Eric;
    How do you know where to add this increase in supination moment?   What
if the supination moment can be achieved not w/ a varus post or skive, but
with a simple 1st ray c/o, or possibly an appropriately place metatarsal
pad?  What if you instead need to add a heel lift to the opposite limb to
increase the supination moment, or decrease the pronation moment on the
opposite limb?
    How do you propose to solve these issues?  In my mind, these are all
sagittal plane facilitation issues.  If you don't know where the Center of
Pressure is, then exactly how to you know where to direct it, and w/ what
degree of post will make things better or worse.  What if what you've done
actually makes the opposite limbs function worse?
    Your explanation seems very simple, or simplistic depending on how you
want to look at it.  Please do not take offense... I'm sure the chapter you
and Kevin are writing will explain more, but maybe you could grace me with
some explanations to what I have asked above.
Respectfully,
Bruce Williams
----- Original Message -----
From: "Eric Fuller" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, December 16, 2004 2:48 PM
Subject: Re: EVA vs Plastic/Carbon Fibre FFO's: Discuss


> Hi all, Jeff writes:
>
> >In my opinion, there seems to be a huge gap between the more complex
> >models and the practical, functional models that clinicians require in
> >order to make basic treatment decisions.  You may (probably do) see
things
> >differently, but I think that's due to your perspective and comfort with
> >the subject.  My question is, how do you put it in a format that the
> >typical clinician can use on a regular basis for making daily treatment
> >decisions in an efficient and effective manner?  What, in your opinion,
> >should clinicians be doing differently than they are today?
>
> Tissue stress is a model, Measurements of forefoot to rearfoot
relationship
> are a model and Sagittal plane facilitation is a model.  Sometimes I have
> difficulty in describing exactly what the model is, but they are all
> models.  The tissue stress model I find to be the simplest model to
> understand and use clinically.  For example, lets take that patient with
> sinus tarsi pain and make an orthotic for them.  In the forefoot deformity
> model, if the pain does not resolve, you decide that you have made a
> mistake somewhere along the line in the making of the orthosis.  So, you
> try again.  In the tissue stress model you think, I did not add enough
> supination moment, so in my next orthosis I will add more supination
> moment.  The tissue stress approach gives the clinician direction in how
to
> modify devices.  I don't really know how to apply this analogy to the
> sagittal plane facilitation model.
>
> The finite element analysis comes into play when you want to prove the
> model.  We all use models without proof that they represent reality.  You
> can live pretty happily without proof that you model represents reality.
>
> The earth is flat.
>
>
> Cheers,
>
> Eric Fuller
>
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