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New Level I EBM Biomechanics Study Surfaces

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  #1  
Old 4th May 2010, 04:42 AM
drsha drsha is offline
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Default New Level I EBM Biomechanics Study Surfaces

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New Level I EBM Biomechanics Study Surfaces

The Jeckyl/Hyde Study Group has just published an amazing RCT paper with mega-analysis confirmation that is going to revolutionize the practice of podiatry.

The paper, published in the prestigious Journal of Red Herring Medicine in its most recent issue (May, 2010) gives Level I Biomechanics Evidence that the International Biomechanics Community, so divided , opinionated and biased, may find hard to accept without reprisal.

Rothbart, B, Glaser, E, Shavelson D: Walking on Hands Cures All Foot and Postural Problems; Journal of Red Herring Medicine, May 2010, pg69

The paper describes a revolutionary new paradigm for practicing biomechanics in podiatry. A three site, 6 month double blinded investigation was conducted that employed the following protocol:

600 patients, all of whom had one or more disabling foot and or postural complaints including medial knee OA were divided into two groups and unknown to the examiners, half of them were given STJ Neutral shell devices, from Kevin Kirby’s Lab, modified with Robert Isaacs treatment modifications personally prescribed and monitored after he examined each patient in a separate area and the other half were taught to walk on their hands.

58% of the 300 patients using Kevin’s suggested casting technique and Roberts Rules showed 94% pain reduction. 8% of them had compensatory new problems and 14% stated that they had to make negative lifestyle adjustments in shoes and activity in order to break in and use the new orthotics in spite of the improved comfort.

100% of the 300 Hand Walkers were totally and permanently cured after the 6 month trial.

This new evidence suggests, no it DEMANDS that all podiatrists immediately stop their current method of practice, no matter how successful it has been in treating patients concerns clinically and convert their Practices into HandWalking Centers (patent pending).

Those wishing to hold on to their current practice habits are to be intimidated, abused and treated meanly so that eventually they will be herded into seeing the light and come on board as biased, self serving EBM trumps ALL.

PS: A sister study for eliminating 5th toe corns is being conducted on patients complaining of painful fifth toe corns where the control half of the participants continue to wear their current shoes and the treated half eliminates all shoes and socks completely. Early results have been encouraging for a barefoot revolution.
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Old 4th May 2010, 06:36 AM
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Default Re: New Level I EBM Biomechanics Study Surfaces

Has it been peer reviewed? I fear it may fall short of Level one evidence.

It was not Blinded, single or double (the study protocol renders such impossible).

I would question the degree to which the groups were randomised since a large proportion of my patients would be unable to walk on their hands and thus would de-facto fall short of the inclusion criteria.

20% of subjects in the Kevin / Robert treatment group were missed from the response rate (presumably through dropout). The numbers for dropout in the hands group were not stated.

No statistical analysis appears to have been carried out on the data.

Seriously though? The example becomes absurd because walking on hands is impossible. If the treatement WERE possible, and it was 100% effective then your later statement that All podiatrists should convert to it becomes entirely plausible. If there was a 100% treatment which was proven by qood quality evidence we SHOULD all convert to it (or at least give it a go). Why would you not? If I offered you the choice of a treatment package 100% proven to prevent heart disease would'nt you want it over one which was 58%

Your point, Dennis, Is lost because you allegory is not consistent with the situation. You suggest an obviously absurd and impractical notion, if supported by evidence must be shown to be true and therefore that the process of evidence is flawed because of it. Obviously this is not true because the evidence would never exist. Because we can't walk on our hands.

Likewise the barefoot one. Most people don't want to / won't walk barefoot. Walking barefoot carries risk. Therefore it's not a valid proposition.

Lets not be getting distracted from the question I'm poised with breathless anticipation for you to answer on the other thread...
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Old 5th May 2010, 05:44 AM
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Default Re: New Level I EBM Biomechanics Study Surfaces

Robert Stated:
Has it been peer reviewed? I fear it may fall short of Level one evidence.

It was not Blinded, single or double (the study protocol renders such impossible).

I would question the degree to which the groups were randomised since a large proportion of my patients would be unable to walk on their hands and thus would de-facto fall short of the inclusion criteria.

20% of subjects in the Kevin / Robert treatment group were missed from the response rate (presumably through dropout). The numbers for dropout in the hands group were not stated.

No statistical analysis appears to have been carried out on the data.

I reply:
Well then, I guess you won't be applying this evidence into your EBP.

As part of your EBM analysis of this evidence, rather then take it at face value, you assessed the evidence for Level, Truthfulness and Applicability, factoring in bias and determined that it lacked applicability and decided not to modify your current treatment or alter your practice.

I once again acknowledge your EBM skills and continue to look to you as a mentor when it comes to EBM. You are the only person I know who is lecturing to groups on Heurism (do you, dare I ask, profit from these lectures you entrepeneur you).

I believe that I am examining much of the evidence you have presented to me using the exact same EBM process and I, like you, decide that it is not relevant for me to incorporate so as to modify my current treatment or alter my practice.

I could take the time to continue to justify walking on hands or barefoot evidence to you until I'm blue in the face, or I can admit that you have made a practical personal decision and move on (without calling your parents mutants or you a cock).


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Old 5th May 2010, 06:41 AM
Jeff Root Jeff Root is offline
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Default Re: New Level I EBM Biomechanics Study Surfaces

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Originally Posted by drsha View Post
[b]The paper describes a revolutionary new paradigm for practicing biomechanics in podiatry. A three site, 6 month double blinded investigation was conducted that employed the following protocol:

600 patients, all of whom had one or more disabling foot and or postural complaints including medial knee OA were divided into two groups and unknown to the examiners, half of them were given STJ Neutral shell devices, from Kevin Kirby’s Lab, modified with Robert Isaacs treatment modifications personally prescribed and monitored after he examined each patient in a separate area and the other half were taught to walk on their hands.
NEWS FLASH: We interrupt this program to bring you this special report:
Today a group of hikers were found dead in a local creek. Apparently the group of hand walkers, all of whom had participated in a study conducted a year ago, attempted to cross a shallow stream today and they all drowned in the process. The group was apparently following an experienced guide who was not a hand walker. The guide attributes his survival to his Kirby orthoses as he was the only survivor. Tune in at eleven for further details. Now back to your regular programming.

In all seriousness Dennis, much of the reaction to you and Ed is based on how you represent your paradigm and product. A golden rule of advertising is, never criticize your competition. Consumers are typically turned off by this approach. This is a basic rule of marketing.

If you feel you have a good or better product (diagnostic and treatment system), then explain the benefits of it. A significant amount of the opposition you experience appears to be related to how you and Ed depict your competitors. By competitors, I am referring to competing theories and products.

The point of my story about the hand walkers is, time will tell what really is in the best interest of the patient.

So let me ask you a question. If I were a practitioner, who for whatever reason was not satisfied with Root type orthoses and I was looking for a new lab, which of the following two labs would get me better results and why? Would it be SoleSupports or Foothelpers? The question is not which product is better than Root, the question is which of these two labs has the better product and why? They are clearly different products and approaches and both claim not to subscribe to strict Root theory. Please compare and contrast them for us. I am especially interested in your opinion of the need for orthotic calibration.

I think it is about time we have a debate between two alternative labs, not traditional labs versus alternative labs. The latter debate ends abruptly every time the line of questioning gets too difficult. Needless to say, I am very frustrated that I can't get Ed to answer Simon’s two fundamental questions on the MASS discussion thread. Whoever said, you can run but you can’t hide, apparently never participated in a podiatry forum with Ed. Time to stop

Sincerely,
Jeff
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Old 5th May 2010, 09:57 AM
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Default Re: New Level I EBM Biomechanics Study Surfaces

Quote:
NEWS FLASH: We interrupt this program to bring you this special report:
Today a group of hikers were found dead in a local creek. Apparently the group of hand walkers, all of whom had participated in a study conducted a year ago, attempted to cross a shallow stream today and they all drowned in the process. The group was apparently following an experienced guide who was not a hand walker. The guide attributes his survival to his Kirby orthoses as he was the only survivor. Tune in at eleven for further details. Now back to your regular programming.


Almost literally PMSL!!!!!!
Quote:
I think it is about time we have a debate between two alternative labs, not traditional labs versus alternative labs.
Perhaps you saw this on the graphs thread?


Why Is that? Why do they never argue in the same threads.
Quote:
I suspect them to be all the SAME INDIVIDUAL . Check the IP addresses Craig!
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Old 7th May 2010, 07:23 AM
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Default Re: New Level I EBM Biomechanics Study Surfaces

To the readers, sit down with a beer and hopefully an open mind for this one.

Jeff Root Stated:
In all seriousness Dennis, much of the reaction to you and Ed is based on how you represent your paradigm and product. A golden rule of advertising is, never criticize your competition. Consumers are typically turned off by this approach. This is a basic rule of marketing.

If you feel you have a good or better product (diagnostic and treatment system), then explain the benefits of it. A significant amount of the opposition you experience appears to be related to how you and Ed depict your competitors. By competitors, I am referring to competing theories and products.

DrSha Replies:

I can't answer for Dr. Glaser but in my case, I am a uniting, EBM advancing and propodiatry force and I have been for decades.
I continue to maintain that as a group, as a group, DPM's are the best educated and clinically prepared to deliver great biomechanical care.

I argue that many of us do not understand the physics and engineering language promoted by Dr. Kirby and The Arena. I have never said that it was anything but correct, I said I didn't undestand it and I am too busy clinically to "catch up".

I believe Kevin's work (what he is known for i.e STJ Axis and the medial skive) is brilliant but it is dedicated to the flexible rearfoot foot types. Otherwise, he has had to take the work of others (i.e., Dananberg) and translate it to a new language and over time, add to it when treating other types that need more than a medial skive or no medial skive at all.
When I lecture, I credit Dr. Root and his greatest student (sorry, not you Jeff) Kevin Kirby, as "The Fathers of the flexible rearfoot type".
I would say that Dr. Kirby's work and especially his protocol for researching (which I am understanding more and more over time) is a role model for us all and is becoming the state of the art for developing evidence.
Where I differ with him is its ability to educate practitioners, the physician community and the foot suffering public about biomechanics. This is where Simon and I differ as to the value of my lay and physician facing material and his inflexibility to change to simpler, more understandable presentations and marketing).

I proclaim Howard Dananberg DPM's work brilliant as he is "The Father of the Rigid Rearfoot/Flexible Forefoot Foot Type, the most common foot type. He is the poster boy of functional foot typing because unlike the critics who call Foot Centering a cookbook paradigm, Dr. Dananberg has dedicated his career to one particular common foot type and its variants and has been an educator, author, clinician, inventor and dare I say it has become (I think) wealthy focusing on the bell curve (the snowflakes) of the rigid/flexible type. I am humbled by Dr. Dananberg as I am humbled by your father, Dr. Root.

Dr. Glaser has revitalized a part of pedal biomechanics that is (for most of you) vestigial and that is the need for many feet to be Vaulted, foot type-specific. Dr. Root lowered the arches and posted the devices of his day and Ed realizes that leveraging and biofeedback is awakened in collapsed foot (feet that flatten Robert) when they are vaulted. He has capitalized on the benifits feet recieve they vaulted that manu of us have forsaken.
I proclaim Dr. Glaser "The Second Coming of Cookbook Vaulting".

I have been vaulting devices for 20 years using different techniques than Dr. Glaser because unlike Ed, in my opinion, many functional foot types need vaulting but THEY NEED MORE. (You guys are giving them more without vaulting so I suggest uniting).

Where I differ most with Ed is that he is a patient advocate. His paradigm is quite simplistic in that three foam casts taken using his very simple MLA raising casting technique, sent to his lab, gets you certified as an expert in his paradigm. This means that eventually (if not already) any 16 year old pimpled man or woman standing in a Mall Kiosk can compete with the years of training of a podiatrist when it comes to expertly working with orthotics.
His devices are simplistic and not expensive to make (pardon me but calibrate my A_ _) and so my vision for Ed is that since his devices serve a very valuable upgraded starting device on the Orthotic Pyramid, they are not professional custom orthotics and should be scaled back appropriately to about $200-250 and used as a first line device for biomechanical problems where if they fail, would bring patients to DPM's or other skilled and educated practitioners for a $600 device that would include the diagnostic, prescribing, monitoring and ancillary treatment skills that they bring to the table.
In addition, my advice to DPM's and other skilled practitioners is to never represent his product as "Professionally Custom" in practice thereby denying Ed the ability to say that the 16 year old is dispensing the same device recommended by podiatry or other professionals.
That remains his reason for buying the lecturn at our lectures and someday, when his product is well branded, he will stop.

I discuss Root from an EBM position and most of the modern evidence (some of which is high level, very applicable and translates well into practice) is revealing Dr. Root's work to need upgrading and or replacement (sorry Jeff). I hope that my EBM mentors are proud of my use of EBM at this moment.
If I had Alladin's Lamp, other than wishing health and emotional and physical wealth for my family and friends, I would wish that the Podiatry community would use EBM at this time to stop the cookbook STJ Neutral Casting (sorry that still means most of you including Kevin) and rearfoot varus wedges and seek an upgrade or replacement for STJ Neutral cookbook biomechanics.

I might as well include ProLabs Sherer and Huppin's "Pathology Speciifc Orthotics" predicated on pain and symptom relief (like most of you have angrily, meanly and argumentatively stated is your goal of care while abusing mine).

I have predicated my entire EBP biomechanics practice for 30+ years on WELLNESS!
I believe I share that common goal with Dr. Root and I have carried on his science in that direction (agree Jeff?).

I include Prevention, Performance Enhancement, Quality of Life as goals in my EBP in addition to immediate comfort and pain relief. I consider what my orthotic will do for the patient long term and have sought correction as a primary goal.

That's why I reject so much of your evidence in my practice because it does not make WELLNESS sense.

Putting a valgus wedge in the rearfoot part of a shoe or device to relieve a complaint of medial knee pain while accepting the compensatory pronation kinetic and kinematic forces that it will have on most feet upon heel contact involving stance, gait, cadence, velocity, stride length and foot and postural sequelae and stating that you have never had or seen any sequelae (without evidence) is more than enough justification for me to decide that your low level evidence is not applicable to my patients needs and does not adequately answer the clinical questions that arise as I search for their answers (my EBM mentors please comment if this is not proper EBP).
My treatments handle medial knee pain while enhancing WELLNESS and if they fail, I suggest that that exposes a need for medical or surgical care by consultants and continue my care pre or post synvisc injection or knee surgery OR I LOWER MY STANDARDS TO YOURS and TREAT AS YU DO.

Very early on, I believed that Root made one major mistake as I saw biomechanics evolve. By sharing his work, he allowed his science to be perverted, basturdized and dismembered and (correct me if I'm wrong Jeff) his dream that his science was not the end all and that it would be researched, upgraded, changed and yes even replaced with better stuff never happened.
How could he have prevented that???
He should have PATENTED!!! (I haven't made a dime on any of you ((YET, hahaha))!

I predict that someday,like working with sagital plane block without crediting Dananberg, you will be vaulting and foot typing in our way or one of your invention or nomenclature and the saddest part of where we are right now is that you are purposely avoiding vaulting and foot typing spitefully in order to avoid giving Ed and I the credit we deserve.

Here's the commercial:
If you believe in WELLNESS as an integral part of biomechanics (that's what Root taught me), in its inherited nature, its predictable lesions, gait patterns, deformities, overuse complexes and the fact that there are groups of patients that have strikingly similar characteristics that deserve sungrouping, I suggest you will be more effective in practice if as part of your exam, you profile all feet into their functional foot types (as an upgrade to pronation/supination, rearfoot/forefoot relationships, etc) and use architectural terminology (The Foot centering Theory) when working with clinically with medical and professional colleagues with less education and experience than you as well as with the foot suffering commnity.

I have a base treatment protocol that I teach that can be used as a start to a Biomechanics EBP but treat as you like (i.e. medial skives for the flexib;e rearfoot types instead of a vertical heel and vaulting) since your treatments may be better than those I suggest because, no matter what, Foot Centering and Wellness Biomechanics will grow.

Jeff:
I close by saying that if you still feel that I am critisizing my competition than I apologize since I do not go to sleep at night thinking how I can eliminate the competition. I think about how I can help my patients and how I can upgrade biomechanics for the sake of us all and I monitor the competition to learn.

I am not the enemy.

I've never asked for this before but HOW ABOUT A THANKS to this posting!

Whew!

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Old 7th May 2010, 09:33 AM
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Default Re: New Level I EBM Biomechanics Study Surfaces

I've had a bad day. I have a headache. And I have 30 sq metres of turf to lay before I can go to bed. Which will be late. I'm in a vile mood. So I'm not going to reply to this today lest there be meanness for real.

But I will tell you this dennis. If you actually expect thanks for this... Well for this, I fear you may be dissappointed.
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Old 7th May 2010, 09:37 AM
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Default Re: New Level I EBM Biomechanics Study Surfaces

Well then Robert, at least it will help clarify things for me.

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Old 7th May 2010, 09:41 AM
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Default Re: New Level I EBM Biomechanics Study Surfaces

Robert I would ask for the hours you spent working gently with the man back.

Goodluck with the turf I´d offer to help but the last time I tried to come to England a volcano got in the way. Beer always helps I´ve found.

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Dennis to quote one of my best mates Jimmy ´cambo´ Campbell one of the hardest men you would ever meet. "You my son need to take a good, long, hard look at yourself".
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Old 7th May 2010, 02:27 PM
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Default Re: New Level I EBM Biomechanics Study Surfaces

I Welcome every one of you to listen to "Meet the Masters'" for free to hear, Drs. Kirby, Dananberg and Shavelson's commets and how each of them answered direct questions.

It's all Free www.PodiatricSuccess.com

See you all at the FIP next week in Amsterdam.

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Old 7th May 2010, 03:20 PM
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Default Re: New Level I EBM Biomechanics Study Surfaces

I liked the illustration of the hand walkers. A a Podiatrist in Michigan,USA our scope of practice includes the soft tissues of the hand. I will still be able to treat both kinds of patients. That being said, I tried to talk to another Doctor today about the diagnosis of equinus using the "McGlameries Comprehensive Foot and Ankle Surgery" text as a reference.I was told since it was not EBM and anybody can write anything they want in a text, he wouldn't discuss it. In my opinion ( even though I am for it) this EBM is getting out of hand. Is there enough EBM out there to base a practice on if we don't use text books? I have started using Foot Centerings and my patients say they work.I also like the simple communication language that goes with it. Just my opinion. Kent Biehler DPM
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Old 7th May 2010, 09:49 PM
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Default Re: New Level I EBM Biomechanics Study Surfaces

Dennis I think you have missed the point of Bio -mechanics. We have laws of nature. These laws Govern how we excist, move and stand up and walk around on earth. Gravity is a law of nature.

The are many laws of Physics, Physics is the key to movement. It should not be and can not be ignored.

As for your long post. There is much to discuss but two areas have seen me wake early this morning shaking my head.

Root et al created a system which for the 1st time looked at the foot and leg in a detailed way, a way to decribe ´normallacy´they also looked at what was not normal and tried to explain the compensation which occurred and how these compesations may cause injury. They gave the profession a system by which to assess patient in a meaningful mannor and then after the results of this exam and treatment path.

By doing this they gave the profession meaning, a path, a boat with a rudder if you will. Think that this was only 40 years ago. Without Root et al we would not be as a profession where we are now.

One day I will reread their text and probably Steven Subnoick sports med of the lower extremity book, they were amazing men.

The other is what you think Kevin Kirby has bought to the profession. I could only hope to do 10% of what he has done.
In my option Kevin has helped us catch up the real world of mechanics think of the word Dennis Bio - Body and Mechancis, now we look at the lower limb and foot, but in discussions with those I know who research the foot they laugh sometimes at what they hear from Podiatrists, while some think they know everything on how the foot works. Those who really look realise we know so little, consider this for a minute.

We should strive to know more.

And in my option Kevin has helped us START looking at the foot by assessing it using the laws of nature I discussed at the start of the post. Force, moments, motion etc. And most importantly Newtonian Physics listed below.


Quote:
Newton's Three Laws
of Motion

--------------------------------------------------------------------------------

Let us begin our explanation of how Newton changed our understanding of the Universe by enumerating his Three Laws of Motion.

Newton's First Law of Motion:
I. Every object in a state of uniform motion tends to remain in that state of motion unless an external force is applied to it.

This we recognize as essentially Galileo's concept of inertia, and this is often termed simply the "Law of Inertia".

Newton's Second Law of Motion:
II. The relationship between an object's mass m, its acceleration a, and the applied force F is F = ma. Acceleration and force are vectors (as indicated by their symbols being displayed in slant bold font); in this law the direction of the force vector is the same as the direction of the acceleration vector.

This is the most powerful of Newton's three Laws, because it allows quantitative calculations of dynamics: how do velocities change when forces are applied. Notice the fundamental difference between Newton's 2nd Law and the dynamics of Aristotle: according to Newton, a force causes only a change in velocity (an acceleration); it does not maintain the velocity as Aristotle held.

This is sometimes summarized by saying that under Newton, F = ma, but under Aristotle F = mv, where v is the velocity. Thus, according to Aristotle there is only a velocity if there is a force, but according to Newton an object with a certain velocity maintains that velocity unless a force acts on it to cause an acceleration (that is, a change in the velocity). As we have noted earlier in conjunction with the discussion of Galileo, Aristotle's view seems to be more in accord with common sense, but that is because of a failure to appreciate the role played by frictional forces. Once account is taken of all forces acting in a given situation it is the dynamics of Galileo and Newton, not of Aristotle, that are found to be in accord with the observations.

Newton's Third Law of Motion:
III. For every action there is an equal and opposite reaction.

This law is exemplified by what happens if we step off a boat onto the bank of a lake: as we move in the direction of the shore, the boat tends to move in the opposite direction (leaving us facedown in the water, if we aren't careful!).
Kevin SALRE helps us assess the STJ AXIS in the transverse plan, we can look at moment arms of the muscle, these give us the amount of work needed by that muscle to create a moment and then maybe movement.It also has helped us look at what the Gound reaction force (GRF)does to the subtalar joint depending on which side of the axis it is.

And this what an orthosis does Dennis it changes the force applied to the foot, but changing the GRF or creating a Orthotic Reaction force. You can´t escape these laws of nature Dennis, if you did you would float off into space or fall flat on your face.

If we really want to know how the foot and leg works putting people in to goups ie foot typing is NOT it. It will not give us the information we need, what we need to discover is how that indivduals gait is being affected by the laws of nature and then with our knowledge of these laws make changes to the forces by creating an ORF.
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Old 8th May 2010, 03:58 AM
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Default Re: New Level I EBM Biomechanics Study Surfaces

Dr. Weber:
You intimate that I have underplayed Professor Kirby's place in Modern Biomechanics.
I believe it exposes your (all the arguers) bias towards me and serves as a reason for you to "take a long, hard look at yourself" (as I do every day).

I labeled Kevin "Root's Greatest Student".
As a teacher, my goal has always been to turn out students that were more advanced and better than I but I have rarely succeeded. I could count the ones who could challange me and add to, alter or replace my science on two or three fingers.

As I believe Dr. Root to be The Father of Modern Biomechanics, I am not sure what better way I could express the depth of respect that I have for Dr. Kirby and his accomplishments.
In addition, I stated:
"I would say that Dr. Kirby's work and especially his protocol for researching is a role model for us all and is becoming the state of the art for developing evidence".

Kevin, are you uncomfortable with these quotes and where it places you in our science?

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Old 8th May 2010, 04:26 AM
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Default Re: New Level I EBM Biomechanics Study Surfaces

Newton was smart enough to center his work on inanimate objects so that his laws would be less arguable (the arguers).

When these laws are attempted to be applied to living, functioning, performing subjects. as in BIO, many additional factors enter the discussion creating debate, diversion and many schools of thought.

In the tissue stress theory, and I may be wrong, the desire is to reduce or remove stress that exists in a biomechanical scenerio so as to reduce pain and discomfort which has developed as the subject lives life.

In function, a system must accept stress in order to perform additional work. By that I mean if my peroneus longus tendon is assisting me in walking at a certain pace, it must develop stress into the subtalar joint in order to use it as a fulcrum for driving the first metatarsal head into the ground. If I increase my pace, the stress into the subtalar joint increases and PL drives that met head stronger into the ground.
If I then continue to walk at that faster pace, eventually, the stress at the STJ (or some other compensatory location) would create microinjuries that if I continue would lead to a clinical event.
I can deal with this fact from many postures (unlike treating a table), the easiest would be to slow down, take smaller steps or stop walking completely (or I could walk on my hands).
If I add a device into the STJ that reduces the stress that my work has produced, in addition to eliminating the pain or discomfort, I would be reducing the leverage of PL and therefore reduce its ability to perform.
If performance is my goal (and not just pain relief) then I must find a way to eliminate the pain while maintaining or improving performance. This is much more of a challange than purely eliminating pain.

The basis of sports medicine as I lived through its development from the sixties was to convert medicine from a profession that when comfronted by a pain/performance issue of "It hurts when I do this" told patients "Don't do this" and we strived to keep them doing this painlessly.

Your are practicing Pain Free Foot Typing and I am practicing Functional Foot Typing.

Are you ready for a profound quote?

"If in his experiments, the apple had an engine, a mind and a desire to resist falling to the ground, Newton would have died a lonely man and the apple would have been a bird".
Dennis Shavelson DPM


We are working on subjects not objects and you, my friends are missing the clinical boat.
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Old 8th May 2010, 08:02 AM
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Default Re: New Level I EBM Biomechanics Study Surfaces

Dennis what I was trying to get at is you keep trying to place other people with your treatment approach, and they all follow you and your thoughts.This as far as I´m concerned is NOT The case.

I was trying to say the mechancis are mechancis what Kevin from where I sit has introduced this into Podiatric Biomechanical discussion.

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As a teacher, my goal has always been to turn out students that were more advanced and better than I but I have rarely succeeded. I could count the ones who could challange me and add to, alter or replace my science on two or three fingers.



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Old 8th May 2010, 08:46 AM
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Default Re: New Level I EBM Biomechanics Study Surfaces

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Very early on, I believed that Root made one major mistake as I saw biomechanics evolve. By sharing his work, he allowed his science to be perverted, basturdized and dismembered and (correct me if I'm wrong Jeff) his dream that his science was not the end all and that it would be researched, upgraded, changed and yes even replaced with better stuff never happened.
How could he have prevented that???
He should have PATENTED!!! (I haven't made a dime on any of you ((YET, hahaha))!
Dennis,

I'm not sure how to respond to the majority of your post, but I want to start with the quote above. I think this is one thing that differentiates my father and his work from you and Ed. My father was a podiatrist who wanted his profession to improve its ability to treat biomechanical conditions of the foot. He was not looking to personally profit from that goal except as a practitioner himself.

My father entered podiatry school, in part, because he thought it was a field that had an opportunity for research and he was interested in doing research. As a student he asked a difficult question of one of his professors. The professor answered him by saying "Mert, you’re better off spending your time playing bridge (i.e. cards)." That comment motivated my father all the more.

My father recognized that it was impossible to compare feet unless they were placed in a standard position, just like we have a standard anatomical position for studying basic anatomy. He developed a standard position (neutral stj, fully pronated mtj) so podiatrists and others could compare feet and communicate about them. He then used that position to begin to define structural variations of the foot and lower extremity. He believed that this basic foundation was necessary before further progress could be made.

He then attempted to determine the relationship between observable structural variations and the function of the foot, especially as it related to pathology of the lower extremity. He eventually began to teach students and lectured around the country to practitioners about his theories. He also attempted to develop methods to treat mechanically induced foot pathology with strapping, padding, orthoses, etc. and he lectured about these techniques as well. As time went on, he continued to develop the functional orthosis and various modifications of its prescription in an effort to address specific pathology based the patient's biomechanical findings, history, symptoms, etc.

My father did not view his “invention” as a means to make money, but rather as a way for his fellow podiatrists to help their own patients. The gratification he got from helping others was his motive. Some say he had a large ego. Ego gratification can be defined as gratification of the mind. I think any good teacher or inventor is in part motivated by this. He was also objective and very interested criticism. He enjoyed the intellectual challenge of defending his beliefs and he would not hesitate to change if something he believed was proved to be wrong.

My father probably never would have written any of his books had it not been for a young podiatrist by the name of William (Bill) Orien, who came to him specifically for that purpose. Bill was the one who made my father sit down and write his books. I personally believe the profession owes Bill a lot, as my father’s work would not be as well understood had it not been for Bill. John Weed played a very important role in the process of writing the books because he was an excellent critic and my father highly respected his opinion.

My father helped train all of the key, original orthotic labs here in the U.S.: Langer, Burns, KLM, PAL. He lectured for most if not all of these labs. He founded his own lab in the mid 1970's but he was never motivated to exploit his own name and reputation. He never once advertised his lab in any publication. At his own lab he continued to offer training to other labs and their technicians. I was the one who eventually discouraged this practice because it was beginning to become exploited (i.e. "I was trained by Root Lab", as if we could really train a liquor store owner, brother-in-law of a podiatrist in a three week class! True story, he was tired of being shot at in his Detroit liquor store so his DPM brother-in-law sent him to train to make orthoses.).

My father actually felt that podiatrists would be better served by small, local labs rather than large, national labs, much like the dental labs were at that time. In spite of his effort to train other labs, he continued to be disappointed by the quality of commercially produced orthoses. This was in part due to the fact that many practitioners lacked the examination, casting, prescribing, and other skills necessary to use orthoses more effectively. So the labs compromised the techniques to make their orthoses comfortable. This often involved using excessive medial arch fill, excessive expansion around the heel, and obliterating any potential intrinsic forefoot varus or valgus support in the shell by filling the forefoot deformity (intrinsic correction) with plaster.

The notion that someone will have an exclusive system or orthotic device doesn’t seem realistic to me. We all have the same raw materials and manufacturing systems available to us. It’s how we use them that distinguishes us. I beleive it's too late to patent the laws of physics. I don’t profess to understand your system well enough to fully critique it, but I do know that those podiatrists who are looking for a magic bullet will be disappointed. Kevin, much like my father, has attempted to apply basic science and the laws of physics to biological structures. In biomechanics, we must refrain from using ambiguous terms and we must use standard scientific and medical terminology if we hope to communicate with one another effectively and if we seek to be accepted by the greater medical and scientific community.

Respectfully,
Jeff
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Old 8th May 2010, 08:51 AM
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Default Re: New Level I EBM Biomechanics Study Surfaces

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Originally Posted by Jeff Root View Post
Dennis,

I'm not sure how to respond to the majority of your post, but I want to start with the quote above. I think this is one thing that differentiates my father and his work from you and Ed. My father was a podiatrist who wanted his profession to improve its ability to treat biomechanical conditions of the foot. He was not looking to personally profit from that goal except as a practitioner himself.

My father entered podiatry school, in part, because he thought it was a field that had an opportunity for research and he was interested in doing research. As a student he asked a difficult question of one of his professors. The professor answered him by saying "Mert, you’re better off spending your time playing bridge (i.e. cards)." That comment motivated my father all the more.

My father recognized that it was impossible to compare feet unless they were placed in a standard position, just like we have a standard anatomical position for studying basic anatomy. He developed a standard position (neutral stj, fully pronated mtj) so podiatrists and others could compare feet and communicate about them. He then used that position to begin to define structural variations of the foot and lower extremity. He believed that this basic foundation was necessary before further progress could be made.

He then attempted to determine the relationship between observable structural variations and the function of the foot, especially as it related to pathology of the lower extremity. He eventually began to teach students and lectured around the country to practitioners about his theories. He also attempted to develop methods to treat mechanically induced foot pathology with strapping, padding, orthoses, etc. and he lectured about these techniques as well. As time went on, he continued to develop the functional orthosis and various modifications of its prescription in an effort to address specific pathology based the patient's biomechanical findings, history, symptoms, etc.

My father did not view his “invention” as a means to make money, but rather as a way for his fellow podiatrists to help their own patients. The gratification he got from helping others was his motive. Some say he had a large ego. Ego gratification can be defined as gratification of the mind. I think any good teacher or inventor is in part motivated by this. He was also objective and very interested criticism. He enjoyed the intellectual challenge of defending his beliefs and he would not hesitate to change if something he believed was proved to be wrong.

My father probably never would have written any of his books had it not been for a young podiatrist by the name of William (Bill) Orien, who came to him specifically for that purpose. Bill was the one who made my father sit down and write his books. I personally believe the profession owes Bill a lot, as my father’s work would not be as well understood had it not been for Bill. John Weed played a very important role in the process of writing the books because he was an excellent critic and my father highly respected his opinion.

My father helped train all of the key, original orthotic labs here in the U.S.: Langer, Burns, KLM, PAL. He lectured for most if not all of these labs. He founded his own lab in the mid 1970's but he was never motivated to exploit his own name and reputation. He never once advertised his lab in any publication. At his own lab he continued to offer training to other labs and their technicians. I was the one who eventually discouraged this practice because it was beginning to become exploited (i.e. "I was trained by Root Lab", as if we could really train a liquor store owner, brother-in-law of a podiatrist in a three week class! True story, he was tired of being shot at in his Detroit liquor store so his DPM brother-in-law sent him to train to make orthoses.).

My father actually felt that podiatrists would be better served by small, local labs rather than large, national labs, much like the dental labs were at that time. In spite of his effort to train other labs, he continued to be disappointed by the quality of commercially produced orthoses. This was in part due to the fact that many practitioners lacked the examination, casting, prescribing, and other skills necessary to use orthoses more effectively. So the labs compromised the techniques to make their orthoses comfortable. This often involved using excessive medial arch fill, excessive expansion around the heel, and obliterating any potential intrinsic forefoot varus or valgus support in the shell by filling the forefoot deformity (intrinsic correction) with plaster.

The notion that someone will have an exclusive system or orthotic device doesn’t seem realistic to me. We all have the same raw materials and manufacturing systems available to us. It’s how we use them that distinguishes us. I beleive it's too late to patent the laws of physics. I don’t profess to understand your system well enough to fully critique it, but I do know that those podiatrists who are looking for a magic bullet will be disappointed. Kevin, much like my father, has attempted to apply basic science and the laws of physics to biological structures. In biomechanics, we must refrain from using ambiguous terms and we must use standard scientific and medical terminology if we hope to communicate with one another effectively and if we seek to be accepted by the greater medical and scientific community.

Respectfully,
Jeff
Well said Jeff. Brilliant.
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Old 9th May 2010, 06:06 AM
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Default Re: New Level I EBM Biomechanics Study Surfaces

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Originally Posted by Jeff Root View Post
Dennis,

I'm not sure how to respond to the majority of your post, but I want to start with the quote above. I think this is one thing that differentiates my father and his work from you and Ed. My father was a podiatrist who wanted his profession to improve its ability to treat biomechanical conditions of the foot. He was not looking to personally profit from that goal except as a practitioner himself.

My father entered podiatry school, in part, because he thought it was a field that had an opportunity for research and he was interested in doing research. As a student he asked a difficult question of one of his professors. The professor answered him by saying "Mert, you’re better off spending your time playing bridge (i.e. cards)." That comment motivated my father all the more.

My father recognized that it was impossible to compare feet unless they were placed in a standard position, just like we have a standard anatomical position for studying basic anatomy. He developed a standard position (neutral stj, fully pronated mtj) so podiatrists and others could compare feet and communicate about them. He then used that position to begin to define structural variations of the foot and lower extremity. He believed that this basic foundation was necessary before further progress could be made.

He then attempted to determine the relationship between observable structural variations and the function of the foot, especially as it related to pathology of the lower extremity. He eventually began to teach students and lectured around the country to practitioners about his theories. He also attempted to develop methods to treat mechanically induced foot pathology with strapping, padding, orthoses, etc. and he lectured about these techniques as well. As time went on, he continued to develop the functional orthosis and various modifications of its prescription in an effort to address specific pathology based the patient's biomechanical findings, history, symptoms, etc.

My father did not view his “invention” as a means to make money, but rather as a way for his fellow podiatrists to help their own patients. The gratification he got from helping others was his motive. Some say he had a large ego. Ego gratification can be defined as gratification of the mind. I think any good teacher or inventor is in part motivated by this. He was also objective and very interested criticism. He enjoyed the intellectual challenge of defending his beliefs and he would not hesitate to change if something he believed was proved to be wrong.

My father probably never would have written any of his books had it not been for a young podiatrist by the name of William (Bill) Orien, who came to him specifically for that purpose. Bill was the one who made my father sit down and write his books. I personally believe the profession owes Bill a lot, as my father’s work would not be as well understood had it not been for Bill. John Weed played a very important role in the process of writing the books because he was an excellent critic and my father highly respected his opinion.

My father helped train all of the key, original orthotic labs here in the U.S.: Langer, Burns, KLM, PAL. He lectured for most if not all of these labs. He founded his own lab in the mid 1970's but he was never motivated to exploit his own name and reputation. He never once advertised his lab in any publication. At his own lab he continued to offer training to other labs and their technicians. I was the one who eventually discouraged this practice because it was beginning to become exploited (i.e. "I was trained by Root Lab", as if we could really train a liquor store owner, brother-in-law of a podiatrist in a three week class! True story, he was tired of being shot at in his Detroit liquor store so his DPM brother-in-law sent him to train to make orthoses.).

My father actually felt that podiatrists would be better served by small, local labs rather than large, national labs, much like the dental labs were at that time. In spite of his effort to train other labs, he continued to be disappointed by the quality of commercially produced orthoses. This was in part due to the fact that many practitioners lacked the examination, casting, prescribing, and other skills necessary to use orthoses more effectively. So the labs compromised the techniques to make their orthoses comfortable. This often involved using excessive medial arch fill, excessive expansion around the heel, and obliterating any potential intrinsic forefoot varus or valgus support in the shell by filling the forefoot deformity (intrinsic correction) with plaster.

The notion that someone will have an exclusive system or orthotic device doesn’t seem realistic to me. We all have the same raw materials and manufacturing systems available to us. It’s how we use them that distinguishes us. I beleive it's too late to patent the laws of physics. I don’t profess to understand your system well enough to fully critique it, but I do know that those podiatrists who are looking for a magic bullet will be disappointed. Kevin, much like my father, has attempted to apply basic science and the laws of physics to biological structures. In biomechanics, we must refrain from using ambiguous terms and we must use standard scientific and medical terminology if we hope to communicate with one another effectively and if we seek to be accepted by the greater medical and scientific community.

Respectfully,
Jeff
As you have carried on your father's lab, work and ideals, there is no one more accurate in memorializing how pioneering, smart, humble and scientific Merton Root DPM was.

Your knowledge of the roads that he developed and led us through and the events surrounding the development of his body of work are educational to us all.

The documentation of just some of the gifts that he gave Podiatry and Biomechanics gain strength coming from your keyboard in his defense.

He is not appreciated enough.

I also appreciate your documentation of how his science became fragmented, unappreciated and especially how others capitalized on his work and detracted from his fame and place in our minds when you stated:
I was the one who eventually discouraged this practice because it was beginning to become exploited (i.e. "I was trained by Root Lab", as if we could really train a liquor store owner, brother-in-law of a podiatrist in a three week class! True story, he was tired of being shot at in his Detroit liquor store so his DPM brother-in-law sent him to train to make orthoses.).

You stated That: "My father actually felt that podiatrists would be better served by small, local labs rather than large, national labs, much like the dental labs were at that time. In spite of his effort to train other labs, he continued to be disappointed by the quality of commercially produced orthoses. This was in part due to the fact that many practitioners lacked the examination, casting, prescribing, and other skills necessary to use orthoses more effectively. So the labs compromised the techniques to make their orthoses comfortable" (I will add marketable and profitable)
"This often involved using excessive medial arch fill, excessive expansion around the heel, and obliterating any potential intrinsic forefoot varus or valgus support in the shell by filling the forefoot deformity (intrinsic correction) with plaster".

I agree that your father was in addition to a scientist and a podiatrist a very principled man who gave appropriate respect to the profession and science that he rocketed to unimagined heights in his lifetime by trusting them in return to guard and protect his work from dilution and perversion as it developed and they benefited from it.

I can sense the bitterness that you hold as you recall the way that the podiatry, biomechanics and laboratory community renegged that trust.

Without a profit motive, wouldn't it have been great if Dr. Root and your family would have had a way of buffering those in science, podiatry and biomechanics who guided by a profit motive (they are the greedy ones, not me)
misrepresented themselves as "Rootians" in order to build their careers in our schools and publications and those who used "excessive medial arch fill, excessive expansion around the heel, and obliterating any potential intrinsic forefoot varus or valgus support in the shell by filling the forefoot deformity (intrinsic correction) with plaster" could have been tempered and challenged and controlled for 20 years.


This is the reason that 90% of all patents involve science!
Where do you think Ritchie's and Dananberg.s work would be today if not PROTECTED BY PATENTs?
Where do you think your fathers memory and work would be today if he had protected it?


I could be totally wrong about wanting to patent my work but by doing so, if my work ever proves to be one iota as important as your Dad's, the fact that I can be involved in steering its growth and future away from the real Charlatans and Capitalists will have been worth accepting the anger and negative reaction that it has generated from the very colleagues that I wish to be among and accepted by.

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Old 9th May 2010, 08:01 AM
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Default Re: New Level I EBM Biomechanics Study Surfaces

Dennis,

I did not intend my comments as a criticism of you or any other modern day lab owner. I just wanted to point out how my father's perspective and motives influenced his decisions and as a result, some of the history of biomechanics and foot orthotic therapy.

Quote:
Originally Posted by drsha
I can sense the bitterness that you hold as you recall the way that the podiatry, biomechanics and laboratory community renegged that trust.
Bitterness is a very unproductive emotion. I am not bitter but I am sometimes disappointed or frustrated with some of what I see. On the other hand, I have seen huge progress in the average practitioner’s level of biomechanical knowledge since the late 70's and early 80's. I have also seen significant improvement in the quality of functional type foot orthoses made at a number of commercial labs. As an example, just last week I was evaluating positive casts we received that were originally made at two other labs. One was a fairly poor representation of the plaster modifications we do and the other, in my opinion, was a very good representation of Root type orthotic modifications. The bottom line is that the quality of work produced by labs is driven by what practitioners demand. Practitioners who do not settle for substandard work, can and do elevate podiatry and the orthotic manufacturing industry.

I do recognize the problems and limitations that we face. I had to frequently remind my father that he needed to lecture at a more basic level because he was frequently speaking at a level that was too advanced for the audience. He sometimes responded that some of those podiatrists that didn’t understand were lazy and were unwilling to invest the time and effort to study on their own. I always had a little more empathy for the busy practitioner who struggled to understand biomechanics but who cared about not understanding it well enough.

I don’t fault any effort to make biomechanics and orthotic therapy more practical provided it doesn’t reduce the potential benefits. That’s where this effort always seems to develop conflicts. Frustration emanates from the discussions where the participants have difficulty attempting to differentiate medicine and science from marketing. In the long run, this is a healthy process but it doesn’t make it any less painful in the process.

Respectfully,
Jeff
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Old 9th May 2010, 08:21 AM
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Default Re: New Level I EBM Biomechanics Study Surfaces

Jeff:

You are a very honorable man and we all admire you for that.
You are not just Merton Roots son, you are Jeff Root!

You need not apologize to anyone, especially me, as we debate.

In light of your post, I am changing my statement to
I can sense the disappointment and frustration that you hold as you recall the way that the podiatry, biomechanics and laboratory community renegged on that trust.

I hope that allows you to address the rest of my recent postings with regards to other theories, patenting, etc.

I hope you feel a desire to respond to those other points as they were written to satisfy your postings.

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Old 9th May 2010, 11:55 AM
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Default Re: New Level I EBM Biomechanics Study Surfaces

This will be a short post as I've just got back from a rather fantastic AGM and am pooped.

Dennis.

Let me start by saying what I agreed with

Quote:
Where I differ most with Ed is that he is a patient advocate. His paradigm is quite simplistic in that three foam casts taken using his very simple MLA raising casting technique, sent to his lab, gets you certified as an expert in his paradigm. This means that eventually (if not already) any 16 year old pimpled man or woman standing in a Mall Kiosk can compete with the years of training of a podiatrist when it comes to expertly working with orthotics.
His devices are simplistic and not expensive to make (pardon me but calibrate my A_ _) and so my vision for Ed is that since his devices serve a very valuable upgraded starting device on the Orthotic Pyramid, they are not professional custom orthotics and should be scaled back appropriately to about $200-250 and used as a first line device for biomechanical problems where if they fail, would bring patients to DPM's or other skilled and educated practitioners for a $600 device that would include the diagnostic, prescribing, monitoring and ancillary treatment skills that they bring to the table.
In addition, my advice to DPM's and other skilled practitioners is to never represent his product as "Professionally Custom" in practice thereby denying Ed the ability to say that the 16 year old is dispensing the same device recommended by podiatry or other professionals.


Like this.

And now the first tranch of points I take issue with.

Quote:
I believe Kevin's work (what he is known for i.e STJ Axis and the medial skive) is brilliant but it is dedicated to the flexible rearfoot foot types.
I think you misinterpret (not underestimate) Kevins contribution. As Michael tried to explain, the rotational equilibrium bit of his work can apply to ALL axial joints in all joint positions and ranges. Whilst you may be able to see the applications for the flexible rearfoot the same science can be applied to any situation and foot type.

Quote:
I can't answer for Dr. Glaser but in my case, I am a uniting, EBM advancing and propodiatry force and I have been for decades.
Quote:
Your are practicing Pain Free Foot Typing and I am practicing Functional Foot Typing.
Quote:
We are working on subjects not objects and you, my friends are missing the clinical boat.
I find your self congratulation obnoxious. There is a saying about those who blow their own trumpets. I honestly don't know what you hope to acheive by such claims, whether it be to convince others or yourself. If the former I suspect it is not effective.

Quote:
I would wish that the Podiatry community would use EBM at this time
Quote:
I am a uniting, EBM advancing
Quote:
I have predicated my entire EBP biomechanics practice for 30+ years
You continue and continually to claim that what you do is evidence based, further fuel to the fire of your self applause. I do not, and have never accept that FFT is (for the most part) evidence based. You do not reference bench data. You do not justify your position with first principles. You do not reference inductive evidence. Beyond a passionate belief in your outcomes and the fact that your thinking has been influenced by things you've read, I have seen no evidence of your evidence.

Quote:
, I would wish that the Podiatry community would use EBM at this time to stop the cookbook STJ Neutral Casting (sorry that still means most of you including Kevin) and rearfoot varus wedges and seek an upgrade or replacement for STJ Neutral cookbook biomechanics.
I find this statement offensive of several levels. Fistly you continue to make assumptions on what "most of you" are doing, building a straw man to attack. You have no way of knowing how other podiatrists practice and to presume that they are all doing "cookbook casting" shows a staggering lack of respect from your colleagues.

I would also question whether if people ARE using cookbook biomechanics, whether the solution is to switch to a different cookbook. Personally I prefer to treat my patients as individuals.

Quote:
Your are practicing Pain Free Foot Typing and I am practicing Functional Foot Typing.
A neat statement incorperating three fallacious assumptions. That you can speak for what "WE" are doing (you can't), that your system is inherently better (a claim you cannot prove) and that you have a way to derive "functional" outcomes better than everyone else.

Quote:
I have predicated my entire EBP biomechanics practice for 30+ years on WELLNESS!
I believe I share that common goal with Dr. Root and I have carried on his science in that direction (agree Jeff?).

I include Prevention, Performance Enhancement, Quality of Life as goals in my EBP in addition to immediate comfort and pain relief. I consider what my orthotic will do for the patient long term and have sought correction as a primary goal.

That's why I reject so much of your evidence in my practice because it does not make WELLNESS sense.
Quote:
My treatments handle medial knee pain while enhancing WELLNESS and if they fail, I suggest that that exposes a need for medical or surgical care by consultants and continue my care pre or post synvisc injection or knee surgery OR I LOWER MY STANDARDS TO YOURS and TREAT AS YU DO.
This is as fine a piece of marketing as I have ever heard. You (alone?) are concerned with long term function. Again you build a straw man of your critics by claiming to know how they work.

And you use woolly and undefinable terminology which sounds wonderfully holistic and huggy but means, in practice, precisely nothing. What, exactly, is wellness biomechanics Dennis? Is it more than a promise to a patient that you can fix a problem which does not yet exist? Do you (alone) have a formula for "optimal" function which has escaped the rest of us? If so, may I suggest you define optimal position / function before you claim you can acheive it?

A claim of long term effectiveness or "wellness" function is easy to make and impossible to prove. One can claim to have made a patient "well" and neither the patient nor the clinician can know if such claim is valid or not. Which, I suppose, is what makes it such good marketing. And on this basis you presume to claim "higher standards".


In summary, I see nothing of substance in your herculean post but claims made on your own behalf with no supporting evidence and breathtaking prusumption of your own superiority. You must be immensely proud of your humility.

Your post was two pages long. I could summerize it in two sentances.

Quote:
I'm great.
You're all rubbish.
Which would be acceptable if you provided justification for your claims of visionary brilliance. But you never do. I continue to be at a loss as to why you think that such claims will impress.

jeff said
Quote:
If you feel you have a good or better product (diagnostic and treatment system), then explain the benefits of it. A significant amount of the opposition you experience appears to be related to how you and Ed depict your competitors. By competitors, I am referring to competing theories and products.
You answered by saying a few nice, if somewhat condescending things about a few people... But you just don't seem to be able to resist the urge to presume your colleagues to be simplistic two dimensional drones. Worse, you presume bad motives on their part. This seems to be primarily in order to claim your own superiority

Since you have graced us with a few of your "quotes", here is one from me to think about.

"Claiming to improve or mend pathology which has not yet occurred is a convenient way to make money by selling people a cure for a non existent problem. Without a validated target of effective function, the relative merit of such a device is impossible to assess and is as such the widespread or indiscriminate application is open to abuse by people selling ineffective devices for non existent lack of wellness."
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Robert Isaacs
Specialist in Biomechanical Therapies

small, yellow, leech-like, and probably the oddest thing in the universe

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