Podiatry Arena members do not see these ads

Null Hypothesis:

Current technology has implanted seeds that
1. pronation is bad
2. pronation means a collapse at the STJ.

and

Historically, the word pronation has become related to:
1. Something bad
2. Existing within the Subtalar Joint alone
3. Dominating on the frontal plane of the subtalar joint

This has placed an unnecessary bias in the direction of the STJ and its pronatory motion (especially the frontal plane) as culpable and treatable in most biomechanical diagnosis and treatment paradigms until now.

Evidence/Fact:
Pronation is one of the tri-plane movements of any joint within the biomechanical postural complex when it does not live exactly on one of the three body planes.
Supination is another, circumduction, yet another.

Planal dominance and the establishment of ORF's and MERF's can be defined and developed joint by joint with, essentially, no one joint within the posture dominating.


Hypothesis:
These myths need to be busted and it will take a Destructive Technology to accomplish that.

When looking at Rootian Biomechanics and the modern innovations that have been built upon it, one is taught to perceive that if a foot is collapsed in closed chain, it is pronated and that pronation exists in the Subtalar Joint (even more isolated, on its frontal plane).

Using heel contact gait as the gauge fosters this perverse understanding of pronation.
Forefoot contact gait obviates the importance of the STJ or its axis, or its importance as a joint in biomechanical diagnosis and treatment (possibly that is why "barefoot running", a disruptive biomechanical technology is considered so threatening to some biomechanists?)

Functional Foot Typing, another disruptive biomechanical technology, by profiling all feet in order to determine the strengths and weaknesses of the rearfoot and/or forefoot inherent in each type as subgroups exposes the weaknesses of each section of the foot that can then be primarily treated in the area of weakness and not elsewhere with no prejudice.

In fact:
Rearfoot hyperpronation leads to a flexible, collapsed rearfoot structure.
Rearfoot hypersupination leads to a rigid, well supported rearfoot structure.
Forefoot hyperpronation leads to a rigid, well supported forefoot structure.
Forefoot hypersupination leads to a flexible, collapsed forefoot.
(See the two figures 1. pronated foot A and 2. pronated foot B)

Labeling either of these feet "pronated" so as to describe it as collapsed or bad is IMHO, the Root of the stagnation in modern biomechanics that needs innovation.

Functional Foot Typing and Foot Centering, define the rearfoot of A as flexible (collapsed) and the rearfoot of B as rigid and the forefoot of A as flexible (collapsed) and the forefoot of B as rigid (supported) which is much more easily understood and teachable. It allows its followers to focus treatment in the area of pathology and reduces the focus upon the rearfoot and The STJ as primarily dominant for either diagnosis or treatment.

The reality is that in pronated foot A, the rearfoot is hyperpronated and in pronated foot B, the forefoot is hyperpronated.
IMHO, most biomechanicst's brains would look at pronated foot B and never call it pronated on a test.

Summarily, since the rearfoot has a positive incline and the forefoot has a negative incline inherent in its truss-tie beam structure, their respective joints have reciprocal pronatory and supinatory impact.
Introducing to the novices and students of biomechanics the thought that pronation is bad and supination is good or that the rearfoot is the primary cause of biomechanical pathology needs replacing with a disruptive technology.

Conclusion:
On this basis, I suggest barefoot running and functional foot typing (Foot Centering) deserve examination and inspection.

Dennis

Attached Images

	Pronated Foot A.jpg (30.3 KB, 256 views)
	Pronated Foot B.jpg (4.2 KB, 264 views)

Tweet

Share

Yawn...

Yawn....yawn...

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

19/3/2012

__________________
Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

__________________
Just a rock `n roll refugee.

If...

Haven't you learned anything, Blinda? If it doesn't have something to do with Foot CenteringTM blah blah blah, then you will be waiting a very, very long time for a response.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Nope

EDIT: Actually yes, I have just received a PM;

Dennis;

Let`s keep this in the public domain, eh? I`m sorry if you feel affronted by the reminder of my unanswered questions but, no I still have no intention of debating your foot typing system with you.

Bel

__________________
Just a rock `n roll refugee.

If...

Even if the question does have something to do with foot typing you will wait a long, long time.

Sounds more like 1972 to me...

__________________
Robert Isaacs
Specialist in Biomechanical Therapies
www.Footprintspodiatrysolutions.co.uk

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

Semper in excretum sum sed alta variat

Who said 1972

http://www.youtube.com/watch?v=hcCuBWXd-hc

Dave

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

Hyperpronation and hypersupination are crappy words. Just like hypermobile 1st ray.

Hyper-uppercut is a cool word though! Streetfighter is a cool game.

Hope this is a valuble contribution to this thread.

Phil

__________________
Phil Marshman
Mackay, Queensland Australia

That is why hyperpronation, hypersupination and hypermobile have been totally eliminated in Foot Centering language and replaced with new terminology.

The first one we dropped was PRONATION which, to use your grammatical tone. is hypercrappy. That term is most confusing and wrenching when it comes to teaching and presenting biomechanics.

You can add flat foot, compensated, partially compensated and fully compensated, forefoot varus and especially Forefoot VALGUS
and STJ Neutral to the crap pile.

How's that for destructive technology Phil?

Dennis

Agreed. very poor terminology. I'd not heard the term before you used it.

This, however, is worse. The rigid actually means limited, not rigid. "Well supported" doesn't mean anything very much, and "rearfoot structure" is pretty meaningless. What is the "rearfoot structure" exactly? The calc? The sub talar complex? The sub talar, talo crural and CCJ?

You Didn't drop the term pronation? Remind me what does PERM stand for again?

Nothing wrong with "pronation". It has a globally agreed meaning (Pronation describes the motion of rotating towards the prone position) and a specific and globally agreed meaning in terms of specific joints (as in sub talar pronation being abduction, dorsiflexion and eversion). Where it goes a bit runny is where people use it in an inappropriate or unclear way such as a "pronated" foot or "over-pronation". Over what exactly? Pronated under which circumstances? Replacing these terms with others which are equally vague and non specific is not really helping, especially when one needs a key to translate the new technology into the existing.

The correct way to describe a foot in which one can evert the rearfoot between, say, 10 degrees inverted to the leg and 3 degrees inverted to the leg is not supinated, hypersupinated, uncompensated rearfoot varus or even rigid rearfoot or rigid Serm. Its a foot in which one can evert the rearfoot between 10 degrees inverted relative to the leg and 3 degrees inverted relative to the leg. Look at it, say what it is. Anything else is not simplifying it, its complicating matters.

__________________
Robert Isaacs
Specialist in Biomechanical Therapies
www.Footprintspodiatrysolutions.co.uk

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

Semper in excretum sum sed alta variat

1.The reason that you have never heard hypersupination before is that pronation is the only movement considered pathological.
In the forefoot (FHL) supination is the bad movement, so why haven't we ever heard of it before?

2. When you deny architecture and take Newton as your king, these words will never have any meaning to you.
Think for a moment about how torque, moment and tissue stress "translate" to the subtalar joint neutral Rootian students and practitioners.
They seem to understand my terminology fairly well (when they actually visit it as so would you IMHO).

3. I did as PERM = pronatory as in a motion not Pronated as in a position.
Put away your microscope for a week (or even a day) Robert.

I googled pronation. The first hit was a runners world article:
Pronation, Explained
Understanding your personal pronation type is crucial to choosing the proper running shoes. From the August 2004 issue of Runner's World
If you have a normal arch, you're likely a normal pronator, meaning you'll do best in a stability shoe that offers moderate pronation control. Runners with flat feet normally overpronate, so they do well in a motion-control shoe that controls pronation. High-arched runners typically underpronate, so they do best in a neutral-cushioned shoe that encourages a more natural foot motion.
This refers directly to a definition that pronation is rearfoot eversion and collapse and that too much must be stopped for healthy and perfomance issues.

The second was Wikopedia, where it stated in addition to your definition:
The pronated foot is one in which the heel bone angles inward and the arch tends to collapse. (A "knock-kneed" person has overly pronated feet.) It flattens the arch as the foot strikes the ground in order to absorb shock when the heel hits the ground, and to assist in balance during mid-stance. If habits develop, this action can lead to foot pain as well as knee pain, shin splints, achilles tendinitis, posterior tibial tendinitis, piriformis syndrome, and plantar fasciitis.
Since the flexible rearfoot type is not the most common rearfoot FFT this means that the collapse and compensations referred to (and accepted) in this definition are in need of destruction.

Your statement of "global agreement" in the definition of pronation is in Phil's words, crappy IMHO.

5. No wonder why Simon says that we're all guessing and why you haven't come up with the evidence that you are trying to find. Your terms are too rigid (or is that limited?).

In summary, The Arena is not global and your opinion of what is "The Correct Way" (until you have proof beyond expert opinion) is spam filtered from being validated and applied in my EBP and my work from day one when I became a member. and in four years of my involvment, nothing has changed (minimal, very low grade evidence and expert opinion).

Dennis

I didn't check that the definition of pronation fitted with the more authoritative sources, wikipedia and a running website?

Damn. Is my face red. Ok, you've made your point. If wikipedia states that "The pronated foot is one in which the heel bone angles inward and the arch tends to collapse" then that pretty much wraps it up. Make me wonder why we bother with textbooks and university and all that. They obviously are not the authorative definitions. Could have just googled pronation and taken the first two descriptions.

I'm going to go count to ten before I resort to saying whats on my mind. Maybe drink a little.

Wikipedia. damn.

__________________
Robert Isaacs
Specialist in Biomechanical Therapies
www.Footprintspodiatrysolutions.co.uk

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

Semper in excretum sum sed alta variat

Interesting point here. There has been sort of a disconnect to how supination of the subtalar joint leads to a sprained ankle. I have to disagree, supination has been termed pathological. A foot that supinates too easily will get peroneal tendonitis. Tissue stress has been talking about these pathologies as be related to high supination moments from ground reaction force for years.



Now this is a straw man argument. Mechanical analysis does not deny architecture or structure.

Dennis, you may have a definition of the terms "rigid" "Well supported" and "rearfoot structure", but you won't find these terms defined the same way in podiatry schools. Changing the definition of words is more confusing. What makes you think that people understand your terminology? They don't ask questions?

Dennis, I don't understand your comment about moment and tissue stress. When I taught these concepts, the vast majority of students were able to answer questions about these topics on the tests that they took. Besides, a year of physics is a prerequisite for entrance into podiatry school in the U.S.

Now we can pick on your definition of global. In the global world of podiatry, we learn the definitions of joint motion and positions from anatomy textbooks. Since the definitions on wikipedia and runners world are different we need to make the decision on whose definition to take. I'd go with the anatomy textbooks. I'd also go with the person who names bones (calcaneus, talus) instead of uses terms like rearfoot structure, because the term rearfoot structure is not precise.


Eric

As Eric has already stated, this is a straw-man fallacy. In addition, it is a disservice to Root and those who have studied and understood his writings. Root discusses torques, moments and tissue stress within his publications. Thus, these terms should need no translation to "the subtalar joint neutral Rootian students and practitioners". Remember too that many of us were directly, and indirectly, students and practitioners of Rootian biomechanics, yet we are more than capable of understanding these concepts; that you may not be able to Dennis, doesn't make it too complicated for the rest of us.

__________________
Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

I'll disagree with you there Simon. While I think they probably grasp the concepts you describe, I'm not sure they'll understand how "moment" translates. Maybe they'll understand it with hour. The concept may become more clear when they've read enough page.
No its because its what I like to call "s**t you made up".

Yeah, thats the problem, the terminology being used is to precise and unambiguous. We'd do better by using looser, more ambiguous terms which have different definitions depending on who is talking about them. Thats much better science.
I'm not sure even you understand your terminology Dennis. Its so vague and amphorus as to be meaningless. What exactly IS a "well supported rearfoot"??

So to be clear, when you SAY you "Dropped pronation" what you MEAN is that you "stopped using pronated to describe a position". But pronation as a motion you dropped. Forgive me for not realising that when you said pronation you meant pronated.

__________________
Robert Isaacs
Specialist in Biomechanical Therapies
www.Footprintspodiatrysolutions.co.uk

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

Semper in excretum sum sed alta variat

Actually its been done

http://www.youtube.com/watch?v=N7yfLwMds5c

"we wanted to cut through that high flown medical jargon"

"Nurse, fetch me the electric paddles that can make you better if you're really sick but can make you sort of ill if you're fine!" Moments later: "Oh no... he was fine. And now he's poorly from too much electric.

__________________
Robert Isaacs
Specialist in Biomechanical Therapies
www.Footprintspodiatrysolutions.co.uk

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

Semper in excretum sum sed alta variat

Bizzarre. That's exactly what I call it when Dennis writes his posts. Independently we have come up with a terminology to define these fallacious outbursts that I believe will be understandable to all. Over time, I've honestly come to the belief that he is making s**t up as he goes along.

P.S. we can agree to disagree, Robert.

__________________
Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

Yawn, I didn't suggest a stronger microscope, I suggested giving up the present one.

Dennis

Yawn

Dennis

[quote=Simon Spooner;262099]It is a disservice to Root and those who have studied and understood his writings. Root discusses torques, moments and tissue stress within his publications. Thus, these terms should need no translation to "the subtalar joint neutral Rootian students and practitioners". Remember too that many of us were directly, and indirectly, students and practitioners of Rootian biomechanics, yet we are more than capable of understanding these concepts; that you may not be able to Dennis, doesn't make it too complicated for the rest of us.[/QUOTE

Very Straw Man here Simon.

I believe that very few of the DPM's now practicing and currently being educated and the labs that are fabricating their devices have "studied and understand the writings of Dr Root.

Disservice to Root has nothing to do with m post.

Dennis

You're forgiven
Dennis

Um, yes, your technology is destructive. But not in the good way that you think it is.

__________________
Phil Marshman
Mackay, Queensland Australia

[quote=drsha;262132] Straw man and other logical fallacies it seems too, Dennis. You asked how the terms torque, moment and tissue stress would be interpreted by students and practitioners of Rootian biomechanics. The original contention had nothing to do with how many dpm's understand Root.

__________________
Who? What? When? Why? Yeah? And? So? What?

"My mission drive is to open up my eyes, 'cause the wicked lies and all the sh!te you say..." http://www.youtube.com/watch?v=V4NW5S1UTPQ

"Science is the antidote to the poison of enthusiasm and superstition."

No problem kind sir.

That's what the horse and buggy makers said to Henry Ford and what the arch makers said to Merton Root, D.P.M.

M. A. Rosanoff: "Mr. Edison, please tell me what laboratory rules you want me to observe."
Edison: "There ain't no rules around here. We're trying to accomplish somep'n!"

— Thomas Edison

I wish you well.

Dennis

[quote=Simon Spooner;262209] Yawn

Dennis

Simon:

As an admitted bad graphics person with ni advanced software as of yet, I have reworked your chart to try and make foot typing sense here.

I think the piece that you are overlooking is that almost all feet upon when a suoinatory motion is applied come to rest rigidly resisting additional movement from that moment in a positiion of inversion to leg in open chain. This repesents the relative contact position in closed chain in heel contact A to B Gait.

From that position if you apply a pronatory moment, some feet will rigidly resist further eversion and end up in an inverted position to vertical, some will end up just vertical to the leg and yet others will end up in an everted position with respect to vertical (your call on how you define verticle.
This position will come close to the position of the STJ on the frontal plane in early midstance in closed chain.

Now:
Inverted SERM inverted PERM = limited in inversion to inverted,limited in eversion to inverted= Rigid Rearfoot FFT
Inverted SERM Vertical PERM= limited in inversion to inverted, limited in eversion to vertical= Stable Rearfoot FFT
Inverted SERM Everted SERM= limited in inverstion to inverted, limited in eversion to everted = Flexible Rearfoot FFT
In addition (different and more clinically applicable as a classification system to Dr. Scherer's nine foot typing grid and the reason It got Patented), some feet resist vertical and are limited in an everted position when a SERM moment (forced inversion) is applied and they then are limited to an everted position when a PERM moment (forced eversion) is applied.
Everted SERM Everted PERM = limited in inversion to everted, limited in eversion to everted= Flat Rearfoot FFT

The chart shows the SERM-PERM excursions to your 5 classes and labels their FFT and I added another to show the Stable RF FFT as you did not have one of those.

I hope you can envision how the STJ Axis, the CIA, the ones that will get PTTD become apparent as you see the total ROM differences and so many other foot type specific characteristics even this simple chart reveal.

For example, you would never put a valgus wedge under the Rigid rearfoot Typers and you would never put a medial Kirby skive under a Flat RF type.

I hope at least some of you can see that this starting platform is then tissue stress friendly.

Also, the Grade 1 Rigid FFT woukd need more agressive treatment and present with more symptoms native to the Rigid RF Type than the Grade 2 Rigid FFT even tohugh both type Rigid RF. THis reduces the guesswork that Dr Spooner refers to.

The Flat FFT of Grade 4 and the Flat FFT of Grade 5, depending on their Forefoot FFT would probably present with the same sympotoms and get the same treatment.
Summarily, no cookie cutter here.

Finally, in Grade 2 Rigid RF FFT, the STJ Neutral Position would be 1/3rd the way from the right to the left and that would be my positon when STJ Neutral castiing it.

In Foot Centering, we apply a PERM moment to the cast everting the foot a number of degrees towards vertical therefore reducing the need for a Kirby lateral skive or Varus posting ORF's while holding the foot in a more Optimal Functional Position than STJ Neutral.

The resulting Shell places the foot in a more centered position. Voila!

Henry Ford (LOL)

See Attached Chart;
legend: the green arrow represents a Stable RF FFT

Attached Images

Dr Spooner's Chart FFT Converted.jpg (28.4 KB, 172 views)

Just the one?

Whats a perm moment?

__________________
Robert Isaacs
Specialist in Biomechanical Therapies
www.Footprintspodiatrysolutions.co.uk

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

Semper in excretum sum sed alta variat