Eric;
You wrote:>
> 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.
So what?! Did the supination moment increase or not?! Did the pain go away?
Does that make my "guess" worse than yours? Why would you not want to use a
c/o w/ a sinus tarsi patient. Maybe the "problematic pronation" is caused
by the delay in sagittal plane progression, which causes a retrograde
prolonged medial STJ position? There are many ways to skin a cat, but why
"wedge, or post" if you don't have too?
> > 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?
Eric continues:
> 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.
Eric I strongly disagree! You cannot know that the CoP needs to be moved
medially in every instance. Often patients w/ pathologic pronation have a
midline CoP progression, and it is only a matter of equalizing the
accelerations in both feet to eliminat their pain. Also, at what point will
you end your guessing about the height of the post needed?
Eric wrote:
> Bruce, How does the treatment of one foot make the other foot function
> worse? Do you have an example?
I'd be happy to show you several hundred f-scan movies where this is exactly
the case. I'm sure that Howard has thousands as well. For instance, I had
a problem w/ equinus on my right foot for a while. I finally relized that I
had my 1/8" heel lift on the wrong side and moved to my right foot and the
early heel lift on that side disappeared. But, now I had an early heel lift
on the left side. I played with this for several weeks, until I used one of
Howards tricks...I put 1/16" ppt as a filler in my 1st ray c/o on the left
foot. Immediately the heel lift on the left equalized to the right side,
and the problem was corrected. You cannot know what you are doing w/ your
modifications in every instance Eric! You will eliminate the patients pain
often enough, but just as often will set them up for future problems.
> What is the old saying. If you have two explanations of the same
> phenomenon you generally should accept the simpler one.
It is called achems razor, and I dont' think it really applies to your
explanation.
Cheers;
Bruce
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