental difference to the prescription of an orthotic and as an underlying model, suggests a quantifiable system.

Quote:
Some people might advocate getting rid of speed limits because 1) there is variability between speedometers, 2) no one actually follows the speed limit, and 3) no one can agree on the best speed. So the solution is to remove all speedometers from cars. But what is a better system?
An interesting analogy, but a flawed one IMO. We are all inclined to drive too fast. Perhaps a better one is how many calories should one consume in a day. We could come up with a system based on BMI, metabolism etc, or we could just let people eat what they feel they need. Both have flaws!


Kind regards
Robert

Quote:
This is a great and timely debate. I predict that it will turn personal and ugly as Kirby's arguments and skills are shown to have many of the same flaws as he denounces others with. At some point, The Administrator will close the thread as he does with all opposing threads whether meritorious or not. I am calling this symptom complex "Arenaitis".
I think you misjudge you're colleagues Dennis.
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Old 7th April 2009, 10:18 AM
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Robert:
I hope I am misjudging but I wrote it to reduce the slimy comments from surfacing by harvesting the energy of some of the members in delighting in proving me wrong.
Dennis
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Old 7th April 2009, 11:38 AM
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Default Re: Are Root Biomechanics Dying?

Hi Dennis

Quote:
I hope I am misjudging but I wrote it to reduce the slimy comments from surfacing by harvesting the energy of some of the members in delighting in proving me wrong.
Dennis
Nope don't think your wrong ,that is that they have proved you wrong,because you are wrong ,and being wronged as you feel you have been wronged, you are very wrong and carrying on your wailing about being wrong is spoiling what is a great discussion.

DENNIS DO YOU SEE A PATTERN EVOLVING HERE?????

Two ears one mouth, listen twice as much as you speak.

Just a piece of friendly advice
Cheers
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Old 7th April 2009, 12:06 PM
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Quote:
Originally Posted by Robertisaacs View Post
Can I play?

I think there is an issue of inductive vs deductive evidence however. SALRE is a model based on deductive reasoning rather than inductive evidence, as indeed is the Rootian model. The latter has been subjected to much inductive testing and provided some mixed results with it. SALRE, as a model, would be harder to test because it is not a fixed protocol.

However I think there is a fundamental difference between the potential unrepeatability of finding an axis and that of bisecting a calc which lies at the core of the difference between SALRE and the Rootian model. The line of the axis is not used as a quantified variable in the prescription of an orthotic. SALRE is not a formula for how to prescribe an orthotic, rather a model of how to think WHILST formulating a prescription. For me axial location is a gross measurement for a gross modification. I'd not be confident in my intra rater repeatibility of finding an axis. I WOULD be confident in distinguishing a foot with a very medially deviated axis from one without. The bisection of a calc, by contrast, makes an incremental difference to the prescription of an orthotic and as an underlying model, suggests a quantifiable system.

.
I agree! When you manufacture an orthosis using a POP cast or a digital, 3-D model of the foot, the frontal plane orientation of the model must be determined during the manufacturing process. We have no choice in this matter. Whether this is determined by the practitioner using heel bisection, forefoot to rearfoot angle, or randomly (post to cast, correct as is, etc), or in the lab by a technician, the frontal plane position of the cast or image must be determined to make a device. Therefore, like it or not, someone is determining the position of the heel in the frontal plane. I find it interesting that the one plane we must actually determine to manufacture an orthosis is the one plane that gives some on this forum so much trouble. It doesn’t matter if the cast is ad/abducted during manufacturing and we do not alter the sagittal plane orientation of the cast.

Questioning the reliability of heel bisections and the value of forefoot to rearfoot relationships within the foot does not absolve us of our obligation to somehow govern the position of the cast in the frontal plane during the manufacturing of orthoses. When we determine the frontal plane orientation of the cast, we are establishing the frontal plane relationship of the forefoot to the rearfoot and the relationship of the plantar plane of forefoot and the rearfoot to the ground. Whether you choose to measure it or not is irrelevant. In my opinion, anyone who suggests that this is not significant has no business prescribing or making prescription orthoses and is living a state of denial.

I doubt that many of those who question the reliability of forefoot to rearfoot measurements actually use the forefoot measuring device that Dr. Root helped develop. Unfortunately they no longer seem to be available. Much to my surprise, I noticed that even Kevin Kirby wasn’t using one in his recent article about Root theory. It’s no wonder there are issues of reliability when we don’t even use proper and consistent measuring tools and techniques.

I also noticed that Kevin Kirby’s heel bisection did not appear to use the same technique as that described by Dr Root and which I describe on our website. Note a solid heel bisection line (Kirby in Podiatry Today) versus a segmented line as per Root (if interested, see http://www.root-lab.com/takingagoodcast_p2.htm).

The posterior, superior aspect of the calcaneus has a parabolic shape which can be palpated and bisected with reasonable clinical reliability. The fact that many people don’t actually bisect the heel as described by Root is the primary reason that there is such wide variability between practitioners. You can lead a horse to water but you can’t make him drink. But when he doesn’t drink, I’m left to beating another dead horse.

Regards,
Jeff Root
www.root-lab.com
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Old 7th April 2009, 12:42 PM
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Default Re: Are Root Biomechanics Dying?

An excellent letter from Larry Huppin, DPM, who is a consultant for ProLab Orthotics just came into my inbox on PM News. Larry replied to reader’s request for information about foot scanners. Read this and tell me if Root theory sounds like it is dying and what paradigm is best represented by Larry when considering a foot scanner.

http://www.podiatrym.com/letters2.cfm?id=25631&start=1
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Old 7th April 2009, 01:55 PM
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Default Re: Are Root Biomechanics Dying?

Quote:
Originally Posted by Jeff Root View Post
I agree! When you manufacture an orthosis using a POP cast or a digital, 3-D model of the foot, the frontal plane orientation of the model must be determined during the manufacturing process. We have no choice in this matter. Whether this is determined by the practitioner using heel bisection, forefoot to rearfoot angle, or randomly (post to cast, correct as is, etc), or in the lab by a technician, the frontal plane position of the cast or image must be determined to make a device. Therefore, like it or not, someone is determining the position of the heel in the frontal plane. I find it interesting that the one plane we must actually determine to manufacture an orthosis is the one plane that gives some on this forum so much trouble. It doesn’t matter if the cast is ad/abducted during manufacturing and we do not alter the sagittal plane orientation of the cast.

Questioning the reliability of heel bisections and the value of forefoot to rearfoot relationships within the foot does not absolve us of our obligation to somehow govern the position of the cast in the frontal plane during the manufacturing of orthoses. When we determine the frontal plane orientation of the cast, we are establishing the frontal plane relationship of the forefoot to the rearfoot and the relationship of the plantar plane of forefoot and the rearfoot to the ground. Whether you choose to measure it or not is irrelevant. In my opinion, anyone who suggests that this is not significant has no business prescribing or making prescription orthoses and is living a state of denial.
We do have some choice in this matter. When I make/prescribe an orhotic I start with how much intrinisc forefoot valgus post I want. (Determined by maximum eversion height measurement.) Then I look at the shape of the plantar surface of the heel. If I want an inverted appearing heel and the heel appears everted, I add more medial heel skive or more plantar lateral expansion to make the bottom of the cast appear as I want it to. So, I'm making an orthotic without bisecting the heel. I've heard of one method to bisect the heel of a cast is to set the cast on the table and rotate it until the underside of heel has its center point contact the ground. So, you could say that I am using a sort of a heel bisection, but that's open for debate. I may be using the concept of forefoot valgus, but I'm not deriving how I use it with the Root paradigm. I believe it is possible to use a forefoot valgus wedge without using the Root paradigm or using neutral position. However, for someone who disagrees with that the Root paradigm will live on forever.

Quote:
Originally Posted by Jeff Root View Post
I doubt that many of those who question the reliability of forefoot to rearfoot measurements actually use the forefoot measuring device that Dr. Root helped develop. Unfortunately they no longer seem to be available. Much to my surprise, I noticed that even Kevin Kirby wasn’t using one in his recent article about Root theory. It’s no wonder there are issues of reliability when we don’t even use proper and consistent measuring tools and techniques.

some cut..

The posterior, superior aspect of the calcaneus has a parabolic shape which can be palpated and bisected with reasonable clinical reliability. The fact that many people don’t actually bisect the heel as described by Root is the primary reason that there is such wide variability between practitioners. You can lead a horse to water but you can’t make him drink. But when he doesn’t drink, I’m left to beating another dead horse.

Jeff, When I was at the California College, we had everyone in the biomechanics depart bisect the same heel. There was a 5 degree range in the bisections. This is just the heel bisection. When you have different loads on the lateral colulmn there will be an additional variatiion in the forefoot to rearfoot measurement. It won't matter what instruments you use if you push with variable amounts of force the forefoot or rearfoot measurement will vary. Even if you got one practioner to standardize their technique, there is no way to determine if this standardization is the correct standardization.

Another problem with basing a prescription off of a forefoot to rearfoot measurement taken in neutral position is that the foot usually stands more pronated than neutral position and in this position there will be a different forefoot to rearfoot measurement because of the increase in range of motion of the midtarsal joint.

Keep the usefull parts and discard what is found not to be usefull. I have not found all those 2/3 - 1/3 calculations that John Weed taught to be usefull.

Regards,

Eric Fuller
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Old 7th April 2009, 02:08 PM
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Default Re: Are Root Biomechanics Dying?

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Originally Posted by drsha View Post

Dennis Debates
I have no argument that these evaluaton and diagnostic techniques you and your colleagues have invented represent one possible direction for consideration as uogrades and expansions on diagnosis and evaluating feet biomechanically but have they led to any advances in treatment?
Have they expanded, upgraded or changed your casting technique for creating an orthtoic shell?
Yes, I use those techniques to change my prescription. I use a variation on the maximum proantion test I call the maximum eversion height. I do not use a forefoot valgus post higher than that measurment because that post would attempt to evert the foot farther than the available range of motion.

I also use STJ axis location to determine whether or not to add a medial or lateral heel skive to the orthosis. I have found that there is not much corelation between STJ axis transverse plane position and pronation end of range of motion position. I can predict how STJ axis position will effect liklihood of certain pathology by STJ axis position. I would have to have a pretty good reason for trying a different approach than this.

So, Dennis, how do your centrings vary for the different foot types and what is the logic for this variation?

Regards,

Eric
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Old 7th April 2009, 02:21 PM
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Originally Posted by Jeff Root View Post
If you reject Root's biophysical criteria for normalcy and do not subscribe to his methods of biomechanical evaluation of the foot, then what non-Root method do you use to determine if the foot is supianted or pronated?
Jeff, I agree with Kevin's comments about using maximally pronated position as a more consistant reference point. However, to go beyond that we should question whether or not we need to determine if the foot, or STJ, is supinated or pronated. Treatment using the biophysical criteria of normalcy is designed to correct the "deformity" with a wedge or orthotic. An alternate paradigm for treating the foot is identifying the structure that hurts and decreasing stress on that structure. You can relieve stress on a structure without deciding if the foot is pronated or supinated.

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Old 7th April 2009, 02:40 PM
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Default Re: Are Root Biomechanics Dying?

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Questioning the reliability of heel bisections and the value of forefoot to rearfoot relationships within the foot does not absolve us of our obligation to somehow govern the position of the cast in the frontal plane during the manufacturing of orthoses. When we determine the frontal plane
Noting this particular image on your site:


I know of at least one chiropodist who uses a felt tip marker to actually transfer the line to the plaster during casting. It seems sensible enough, segmented or otherwise, and is very useful to eliminate lab discreprencies. they also inscribe the center of the 1st and 5th metatarsals, which is particularly helpful for the 5th in some cases.
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Old 7th April 2009, 02:54 PM
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Default Re: Are Root Biomechanics Dying?

I think Jeff has hit the crux of this.

You may think you can discount forefoot to rearfoot relationship in prescribing but you cant when it comes to manufacture.

The forefoot to rearfoot relationship may not be necessary to explain the function of a real foot but in rigid plaster cast it has to be accounted for. You may not but your lab will have to for you.
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Old 7th April 2009, 03:08 PM
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Sorry all, In an earlier post I meant to answer this post.

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Originally Posted by Jeff Root View Post
Kevin,

Can I assume that you are no longer using subtalar joint equilibrium theory since there is no evidence that it can be reproduced from one examiner to the next? How much variability is there in the placement of the line drawn on the plantar surface of the foot from one examiner to the next? Is there any difference between experienced and inexperienced examiners? Craig, where's the study on that one?
I believe Craig did something on supination resistance and STJ axis position.

One of the major advantages, for me, of the tissue stress over neutral position theory, is the explanation of pathology and the logic behind treatment. Peroneal tendonitis is a good example. Peroneal tendonitis is often associated with lateral ankle instability. Under STJ neutral theory people have used the rationale that we should supinate the STJ to make it more stable. In my experience this makes the problem worse. Under tissue stress you use a forefoot valgus wedge to pronate the STJ and "rest" the peroneal tendon. You could do this without looking at axis position, but in my experience, most people with peroneal tendonitis have laterally deviated STJ axes. (It's often hard to palpate the location of the axis in these individuals because they have a very strong anti supination reflex. When you push medial to their STJ axis, their peroneal muscles will contract to the slightest inversion motion.)

Tissue stress helps you design the treatment. If it doesn't work you could have done too much or too little and you modify your treatment based on the response. When I was a student, when an orthotic didn't achieve the desired results, my instructors would start over again. I can't always say that we looked for our mistake in applying the paradigm. But there must have been one, otherwise the orthotic would have worked.

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Originally Posted by Jeff Root View Post
You contend that we don't need STJ neutral to evaluate feet yet you continue to use the concept of forefoot varus, valgus, forefoot supinatus, etc. That seems hypocritical. For example, if you have a forefoot supinatus and you pronate the foot, the inverted forefoot to rearfoot is reduced or gone. Unless you use STJ neutral to determine the presence and quantity of forefoot supinatus, how can you determine if the patient has a forefoot supinatus? There are many clinical benefits to using STJ neutral as a basis for comparing feet. While you may advocate discarding them, many practitioners do not. Regardless of your preference, you will continue to need the concept to communicate with others until you can develop or adopt a foot classification system that replaces it. As an example, how many surgical procedures require an neutral position x-ray as a basis for calculating osseous surgical intervention? Since the angular relationship of the osseous structure of the foot changes with positional changers of the foot, which of the alternative systems that you mentioned above will allow x-rays to be taken that are clinically more useful than the neutral position files used today? Random position surgical intervention? Not on my foot!
Certainly, I would not have any surgery performed on my foot based on an xray finding alone whether the x-ray was done in neutral or not. I question how much thought went into suggesting that x-rays be taken in neutral position for making x-ray measurements. I'm trying to think of a procedure where it would be necessary to know a neutral position X-ray angle before doing surgery.

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Originally Posted by Jeff Root View Post
Some people might advocate getting rid of speed limits because 1) there is variability between speedometers, 2) no one actually follows the speed limit, and 3) no one can agree on the best speed. So the solution is to remove all speedometers from cars. But what is a better system?
This is an excellent argument for using STJ axis position as well as using netural position related measurements. However, I can explain pathology based on STJ axis measurements. I often have a hard time explaining pathology using the neutral position explanations. For example posterior tibial dysfunction. STJ axis position gives an explanation of why some feet are more likely to get this pathology. The windlass can explain bunion formation through reverse buckling. I challange anyone to make sense of the hypermobility explanation of bunion formation in Normal and Abnormal Function of the Foot.

I think the neutral position concept of a not fully compensated rearfoot and forefoot varus is a very important clinical concept. However, I don't understand why you need to separate out whether it's a forefoot or a rearfoot varus. Either way the STJ runs out of range of motion before the medial forefoot gets to the ground. Now, if they only connected this to sinus tarsi syndrome which occurs when the lateral process of the talus hits the floor of the sinus tarsi when the STJ is at the end of its range of motion. We can certainly keep the concept of not fully compensated varus, but we don't need neutral position to do it.

Regards,

Eric Fuller
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Old 7th April 2009, 03:31 PM
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Originally Posted by Lawrence Bevan View Post
I think Jeff has hit the crux of this.

You may think you can discount forefoot to rearfoot relationship in prescribing but you cant when it comes to manufacture.

The forefoot to rearfoot relationship may not be necessary to explain the function of a real foot but in rigid plaster cast it has to be accounted for. You may not but your lab will have to for you.
Lawrence:

I have been using the plane of the plantar forefoot relative to the ground as the reference position for how most of my postive casts are balanced relative to the ground by the orthosis lab for many years now. I have used this method in approximately 3,000 pairs of orthoses with very good results. This method of "cast balancing" eliminates the need for heel bisections and overall improves accuracy.

Therefore, contrary to the opinion you expressed above, you can discount forefoot to rearfoot relationship when it comes to orthosis manufacture by simply indicating to the orthosis lab how inverted or everted you want the plane of the forefoot balanced relative to the ground when the orthosis is manufactured. There is not just "the one right way", like I was taught at CCPM, when it comes to orthosis manufacture.
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Old 7th April 2009, 03:40 PM
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Default Re: Are Root Biomechanics Dying?

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Are Root Biomechanics Dying?
...all depends how you choose to define "Root Theory"
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Old 7th April 2009, 03:43 PM
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Default Re: Are Root Biomechanics Dying?

I want to add some questions because I know I can not provide any answers or rational explanations to this discussion.

First of all, is podiatry an science? I have done some search on Podiatry Arena and I have rescued a not very successful thread open by David Smith
Falsafiability of Podiatric science. I think you can find some interesting points reading David Smith comments. Mainly: all podiatric biomechanichs theories are falsifiable. Falsifiable does not mean false. Just means I can show enough data (or just one) for any of them that demonstrate flawed or wrong hypothesis by experimentation. None of the podiatric biomechanichs theories authors have been able to demonstrate their theories by experimentation. Of course, you can argue about owns Popper's Falsafiability theory falsafiability by citing Kuhn's work (The Structure of Scientific Revolutions) for example. But, any podiatrist in the world should be aware about this fact before embracing a podiatric biomechanichs theory without some degree of criticism.

Second, before someone fire the statement "my clinical experience shows me that my theory works". I am sure that Jeff, Kevin and Dennis have high success rates or they would be out of the market years ago. Clinical evidence do not explain us how a device work or why patients refer an improvement. Can anyone tell me why a foot orthotic do not work ? Do not tell me it is patient's fault! If you have been following any paradigm you choose and you are sure that a device must work, but it does not. How can you explain it? If it works you explain using your paradigm but if not?

Third, I can recall an historical trivia about a German Prince asking Gottfried Leibniz to explain him Newton's Principia Mathematica without the maths. Leibniz told him it was impossible. But it seems possible with podiatric biomechanics, we use the word biomechanics without the maths. Why should be we worried for such a thing like maths that it is not in our academic curriculum? It is a waste of time we said. It is all about clinical evidence, we state.

Result: podiatry is not a science and we use the maths that run our computers for repetitive discussion without end like a Moebius strip.

Also philosophy of science should be considered before signing a theory's dead certified.

Just a thought.
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Old 7th April 2009, 03:51 PM
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Default Re: Are Root Biomechanics Dying?

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Originally Posted by Kevin Kirby View Post
Lawrence:

I have been using the plane of the plantar forefoot relative to the ground as the reference position for how most of my postive casts are balanced relative to the ground by the orthosis lab for many years now. I have used this method in approximately 3,000 pairs of orthoses with very good results. This method of "cast balancing" eliminates the need for heel bisections and overall improves accuracy.

Therefore, contrary to the opinion you expressed above, you can discount forefoot to rearfoot relationship when it comes to orthosis manufacture by simply indicating to the orthosis lab how inverted or everted you want the plane of the forefoot balanced relative to the ground when the orthosis is manufactured. There is not just "the one right way", like I was taught at CCPM, when it comes to orthosis manufacture.
Sounds to me like a very subjective approach to foot orthotic therapy unless one relates the plane of the forefoot to the other anatomical structures to which it attaches, including the rearfoot and leg. How does one know if the plane of the forefoot should be inverted or everted to the ground? I have some lab customers who request their orthoses be corrected to a certain forefoot or rearfoot position (i.e. balance forefoot 10 degrees everted or balance cast with heel 5 degrees inverted, etc.) Nothing new there. Hopefully they are using some criteria such as RCSP, STJ rom, etc and are not just picking a number out of thin air. "Root theory" is much more than neutral postion theory as suggested. Merton Root never called it Root theory or neutral postion theory, he just called it biomechanics. Wouldn't it be great to just discuss biomechanics and leave the labels that detract from the meaing of it out of the equation.
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Old 7th April 2009, 03:51 PM
Lawrence Bevan Lawrence Bevan is offline
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Default Re: Are Root Biomechanics Dying?

Kevin

Having read your books I understand you.

However what I was getting at is although a clinician may discount a forefoot deformity if you capture one in your cast it can have potentially a large effect on the shape of the device unless it is dealt with by the prescriber (or lab).
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Old 8th April 2009, 12:07 AM
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Default Re: Are Root Biomechanics Dying?

What a fantastic thread Thanks to all taking part!

A thought came to me last night vis a vis this comment

Quote:
You contend that we don't need STJ neutral to evaluate feet yet you continue to use the concept of forefoot varus, valgus, forefoot supinatus, etc.
Variations on which have appeared before. It was while I was eating set menu b (crispy shredded chilli beef, seaweed and special fried rice). Perhaps the original root theory was the first real recipe book. It gave us fantastic ingredients we had never seen before and a detailed recipe for how to cook them into a wholesome dish. Previous to that we had just been putting bits of meat in the oven til they went brown and eating them.

Since then there have been new ingrediants discovered and many new recipe books written. Most of these make a dish which is unpleasant to most paletes. Some of the new ingrediants are unwholesome, many are nice but not to everybodies taste.

Many of us are now saying that we can create new dishes by cooking some of the old, and some of the new ingrediants to make different food. Thats not to say the original recipe is less wholesome than it ever was. But must we forever use those ingrediants in the same way.

I suppose to extend the metaphor one might say that if one is a poor or inexperianced chef its best and safest to stick to the recipe of a great one. If, however, one is a good chef, who understands how the ingrediants work, it would be a shame for that chef not to try to make their own dish.

Regards
Robert
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Old 8th April 2009, 12:25 AM
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Quote:
Questioning the reliability of heel bisections and the value of forefoot to rearfoot relationships within the foot does not absolve us of our obligation to somehow govern the position of the cast in the frontal plane during the manufacturing of orthoses.
Depends which way one looks at it. If we assume that an orthotic represents a position that we seek to acheive then certainly. If we view an orthotic as something which changes forces to move away from a certain tissue stress crisis then the biometrics and morphology of the foot may have little to do with the desired morphology of the orthotic!

For me the posting and modifacation of the shell is more about being able to extert force on the foot in the most comfortable way possible rather than acheiving a certain position of the foot.

Regards
Robert
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Old 8th April 2009, 03:50 AM
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Default Re: Are Root Biomechanics Dying?

This thread seems to me like a microcosm of modern podiatric biomechanics.
Dr. Root gave us gifts that have been examined, expanded, upgraded and modernized. Theories have risen on Roots shoulders but they are in opposition instead of in sync as they could be. Clinically valid yet scientifically flawed ways of examination, diagnosis and care remain isolated and encapsulated without a common foundation.

Although everyone tauts to be a whole foot specialist when it comes to examination, casting, Rx'ing and fabrication of orthotics, the bulk of the discussion remains entrenced in the rearfoot and the STJ as the center of the universe where Dr. Root started.

There is little discussion relative to The Vault of The Foot and the forefoot or the foot taken as a whole.

What if the center of our care is The Vault and the two bases (rearfoot and forefoot) are where the foot plants to recieve GRF and all three need equatable evaluaton, diagnosis and care?

If we had Alladin's Lamp what would be our three wishes.

1. Be capable of reducing abnormal moments around the STJ while enabling the musculotendonous units to fire with power and in phase (relative to gait) and translate function from aboverand into the forefoot through The Vault.
2. Enable The Vault of the foot to be supported to the extent that it leverages the extrinsic and intrinsic musculotendonous units while reducing the need for the plantar fascia, plantar plate, spring ligament, etc to be a part of that support since these structures cannot support and perform over ones lifetime without breakdown, injury and performance issues.
3. Enable the forefoot to be an excellent adaptive structure, when necessary, a rigid lever and supporter, when necessary and most important be able to morph and multipurpose upon command throughout all of its flexible-rigid tasks, with power and in phase.

We need a system of examination and treatment that includes (unskewed) all three areas and a treatment protocol that includes the ability to control and correct problems where they exist and where they are best attacked.

All the math, science, art and unexplained entities that make up biomechanics can then be organized and applied to all foot, foot type and then even further patient specific.

We are debating mousetraps. Maybe we need to decide what we need to look differently at the mouse.

The bias, passion and personalizations that blur our task reflect our frustration, that so far, no one of us has the entire answer and all of our theories are flawed.

The biomechanical glass is more than half full and yet, a visitor suffering from foot and postural pain to The Arena might walk away in pain thinking it was more than half empty when most of us would be able to offer him/her some level of relief and comfort.

Which one of us is willing to say that there is one theory amongst the pack that is the most well rounded and applicable to incorporate all the others so that we can use our combined talents and energy positively?
Don't look at me (hahahahahaha).
dennis
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Old 8th April 2009, 11:12 AM
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Default Re: Are Root Biomechanics Dying?

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There is little discussion relative to The Vault of The Foot
That, Dennis, is because only you and about 12 other pods recognise it or use that terminology! . And you have singularly failed to reach number 13 on this forum by my reckoning!


Whilst neoteric biomechanics is an interesting little sideshow its scarcely one of the dominant models for biomx now is it. . Lets not divert a rather interesting thread on Rootian / Tissue stress biomechanics into another Neoteric sales pitch / tar and feathering. Bored of that now!

Sorry. Bad day again.

Robert.
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Old 8th April 2009, 11:37 AM
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That, Dennis, is because only you and about 12 other pods recognise it or use that terminology!
Nah it can't be that many subscribing to that pish surely...
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Old 8th April 2009, 11:44 AM
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Nah it can't be that many subscribing to that pish surely...
Interesting. Straight forward question, that requires a straight forward answer in numerical digits (if I get one from Dennis, I'll drink my own... again): Dennis, how many people have requested and paid you to use your patented system of foot classification?

I'm considering using it in a piece of research, how much would this cost me?

I'll give you ten pence and a big orange. Not a penny more, or strike me dead.
Sorry for the diversion 'beer but: "you know", another baby peeled, is one less potential scum bag roaming the street.

Chin up
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Old 8th April 2009, 12:27 PM
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Default Re: Are Root Biomechanics Dying?

Dennis

Ive tried, oh how Ive tried to resist this

BUT

Quote:
If we had Alladin's Lamp what would be our three wishes.
Wish # 1 :- To have an OFF switch on your mouth

Wish # 2 :- To enable you with a brain that can integrate with others.

Wish # 3 :- Last but not least

Quote:
Don't look at me (hahahahahaha).
To have the intelligence to wonder why , we are not interested in doing that


Do please try and keep up if you have the mind to continue in this great discussion BUT .......


Cheers
Derek
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Old 8th April 2009, 01:06 PM
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Default Re: Are Root Biomechanics Dying?

Dennis

"He wants the world
Screams everything
Follows in love
Love brings the fall"
70 cities as love brings the fall- simple minds
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