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October Runners World Quote
Dr. Kirby's debate on barefoot Running:
"I don’t deny that minimalist shoes can help certain people, but to say they will help everyone is dead wrong. Running is a very individual thing, and you have to experiment and find out what works for each individual. I am putting this in the context of 40 years of distance running and 25 years of treating patients. As a sports podiatrist, I look at the type of injury, foot type, and training, and then recommend options that change bad patterns".
I wonder if he can expand on the foot typing system that he uses in practice.
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
October Runners World Quote
Dr. Kirby's debate on barefoot Running:
"I don’t deny that minimalist shoes can help certain people, but to say they will help everyone is dead wrong. Running is a very individual thing, and you have to experiment and find out what works for each individual. I am putting this in the context of 40 years of distance running and 25 years of treating patients. As a sports podiatrist, I look at the type of injury, foot type, and training, and then recommend options that change bad patterns".
I wonder if he can expand on the foot typing system that he uses in practice.
I thought Kevin never uses the "F" Word.
Dr. Sha
Seriously Dennis??
Are we to endure another year of this? I haven't seen a tool so big since I watched Boogie Nights.
And Ive broken 1 of my rules which means I owe Robert a beer.
Yes. Yes you do.
However.
I call foul. Notwithstanding the combatative tone othe the thread title, there is a reasonable point to be made here. As Kevin's quote indicates, we DO "type" feet to a greater or lesser extent, conciously of subconciously. With my cognititive psychology hat on its the "representativeness heuristic" with a healthy dose of the anchoring heuristic. We look for patterns and make assumptions whether we want to or not.
There may be a grammatical difference between a foot type and a type of foot, but thats splitting hairs.
Quote:
I may discribe a persons foot type as medially deviated STJ axis.
I bet you wouldn't. You might say that medially deviated STJA is the type of sub talar joint, but would you call that a foot type?
I think Dennis has asked a reasonable question which deserves a reasonable response. When we talk about what type of foot it is, we don't generally refer to a formalised, prescribed type as dennis does, but the terminology has crept in. One of the first lessons Kevin taught me was to be precise with my terminlogy and If there is one man who does not use terminology casually, its Kevin. So I'd like to know the answer to the OP question.
However, I have to admit that when I first saw the title of the thread, the names of two potential initiators came immediately to mind, in the following order: Dennis and Ed Glaser. At the risk of sounding uncharitable, I would think that uppermost in drsha's mind when writing the posting was 'to have a pop' rather than engage the arena's community in an informed debate. As usual, reading it caused what I once heard someone term the MEGO (My Eyes Glaze Over) Effect.
I no longer tend to read the material that Dennis and Ed post in as it generally causes me to break out in cold sweats and fits of irritability - rather akin to the after effects of reading or listening to Vogon poetry.
Notwithstanding the above gripe, I repeat my opening line:
I call foul. Notwithstanding the combatative tone othe the thread title, there is a reasonable point to be made here. As Kevin's quote indicates, we DO "type" feet to a greater or lesser extent, conciously of subconciously. With my cognititive psychology hat on its the "representativeness heuristic" with a healthy dose of the anchoring heuristic. We look for patterns and make assumptions whether we want to or not.
There may be a grammatical difference between a foot type and a type of foot, but thats splitting hairs.
I bet you wouldn't. You might say that medially deviated STJA is the type of sub talar joint, but would you call that a foot type?
I think Dennis has asked a reasonable question which deserves a reasonable response. When we talk about what type of foot it is, we don't generally refer to a formalised, prescribed type as dennis does, but the terminology has crept in. One of the first lessons Kevin taught me was to be precise with my terminlogy and If there is one man who does not use terminology casually, its Kevin. So I'd like to know the answer to the OP question.
When I am speaking to the lay public, for example, when I am doing magazine interviews, the terminology I use in these interviews is less precise than usual since the understanding of the mechanics of the foot is poor in the lay public. In other words, I must often use less precise words that the lay public will understand in order to get the point across. However, in my academic discussions to other podiatrists, I don't use the term "foot type" since I think it is archaic terminology that is useless when one is endeavoring to understand the kinetics and kinematics of the foot and lower extremity.
Hope that answers your question, Robert. Now you owe me a beer!
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
The point I am trying to make is that I maintain that foot typing is more easily understood by everyone.
It represents a common explanation of why feet differ, need custom care and deserve professional care to the MD's and the masses. It allows for a good presentation of the facts by DPM's to their patients. It is a custom care program and not the reductionist, cookbook system that you have declared it without looking at it.
Who would understand a medially deviated subtalar joint axis (whether its a foot type or not).
Lady, you have the dreaded dorsiflectory stiffness.
I;m still waiting for sagital calcaneal stiffness (or has it come without my knowledge).
Kevin uses my language to dummy down his arrogance (even the DPM's don't understand him).
He calls for our schools and research to be based on his physics and to be the guiding force to podiatry practice at the detriment of our ability to communicate to the world and care for it.
Biomechanics is a misspelling on Word Spellcheck. So is orthotic!!
We've done a poor job over the 30 years we have sat atop the biomechanics pyramid.
and not the glasers and the scanners, the stj neutral wanna bee's and the barefoot runners are replacing us.
I am not the enemy.
Wellness Biomechanics, Functional Foot Typing, Foot Centirngs, Muscle Engine Training, Barefoot Running, Training Orthotics etc, has room for it all.
It takes the best from all paradigms starting with a functional foot typing that profile feet into subgroups for more custom care.
I bet none of you use biophysics when you write your notes in charts for insurance purposes. They wouldn't understand it and would deny your claims.
Kevin's reaction to this thread is bring it on!!! with
I stopped using the smiles ages ago!
He loses so much power in my eyes when he does that.
I've had 2 years of it.
Are we ready to meld to greatness and the benefit of mankind?
When I lecture, I credit Kevin with his GRF concept years ago that showed how the first ray did different things for different feet that were supported by the heel and the fifth ray. He was describing foot types.
I use the fifth ray as the base for my forefoot exam (it used to be 1-2) on his shoulders (I made it 1-5).
I am a foot typer making foot centrings and training the muscle engines to support the flexible tie beam of our truss system, foot type-specific. Many of you can understand that.
Peroneus longus is my sun, not the subtalar joint or its axis.
Pronation should be the misspelling (right Dr, Menz?)
The position of the bony surface (casting position for orthotics) should be the day that bone growth stops (unless there was juvenile expansion that can be foot type specific predicted (on this I lean towards Dr. Glaser).
and..
the saddest thing about meeting so many of you that work in socialized medical climates at The Arena is that the only way to get your system to thrive is to practice prevention, performance enhancement and quality of life issues in order to reduce the expense of knee, hip and back surgery, obesity, diabetes, etc.
and Kevin and Spooner have you waiting for pain and evidence while my science keeps growing and getting stronger with greater applications.
My sadness led me to decide to recuse International Patenting for my work (and I had the money).
So you guys and gals can do whatever you want with my work and I will never make a dime off of you.
I never patented TIP (and I could have) that's for all of us to enjoy.
I just wanted to prevent what my profession and the labs did to Dr. Root's science 30 years ago by owning it for 17 years in my country. (That's why I use DPM's to distinguish).
I have learned so much from The Arena as you isolated me. I continue to thank you and credit those who mentored me.
i.e. Spooner has given me more references in 2 years than in my previous 10
One of the first lessons Kevin taught me was to be precise with my terminlogy and If there is one man who does not use terminology casually, its Kevin.
Kevin has labeled me as being an "average runner" in 3 or 4 of his recent posts. I'm not sure if he is trying to get a reaction out of me so I haven't bothered to respond because I have no idea what Kevin means by average.
While we are on the subject of Kevin being precise with terminology, Kevin would you mind defining what you mean by "average runner"? Be precise, please.
No. Dennis you didn't even get a bite from Ed, how likely do you think it is that you'll get a bite from either Kevin or I?
What are your chances? Negligible.
My first and last post in this thread.
Carry on... Knock yourself out. I look forward to reading the research Craig spoke about recently in the UK, which tests your foot-typing hypothesis, Dennis.
P.S. the tags to this thread are inaccurate Craig, it has nothing to do with barefoot running.
Who would understand a medially deviated subtalar joint axis (whether its a foot type or not).
My patients, when I explain it to them
Quote:
Lady, you have the dreaded dorsiflectory stiffness.
And again. Although, I tend not to use Lady, I prefer "darlin'" or "love" or "hen" when I am in Scotland.
Quote:
I am a foot typer making foot centrings and training the muscle engines to support the flexible tie beam of our truss system, foot type-specific. Many of you can understand that.
Do you use this type of language with your patients?
__________________
I see you girls checkin' out my trunks
I see you girls checkin' out the front of my trunks
I see you girls lookin' at my junk, then checkin' out my rump, then back to my sugarlumps
The Following User Says Thank You to RobinP For This Useful Post:
And again. Although, I tend not to use Lady, I prefer "darlin'" or "love" or "hen" when I am in Scotland.
Och aye wee hen. I love that dialect.
It occurs to me that while it is important to have language the patients can understand, it is also important that we don' that that become the language we use to discuss things ourselves.
Pardon the rant:
I am a foot typer making foot centrings and training the muscle engines to support the flexible tie beam of our truss system, foot type-specific.
This chap named Shavelson, he's an amateur when it comes to salesmanship. He has no idea.
I must have missed that memo that said "let's verbally crap all over Kevin Kirby (because it makes me feel better about my own shortcomings, insecurities and my pet wont come when I call him) "!
__________________
"If we all worked on the assumption that what is accepted as true is really true, there would be little hope of advance." - Orville Wright
Craig:...I'll bet you a beer you'll post again on this thread.
Dennis
Goodaye drsha, if you'd like to bet with real money, please do me the favour, as I think you've grossly underestimated Simon Spooner's behavioural traits.
Hope that answers your question, Robert. Now you owe me a beer!
speak to michael. Tell him I sent you
Further too my last, there is another valid point In Dennis' last rant.
Quote:
(even the DPM's don't understand him).
This, sadly, is my experience. Most Pods I teach do not understand the language of physics. More often than not I find people using the terminology without really understanding it. Had someone recently, when I asked them recently WHY we needed 10 degrees ankle dorsiflexion for normal gait, answer on the lines of "to prevent tissue stress". She knew the words, just didn't know what they meant.
But herein is the rub. As a profession, where should we set the bar? The language Kevin, Simon, Dave and others using is precise and specific. It's also complex and yes, it takes work for most of us to learn / keep up with. But does these mean we must lower the bar to allow everyone to keep up? Is it arrogance to push the boundries?
I think not. Unless, as per the YouTube clip I posted, we want to be standing around saying "quick, get the bendy bit of plastic, this man has a hurty knee caused by to much stressy force".
As when I forst entered The Arena, it is you who wants to bully and pick fights.
What is your problem?
Can't you allow some dissent to keep you honest and unbiased?
You have focused so much attention to my foot typing system and the lack of a need for one.
You have now explained that you need one to discuss biomechanics (and maybe many DPM's until they acculturate to your language when researching and talking peer).
So:
1. What is the foot typing sytem that you use to talk down to (and reduce rapport) when talking to patients, lay public and I assume the physician community?
2. How do you know when to take one hat off and the other on?
3. Does any of your intended meaning and education get lost in the translation?
4. Do you think that those who realize that you are talking to them in a dummy down language (like the barefoot runners) take it as arrogance and elitism and showing off as a professional instead of using your own evidence?
Sorry Denis but I really think that you are off beam here in this thread and ultimately doing your self a disservice in it.
Certainly this last post of yours seems to confirm that your interpretation of Kevin's comment is more a product of your own bias and frustration. That and the fact that others can read it without immediately arriving at your interpretation should perhaps indicate to you that you are trying to make something out of nothing.
A reading of the article soon reveals that there are a couple of ways Kevin's comments can have been construed, of which one is yours. It certainly was not my interpretation of the comment and I think that to continue down this road serves no point to anyone.
I am no defender of Kevin, he is quite capable of this himself, but to be fair to him, in all the reading of his material I have undertaken, I have never come across any indication where I could begin to find him devising or implying a foot type classification.
Leave this one alone Denis, it will only serve to isolate you and your views.
Nonsense. Dennis is an invaluable resource for mankind. Who else could we turn to once we start intergalactic podiatry care?? Who else has an encyclopedic knowledge of Klingon keratosis or Ibshi tib tib syndrome or Acshu granulosum?? Dennis, if you're feeling under pressure, just ignore them and thank you for the kind referral last week. Not sure I can be of any help really, but you're quite correct in that they just seem to snap off at the ankle (or idshu as you correctly call it) and they do make rather delightful soup. Will send some once it starts to ferment.
In SALRE, a medial deviated STJ Axis would exit the medical side of the foot fefore the ends of the metatarsals.
Like the one called Shavelson, you might need help when it comes to selling your product. Maybe you just need help with using a computer keyboard accurately? Visit us at the Church of the Sub-Genius, you will be offered the warmest welcome. We offer a wide range of courses, including marketing and computer literacy.
In SALRE, a medial deviated STJ Axis would exit the medical side of the foot fefore the ends of the metatarsals.
How would you utilize a SALRE Typing to describe pathology of the forefoot when talking to a patient?
Dr Sha
Dennis take Ian's advice...
My beer count is rising. I would use tissue stress theory to discuss their forefoot pathology which may or may not include a discussion of the subtalar joint axis but would include mechancial discussions on why they have forefoot pain.
diagnosis of stressed tissue
work out why they have excessive tissue stress during weightbering activities
build a treatment program to reduce stress on the required tissue.
I just used the medial deviated axis as an example and another cheap shot from Dennis.
In SALRE, a medial deviated STJ Axis would exit the medical side of the foot fefore the ends of the metatarsals.
How would you utilize a SALRE Typing to describe pathology of the forefoot when talking to a patient?
Dr Sha
Let's see now an example for Dennis in lay terminology and in terminology that Dennis does understand?
We see a patient complaining of forefoot (under the big and small toes) and lateral foot and leg pain. We examine him/her and find a flexible cavovarus foot 'type' and a very laterally deviated STJA, varus heel, compensatory forefoot valgus, sub fifth met head and lateral callus, let's toss in metatarsus adductus and a plantarflexeed first ray for good measure..... We perform a Coleman Block test and determine that the heel varus is a compensation that corrects and that an orthoses is indicated. Perform resisted muscle testing to rule out frank peroneal dysfunction, that dorsiflexion is intact at the ankle and first ray etc. In gait we confirm a long midstance period that does not pronate adequately and poor toe-off. This patient has a previous history of lateral ankle sprains btw
Dennis I would expect to of course understand the frontal plane deformities, lateral column overload and the compensatory mechanism of the forefoot, The varus heel, plantarflexed first ray and the possible transverse plane deformities of the lesser toes, the clinical reasoning behind lateral wedging, the appropriate points on the shell to do such, goals, measurements etc.
To the patient I would explain that their foot is simply of a 'type' that has a very high arch, which leads to more rolling out of the foot than in. This places more stress on the outer structures of the foot and causes overuse of the muscles on the outer side of the lower leg to try and aid in stabilize the foot, resisting rolling further out. This in turn is causing the pain in the leg. The undue stress on the lateral column and excessive supination (describe for patient and quantify pronation versus supination) is causing those now raw callus here and here (use fingers, actually touch the patient's foot; thats what they're paying you for!), the tiliting outward attitude of the heel and in compensation, get this part Dennis...wait for it....wait for it....the compensation on the forefoot to achieve the ground when all of your weight on it is necessary for you to ambulate so the big toe and forefoot try to reach the ground like a plant searches for the sun (which is one reason why I disagree with everything about foot typing and MASSSS casting btw, in the case of MASSSSS it is completely inappropriate for this 'type' of foot IMO)!
What I intend to do Mr./Mrs. Jones is provide a mechanical advantage to counter those forces causing your pain by addressing and using an orthotic device that will be built custom to your foot and that will address these biomechanical faults. It is much like the concept of eyeglasses and will only correct your problems while being worn.
My clinical experience tells me that after successfully mediating this 'type' of foot and subsequent complaints in literally hundreds if not thousands of similar cases is that we can expect a good reduction in symptoms over time if you wear them and follow through with treatment. It will be designed to reduce the stress being placed on the tissues that you are complaining of today.
Mr./Mrs. Jones does that make sense to you and does that seem reasonable?
Calling a foot a 'type' does not mean that you can categorize every similar foot into that precise category and function for that matter. I do see cavus foot "types' that pronate, so this negates the idea of a Foot Typing system that is universal. That is the issue we have with FFT Dennis; it is the concept and validity of what you're offering, not the person offering it. It is useful as a baseline for OTC devices but with pathology not every 'type' has the same precise shape, dysfunction or symptomatology. You're playing with words good doctor Dennis, carry on but in all truth this thread was a poor and cheap shot. I and other do expect more from an intelligent man like yourself. Take this as you may....
Regards,
__________________
"If we all worked on the assumption that what is accepted as true is really true, there would be little hope of advance." - Orville Wright
David G. Wedemeyer, D.C., C.Ped.
Last edited by David Wedemeyer : 8th January 2011 at 05:18 PM.
Reason: Syntax
The Following User Says Thank You to David Wedemeyer For This Useful Post:
Let's see now an example for Dennis in lay terminology and in terminology that Dennis does understand?
We see a patient complaining of forefoot (under the big and small toes) and lateral foot and leg pain. We examine him/her and find a flexible cavovarus foot 'type' and a very laterally deviated STJA, varus heel, compensatory forefoot valgus, sub fifth met head and lateral callus, let's toss in metatarsus adductus and a plantarflexeed first ray for good measure..... We perform a Coleman Block test and determine that the heel varus is a compensation that corrects and that an orthoses is indicated. Perform resisted muscle testing to rule out frank peroneal dysfunction, that dorsiflexion is intact at the ankle and first ray etc. In gait we confirm a long midstance period that does not pronate adequately and poor toe-off. This patient has a previous history of lateral ankle sprains btw
Dennis I would expect to of course understand the frontal plane deformities, lateral column overload and the compensatory mechanism of the forefoot, The varus heel, plantarflexed first ray and the possible transverse plane deformities of the lesser toes, the clinical reasoning behind lateral wedging, the appropriate points on the shell to do such, goals, measurements etc.
To the patient I would explain that their foot is simply of a 'type' that has a very high arch, which leads to more rolling out of the foot than in. This places more stress on the outer structures of the foot and causes overuse of the muscles on the outer side of the lower leg to try and aid in stabilize the foot, resisting rolling further out. This in turn is causing the pain in the leg. The undue stress on the lateral column and excessive supination (describe for patient and quantify pronation versus supination) is causing those now raw callus here and here (use fingers, actually touch the patient's foot; thats what they're paying you for!), the tiliting outward attitude of the heel and in compensation, get this part Dennis...wait for it....wait for it....the compensation on the forefoot to achieve the ground when all of your weight on it is necessary for you to ambulate so the big toe and forefoot try to reach the ground like a plant searches for the sun (which is one reason why I disagree with everything about foot typing and MASSSS casting btw, in the case of MASSSSS it is completely inappropriate for this 'type' of foot IMO)!
What I intend to do Mr./Mrs. Jones is provide a mechanical advantage to counter those forces causing your pain by addressing and using an orthotic device that will be built custom to your foot and that will address these biomechanical faults. It is much like the concept of eyeglasses and will only correct your problems while being worn.
My clinical experience tells me that after successfully mediating this 'type' of foot and subsequent complaints in literally hundreds if not thousands of similar cases is that we can expect a good reduction in symptoms over time if you wear them and follow through with treatment. It will be designed to reduce the stress being placed on the tissues that you are complaining of today.
Mr./Mrs. Jones does that make sense to you and does that seem reasonable?
Calling a foot a 'type' does not mean that you can categorize every similar foot into that precise category and function for that matter. I do see cavus foot "types' that pronate, so this negates the idea of a Foot Typing system that is universal. That is the issue we have with FFT Dennis; it is the concept and validity of what you're offering, not the person offering it. It is useful as a baseline for OTC devices but with pathology not every 'type' has the same precise shape, dysfunction or symptomatology. You're playing with words good doctor Dennis, carry on but in all truth this thread was a poor and cheap shot. I and other do expect more from an intelligent man like yourself. Take this as you may....
Regards,
David:
This is a very telling post for me and I am pleased that you have taken the time to construct this hypothetical patient having a flexible cavovarus foot type.
1. I believe that your lengthy and complicated explanation of this foot type is summed up in my system in four words that any knowledgeable reader, would then infer the presenting complex if they have reviewed my published work.
Can anyone guess? _______reafoot/_______forefoot.
2. In addition to the orthotic, Dr. Wedermeyer, would you possibly debride the callus, add a pad onto the painful feet, consider oral or injectable antiinflammatories, corrective foot surgery or make comments on reshaping the patients shoe wardrobe without any need for your biomechanical consideration?
These would probably give the patient tissue stress and symptomatic relief of their chief complaint and save you and the patient a lot of time and expense even discussing or considering biomechanics.
3. This same flexible cavovarus foot type that you have worked with thousands of times, did you make the same "reductionist, cookbook" orthotic for all of them or did you further customize them using your cavovarus guidelines to benefit the patient in front of you?
4. In the cavus foot types you see, what is the end range of STJ inversion and eversion for the ones that pronate (as you scientifically call it) on the frontal plane?
What is the end range of motion of STJ inversion and eversion for the ones that you see that don't pronate (I assume those would be all others or do you have other types of cavovarus feet?) on the frontal plane?
Notwithstanding the sinking feeling in the pit of my stomach I am soldiering on with this thread trying hard to keep an open mind.
Quote:
1. I believe that your lengthy and complicated explanation of this foot type is summed up in my system in four words that any knowledgeable reader, would then infer the presenting complex if they have reviewed my published work.
Can anyone guess? _______reafoot/_______forefoot.
1.a. Which published work?
1.b. The thing is, a rigid rearfoot rigid forefoot (or whatever) is not the end of the description. It is, to the consumer and indeed the podiatrist who does not use FFT, just as obfuscated as "flexible cavovarus" foot. More so in fact, because as a podiatrist I know what a flexible cavovarus foot is. I'm less clear on an FFT description.
Once typed, the podiatrist has still to explain what that type means.
2. Don't understand your point here Dennis.
3. This one also. Although I know you dislike having what you do described as "reductionist cookbook". I therefore wonder why you are throwing this epithet at someone else. Are you trying to be provokative or are you unaware that you are being combatative?
I have no interest in another round of scrapping but that is what this sort of comment will cause.
4.
Quote:
In the cavus foot types you see, what is the end range of STJ inversion and eversion for the ones that pronate (as you scientifically call it) on the frontal plane?
What is unscientific about "pronate"?
Although one cannot "pronate" the STJ on the frontal plane as you say. Sub talar pronation is triplanar.
If you are asking about the movement of the calc in the frontal plane, the answer, I suspect ,is that no one really knows. Short of clamps, calipers or bone pins, its well nigh impossible to measure calcaneal inversion / eversion with a degree of accuracy which would make the measurement useful. If I said, "5 degrees everted" you could not take my answer seriously because evidence shows that I could easily be 6+ degrees out! And thats the BEST estimate I've seen.
That goes for everyone. The measurement of calcaneal position is grossly innaccurate taken clinically. One reason I would not base any treatment choice on it.
Quote:
What is the end range of motion of STJ inversion and eversion for the ones that you see that don't pronate
Trick question. There is no range of motion of STJ motion for feet that don't pronate. No pronation = no motion. No Motion = no range of motion. No range of motion = no end range.
Notwithstanding the sinking feeling in the pit of my stomach I am soldiering on with this thread trying hard to keep an open mind.
1.a. Which published work?
1.b. The thing is, a rigid rearfoot rigid forefoot (or whatever) is not the end of the description. It is, to the consumer and indeed the podiatrist who does not use FFT, just as obfuscated as "flexible cavovarus" foot. More so in fact, because as a podiatrist I know what a flexible cavovarus foot is. I'm less clear on an FFT description.
Once typed, the podiatrist has still to explain what that type means.
2. Don't understand your point here Dennis.
3. This one also. Although I know you dislike having what you do described as "reductionist cookbook". I therefore wonder why you are throwing this epithet at someone else. Are you trying to be provokative or are you unaware that you are being combatative?
I have no interest in another round of scrapping but that is what this sort of comment will cause.
4.
What is unscientific about "pronate"?
Although one cannot "pronate" the STJ on the frontal plane as you say. Sub talar pronation is triplanar.
If you are asking about the movement of the calc in the frontal plane, the answer, I suspect ,is that no one really knows. Short of clamps, calipers or bone pins, its well nigh impossible to measure calcaneal inversion / eversion with a degree of accuracy which would make the measurement useful. If I said, "5 degrees everted" you could not take my answer seriously because evidence shows that I could easily be 6+ degrees out! And thats the BEST estimate I've seen.
That goes for everyone. The measurement of calcaneal position is grossly innaccurate taken clinically. One reason I would not base any treatment choice on it.
Trick question. There is no range of motion of STJ motion for feet that don't pronate. No pronation = no motion. No Motion = no range of motion. No range of motion = no end range.
I get what you are saying Robert, although you are avoidong my questions to some extent and you are being biased because Dr. Wedermyers statement that "wait a minute. you have to actually touch the foot, here and here was provocative and combative yet you do not entreat him with suggestions aon altering.
Kirby's loser post
the russels post was so over the top but unscolded.
Be fair and so will I.
I simply asked Dr. Kirby what his foot typing was that he described in an article.
What kind of trick? or degrading?
1. I didnt say published research.
I have many articles, podiatry mangement, podiatry today, practicle diabeticum, my diabetic foot chapter, radius magazine, my patent aps and the "Foot in Motion" series of 12 articles.
It would be fair and comfortable to hear that functional foot typing is one more paradigm of biomechanics that has been suggested and practiced and that it is the intrapersonal choice of practitioners to decide which to follow as no one is well practiced and researched.
2. My point is that Dr. Wedermyer seems to be treating an underlying biomechanical etiiology that is rooted to thousands of his patients which may exist in many of his tissue stress diagnosis that require similar foundational biomechanicval control.
Then there are pathology specific treatments that would be used with or without biomechanical care to treat tissue stress.
3. I get what you are saying Robert, although you are avoidong my questions to some extent and you are being biased because Dr. Wedermyers statement that "wait a minute. you have to actually touch the foot, here and here was provocative and combative yet you do not entreat him with suggestions on altering or slowing down.
Kirby's loser post
the russels post was so over the top but unscolded.
Why doesn't Dr. Kirby simply answer my reasonable question.
If its printed that he checks a patients foot type, what is his typing method?
4. I see very, very, very few feet that literally cannot move on the frontal plane at the STJ (tarsal coalitions).
I thought he meant that these were patients that had some small range of motion on the frontal plane (small pronatory ROM but (since the STJ Axis is laterally placed) they were close to vertical and never "pronated" (hyperpronated.
i.e. not pronated could mean that a foot everts towards vertical but never goes beyond it "to be everted".
would then infer the presenting complex if they have reviewed my published work.
Quote:
Originally Posted by Robertisaacs
1. Which published work?
Quote:
Originally Posted by drsha
1. I didnt say published research.
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Dr. Kirby Caught Typing Feet
and a very laterally deviated STJA, varus heel, compensatory forefoot valgus, sub fifth met head and lateral callus, let's toss in metatarsus adductus and a plantarflexeed first ray for good measure..... We perform a Coleman Block test and determine that the heel varus is a compensation that corrects and that an orthoses is indicated. Perform resisted muscle testing to rule out frank peroneal dysfunction, that dorsiflexion is intact at the ankle and first ray etc. In gait we confirm a long midstance period that does not pronate adequately and poor toe-off. This patient has a previous history of lateral ankle sprains btw
Linear Mode
