Hi all,

Bruce wrote:

>Eric;
>     How do you know where to add this increase in supination moment?


If you are applying a force from under the foot you need to apply it medial
to the STJ axis.

>   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?

A first ray cut out does not directly cause a supination moment.  If you
see increased supination after the addition of a first ray cut out then the
increased supination moment probably is related to either increased
supination moment activity or decreased pronation moment activity.  The
original example was the discussion on how to treat sinus tarsi
pain.  Bruce, do you treat sinus tarsi pain with first ray cut out.  If so why?

>     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?

If you have a problem that you feel is caused by high pronation moment from
ground reactive force (i.e. sinus tarsi pain) then you need to increase
supination moment.  You don't need to know where the COP is.  You know you
need to move it more medial that it already is to increase the supination
moment.  The amount of post is guessed at.  If you guess wrong, and
symptoms don't reduce you add more post.

Bruce, How does the treatment of one foot make the other foot function
worse?  Do you have an example?

>     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.


What is the old saying.  If you have two explanations of the same
phenomenon you generally should accept the simpler one.


Cheers,

Eric Fuller

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