Live Updates from i-FAB

Here is the first update. Went to the Brooks lab today and got the attached blast from the past!

Who is old enough to remember it!

 

Not only am I old enough to remember, Craig, but I ran a lot of miles in college in the Brooks Vantage back in the mid 1970s. The idea of the varus rearfoot wedge was great, but the quality control at Brooks was so poor at the time, that some shoes had 4 degree varus wedges and other shoes could hava a 4 degree valgus wedge. The quality of Brooks running shoes have improved considerably since then.

I just arrived in Seattle and am now resting comfortably in my room at University Inn. Will go for a run in the morning (being sure to check for pigs igs: igs and then head to Steve Piazza's workshop on "Foot and Ankle Considerations in Rigid-Body Dynamics Modeing of Human Movement" and then on to Ahmet Erdermir's workshop on "Finite Element Analysis in Foot Biomechanics and Footwear Design".

Should be a great seminar!

 

First live update. I sitting down the back with Bruce and Paul Minon .... I have so far counted 22 podiatrists out of 270 registrations (thats really impressive for a conference of this nature). There are more podiatrists from Australia, than DPM's from USA ..... More from the UK too .....

Peter Cavanagh opened the mtg with the comment that there are 170 presentations at the conference ...probably the greatest concentration of foot and ankle science for long time.

We now being entertained by the Evan Woodle Quartet .... Some jazz majors at the University of Washington

 

What has science done for the foot and ankle surgeon? M Richter

*75% of guidelines are at lowest evidence level. (expert panel)
*research is better than experience due to conflicts
*clinical outcome measures rarely validated
*highlighted the problems of RCT's in surgery
*39% of implants changed intraoperativly with use of intraoperative CT (mostly fractures) -reduced need for re-operation
*higher accuracy of arthrodesis procedures using computer assisted surgery
*uses plantar pressure measurement intraoperativly ... esp with metatarsal alignment based on met head pressures ... Supported by RCT - better outcomes .... 46% of cases changes made due to intraoperative plantar pressure measures
*Plantar pressures to determine if plantar grade foot achieved during ankle replacement surgery

Finishing quote:
"a greet fool with a great tool is even a greater fool" ... bit like me down the back with my iPad

 

Craig;
This was a great surgical presentation and even
though I don't do that type os surgery I can
see that it would be very beneficial to have introp
3d CT available.
Bruce

 

"Foot structure and function. Six blind men and the elephant revisited" BJ Sangerorzan

"How do bright people with extensive education look at the same problem and see different thing?"

Go read the poem: the blind men and the elephant

"Most improvements in surgical care are made by trial and error"

Talked about 2 column theory of foot function..

I never really got what this presentation was about ... but I did like the blind men story and will make use of it.

 

"Metatarsal loading pattern differences with age and sex in adolescent athletes". KR Ford

Lateral forefoot pressure higher in adolescent males --> increased risk for stress fractures? How many fifth metatarsal stress fractures have you seen in adolescent males? I can't remember that last one I came across...

 

If you're a big Starbucks fan (which I'm not although I do have a cup from time to time) you might want to go to the original Starbucks at Pike Place Market. Even if you don't like Starbucks, the market is worth the trip.

http://www.cityofseattle.net/html/visitor/starbucks.htm

 

Spatiotemporal Volumetric Analysis of Dynamic Pedobarographic Data
1T. C. Pataky

Cool way to make plantar pressure data look pretty ...

 

Deep plantarflexor strength increase changes rearfoot motion in shod running M. Hagen

From the title and abstract this one looked exciting....

BUT the analysis they did was not how you analyse a randomised study. They did a within groups comparison and NOT a between group comparison. The claim in the abstract "this study shows the
beneficial effects of functional pronator and supinator strength training for runners in controlling rearfoot motion" was not supported by the data. From the confusing way the data was presented, I am taking a guess that they actually showed the opposite ... that there was no benefit.

It was exactly the same faulty (and fatal) analysis we discussed in this thread: Shockwave therapy for Morton's neuroma

 

Measuring dorsal arch height in different stances with plantar foot muscles passive and active:
A reliable determinant of MLA articulation in older people. P. J. Latey,

There were a lot of 'eyes rolling' at this one. I did not get it either. I do not see any point in it. The intrinsic muscles do not fire until the heel starts to come of the ground, so who cares what they are doing during static stance.

 

The relevance of subtalar-joint-anatomy for chronic overuse injuries of the lower limbs. C.A. Reule

Now, this one sounded impressive, the abstract looked good and it lived up to the expectation.

They looked at the transverse plane variation of STJ axis in achilles tendon problems (ATP):

Those who have heard me talk recently about orthotics and achilles tendonitis will know why I smiled at the results. The greater deveiation of the axis --> greater lever arm --> calf muscles have to work harder --> greater risk for achilles tendon problems! .... don't love it 'when a plan comes together'! (...and I did watch the A-Team movie on the plane)

 

I actually next missed some presentations. Chewed over lateral wedging for knee OA with Richard Price from Salford and the issues

 

Effect of fatigue on GRF and ankle joint loading during drop landing. K.K. Lee

Interesting result. Most biomechanical studies are done with subjects fresh and not fatigued. Intuitively I would have thought the results of this study would have been different. We have had a few threads on the effects of fatigue.

 

This poster caught my eye:

Foot Architecture Affects 1st Metatarsophalangeal Joint Function. S. Rao

Going to have to wait for the full publication of this one. There were some bits of it not clear and would like some more details on what they actually did. It did look OK, but as the results were somewhat counterintuitive would like more details on the method.

(Smito, if you read this i was looking for you to chat!)

 

I better do my best to bag this poster: :butcher: :deadhorse: :boohoo: :boxing:
Impact of Chronic Gout on Foot Function: Case-Control Study. K. Rome,

I don't understand why US Customs did not stop this one at the border.

Good job, Keith

 

Another poster on Achilles tendonitis:

Lower Extremity Movement Strategies in Individuals with Achilles Tendinopathy. Yu-Jen Chang

Very small sample size, but never-the-less, the results are interesting.

 

Is a neutral foot posture optimal for runners:
A comparative study of different foot postures on injury survival. R.G. Nielsen

Why am I not surprised at this result despite the small sample and short follow up?

 

Another poster:
The Effect of Foot Invertor Fatigue on Rearfoot Motion and Tibial Rotation During
Running and Turning G. Kandasamy

Note the comment in the into: Many overuse injuries in running are associated with excessive pronation ... and then notice the comment in the intro to one of the studies above: Despite this conviction of clinicians, runners, and shoe manufacturers, we found no clear evidence published showing a higher incidence of RRIs in persons with pronated foot postures. I think most know which camp I am in ...

 

Here's my llive update from the i-FAB meetin in Seattle....left Craig Payne on University Avenue to go shopping a few hours ago. Then Craig Tanner called to say they were finally ready to go out "beer tasting"....This event was sponsored by RS Scan. Kerstin, Craig and a few others joined us to drink lots of Belgian Beer at the bar. Now it is 12:30 AM, and way past my bedtime, but I'm sitting here for some reason at my laptop telling you all what we are doing at this seminar.

Good conference so far....really enjoyed Steve Piazza's workshop on Forward Dynamics Modeling....and the lecture on STJ axis location and Achilles tendon injuries....those were the two highlights from the conference so far for me...other than catching up with many old friends.

Good night.

 

It has been a fantastic conference so far. I have learned more at this seminar on foot and ankle biomechanics than I have learned at any seminar in recent memory.

Ton van den Bogert gave a great lecture this morning on combining forward dynamic analysis along with a finite element model (FEM) of the foot to try and create a dynamic FEM of the foot. To me, this modeling approach seems to be one of the most exciting new avenues for our future understanding of the tissue stresses that cause the pathologies we treat. Neil Sharkey also gave a very nice presentation on his Penn State cadaver gait simulator followed by Erin Ward and others talking about their own cadaver gait simulators which was also very interesting. Benno Nigg gives the keynote tomorrow morning on his preferred movement pathway theory which should also be another "state-of-the-art" lecture on foot and lower extremity biomechanics and its central nervous system control.

Too bad more of you couldn't attend.

 

The first session today was on computational biomechanics and things like finite element modelling. Ton van den Bogert started the session with the keynote: Brain, Body, and Foot: A Multidomain Approach for Predictive Computational Modelling. ... heavy stuff...

 

The next group of presentations were on ankle instability:

Mechanical and Functional Measures Reveal a Coherent Structure to Ankle Instability: A Principal Component Analysis. T.W. Croy

Muscle Activation Patterns For Functional Ankle Instability and Normal Subjects During Anticipated and Unanticipated Jump-landings. M. J. Coglianese

Preparatory Muscle Activation during a Lateral Hop Before and After Fatigue in Those With and Without Chronic Ankle Instability. K.A. Webster

Note to self: must publish the data on the relationship of low supination resistance to chronic ankle instability

 

There were then two presentations from the some group that did generate some discussion:

Plantar Loading in the Cavus Foot. A. Kraszewski

Does Foot Type Affect Foot Contact Dynamics? R.Mootanah

Both studies rported the mean resting calcaneal stance position of 0 degrees, so there was a question and some discussion over the break as if this was really a cavus foot or not?

 

Effect of Modified Low-Dye Taping on First Ray Mobility in Individuals with Pronated Foot. J. M. Tai

A lot of work went into the experimental set up, data collection and analysis, but based on the video clip they showed of how they applied the low dye tape...I don't know of anyone who actuall uses the tape that way clinically! It certainly was what I would have called 'low dye'.

 

The first session after lunch was mostly on the use of cadaveric gait simulators like this one:



Papers looked at changes in function with the alteration (eg joint fusion) and function.

Kevin asked a question at the end and there was some discsussion that the model do not include the intrinsic muscle function. The answer to teh question and the validity of the model will probably depend on the research question and how important you think the intrinsic muscles are ..

 

The last session was on the diabetic foot:
The Diabetic Foot: Unresolved and Future Issues Edward J Boyko

Stress Thresholds for Injury and Adaptation on the Neuropathic Foot; Moving Targets Michael J. Mueller

The diabetic foot: unresolved and future issues. Sicco A. Bus

Feasibility of using plantar temperature to assess the biomechanics of the plantar foot. John Gerhard

The Compressive Mechanical Properties of Diabetic Plantar Soft Tissue. Shruti Pai

A longitudinal investigation into functional and physical durability of insoles used for the preventative management of neuropathic diabetic feet. JS Paton

 

Time for a quizz...

What do Craig and Kevin talk about when they go out for dinner? (hint)

 

Viagra?

 

Update for Saturday at I-FAB:

Benno Nigg keynote highlights:
Muscle tuning
Piper rhythms
Cushioning not helpful
Motion control small benefits
Trampoline shoes a future thing
Barefoot shoes a contradiction in terms
Barefoot running big every 25 years
Finally the first truly funny video/slide of the conference
And his book on sports shoes comes out in November!
Cheers!
Bruce

 

Five toed socks with grippers:
Big deal in japan
Make your feet look lik Godzilla (IMHO)
Might be better postural control
Keith says "a lot to be desired"
There you have it!
Cheers,
Bruce

 

Five-Toed Socks with Grippers on the Foot Sole Improve Static Postural Control
Among Healthy Young Adults as Measured with Time-to-Boundary Analysis. J. Shinohara,

 

Benno's first edition of "Biomechanics of Running Shoes" came out in 1986. This book sits prominently on my library shelf at home and is frequently referenced, even now 24 years later. Benno's earlier research and books were very influential in the development of my theories on subtalar joint axis location and the effects of ground reaction force on STJ axis location variation. It is just a shame that more podiatrists don't appreciate what Benno Nigg, and his research collaborations, have done for our understanding of foot and lower extremity biomechanics.

Luckily, Benno and I got to talk for a bit at the conference on running shoes, "barefoot shoes" etc. Additionally, I thought his keynote speech this morning was excellent. His preferred movement pathway theory certainly makes sense, even though I think preferred movement pathway theory is an oversimplification of the complex process of how humans decide to walk, run and perform other weightbearing tasks.

The i-FAB meeting here in Seattle has been an excellent conference. Got to head off to the airport now to catch my plane before the Nebraska vs. U of W football game lets out and creates a major traffic jam to the airport.

Nice talking to all of you that attended the meeting and special thanks to the meeting organizers for putting together one of the best foot and lower extremity biomechanics meetings I have ever attended. Maybe I'll get to see you all again at the next i-FAB meeting in Sydney in 2012!

 

STJ Neutral Theory and Sagittal Plane Facilitation Theory......NOT!! :drinks

 

If anyone reading this at conference .... The airport is a nightmare ....I been in queue for 90 mins just to check in .....I only came out here early to get some work done ....that's not going to happen.

 

Kinematics of the foot and ankle -Leardini:

Kinematics knowledge implies kinetics and careful analysis of the former enhances the latter.
Do modeling!!
Every model is fine as long as it explains something in a clear way.
Little biomechanic knowledge has been used in design of surgical treatments.
Cheers
Bruce

 

Medial longitudinal arch deformation during walking and running:

This was Erin Wards masters student from Iowa State u
There is more MLA, medial long arch, deformation with walking than running.
Possibly due to increased GRF's and increases Achilles forces
Timing of navicular displacement of walking occurs much later than with running and well into midstance.

Very well done and she handled three good questions with great candor and knowledge.
Well done!
Bruce

 

The relationship between static arch rigidity and foot kinematics during gait:

Flexible arch subjects had greater sagittal plane excursion in midfoot than rigid arch subjects.
Forefoot DFion associated with more arch lowering.
Greater peak FF abduction in flexible arch subjects
Cheers
Bruce
Ps I expect a beer allowance next time we meet Dr Payne! ;-)

 

One of the keen observations made by Benno Nigg regarding the subject of barefoot running at his morning keynote lecture at i-FAB:



1960 - Abebe Bikila wins Rome Olympic Marathon while running barefoot

25 years later....

1985 - Zola Budd claims the women's world record in the 5,000 meters while running barefoot

25 years later.....

2010 - The virtual barefoot running trend gains momentum again


Expected future for barefoot running??....barefoot running hype will die down....only to resurface for another 25 year cycle.....in the year 2035.....(Benno got a good laugh out of this one). :drinks