Simon,
You wrote:(with respect, I am not asking for
> explanations of, or questioning prescription writing protocol using
> traditional theory in this posting), I am familiar with prescription
writing
> theory using the R,O,W system, but I am uncertain of prescription
protocols
> using rotational equilibrium / tissue stress theories. I'm sure you will
> agree, that if we are to think in terms of forces and moments, simply
> correcting to the degree of deformity tells us nothing of the changes in
> forces produced in the individual by the forefoot balance. But what I
really
> want to know is: why prescribe a 15 degree medial heel skive? Why not 20,
10
> or 30 degrees?
>
> Also, I do not wish to be too side-tracked from my more recent question,
> that of the relationship between callus patterns and STJ axial
position-your
> thoughts please ladies and gentlemen.
I understand the intent of your question. I too would like to hear the
answers to these questions. I wanted to point out the fact that the
orthoses used in conjunction with both theories are not all that dissimilar
and both include components of Root type corrections including the forefoot,
which is determined by the negative cast of the foot. And I would contend
that rotational equilibrium theory also requires subjective decision making
in order to arrive at an orthotic prescription, which is part of the
distinction between the practice of medicine
and the purity of science.
Let me add one more question, if the intent is to reduce STJ pronation
moments, then why not supinate (invert) the forefoot of the cast? Why use
Root technique which calls for pronation the MTJ? Wouldn't rotational
equilibrium suggest that it would be better to maximally supinate the
forefoot to increase the MTJ and STJ supination moments? Why not supinate
the STJ as well? While I do not advocate such an approach, I would ask
these questions from an academic basis.
Respectfully,
Jeff Root
----- Original Message -----
From: "spoonz" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, October 16, 2001 11:49 AM
Subject: Re: cutaneous lesions and rotational equilibrium theory
> Jeff, Ray, Kevin and all,
>
> Jeff wrote:
> >>>This is exactly why reliable casting is important. If a cast captures
> the forefoot to rearfoot relationship (this is a complex triplane
> relationship but we only measure the frontal plane component of forefoot
> inversion or eversion relative to the rearfoot bisection) then the amount
of
> forefoot posting is intrinsic in or determined by the cast itself.
Provided
> that the plaster cast additions are applied to incorporate intrinsic or
> extrinsic correction (balancing), then the degree of forefoot posting
> (wedging?) it determined by the negative cast. This correction should be
> consistent with the amount of forefoot deformity seen (measured) in the
foot
> by the clinician.<<<
>
> Agreed, but this is only one solution, that offered by one biomechanical
> theory, specifically R,O,W's conjectures: that if we bring the ground up
to
> the foot, i.e we post to the degree of frontal plane deformity, we negate
> the need for abnormal compensation ( I know this is a simplified
> paraphrasing), but this appears to ignore the other two cardinal planes
(by
> your own admission, we are dealing with complex triplane relationships!)
and
> moreover, others are now offering alternative conjectures! The
prescription
> writing protocol put forward by your father and his co-workers does not
> appear to fit well with rotational equilibrium/ tissue stress theories
(that
> is not to say, that I have not had successes utilizing this protocol: I
> have, and continue to use and teach it); but prescription writing within
the
> emerging, alternative theories seems uncertain and this uncertainty is
> precisely what I wish to explore (with respect, I am not asking for
> explanations of, or questioning prescription writing protocol using
> traditional theory in this posting), I am familiar with prescription
writing
> theory using the R,O,W system, but I am uncertain of prescription
protocols
> using rotational equilibrium / tissue stress theories. I'm sure you will
> agree, that if we are to think in terms of forces and moments, simply
> correcting to the degree of deformity tells us nothing of the changes in
> forces produced in the individual by the forefoot balance. But what I
really
> want to know is: why prescribe a 15 degree medial heel skive? Why not 20,
10
> or 30 degrees?
>
> Also, I do not wish to be too side-tracked from my more recent question,
> that of the relationship between callus patterns and STJ axial
position-your
> thoughts please ladies and gentlemen.
>
> Best wishes,
> Simon
>
> **************************************************
> Simon K. Spooner PhD, BSc, SRCh
> Lecturer Biomechanics
> Plymouth School of Podiatry
> North Road West
> Plymouth, UK
> PL1 5BY
> *************************************************
>
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