----- Original Message -----
From: "Greiner, Thomas M. Ph.D." <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, January 21, 2004 2:08 PM
Subject: Foot Movement Survey Results


> Below is my summary of results for the foot movement survey that I sent to
> the podiatry list a few months ago. Please post this summary to the list,
> and thank the membership for their participation.
>
> Thomas M. Greiner
>
> ----------------------------
>
>
> Dear Friends:
>
> I again thank everyone who has taken the time to respond to my survey on
> foot movements. The survey was sent to the Biomechanics, Clinical Anatomy
> and Podiatry list servers. I received 50 responses. I will summarize those
> responses below. I am now in the process of surveying journal articles and
> textbooks for uses and definitions. Eventually, I plan to write this up as
a
> journal manuscript - any suggestions, especially from editors, about an
> appropriate journal would be welcome.
>
> IF YOU HAVE NOT YET RESPONDED TO THE SURVEY you may still do so, but
please
> send me your response BEFORE reading the rest of this summary. The survey
> asked:
>
> Based solely upon your own understanding and experience (ie., without
> reference to any written text), please define the following terms. When
> possible, please also indicate the specific joint, or joints, where this
> movement occurs.
>
> Foot Pronation:
>
> Foot Inversion:
>
> Foot Supination:
>
> Foot Eversion:
>
> If you consider any of these terms to be synonymous, please so indicate.
> Your definitions may state that one movement should be considered as a
> component of another. Also, please indicate if you never use one, or more,
> of these terms to describe foot motions.
>
> Finally, so that I can get a sense of where this diversity is coming from,
> please provide the following information about your background:
>
> Highest Degree and Discipline:
>
> Current Specialty:
>
> Are you an active clinician?
>
> Do you consider yourself to be a specialist, or an expert, on the foot?
>
> It would be best if people responded to my personal email
> ([log in to unmask]) rather than to the list as a whole. If there is
> interest, I will post a summary of my findings to the list.
>
>
> Now for the summary:
> Undoubtedly some people will quibble over how I combined some definitions
> and failed to combine others. Since it was rare that two people would give
> me identical definitions, this type of problem is unavoidable. I did not
> reject anyone's response unless they told me that they were quoting from a
> book or some other authority. I wanted to know how people read and think
> about these terms, rather than telling me about some text that may not be
> universally consulted. I expect that there were a few instances of
> respondents quoting from texts and I failed to recognize the response as a
> quotation. All these are methodological problems associated with Internet
or
> reader response surveys. With these restrictions in place, I consider all
> replies as equally valid examples of how knowledgeable and informed people
> treat these terms. While the results I report here may not be definitive,
> they do give a sense of what's going on.
>
> INVERSION/EVERSION
>
> Definition A: 50% of the respondents agreed that Inversion should be
defined
> as motion about the long axis of foot so that sole faces medially; and
that
> Eversion should be defined as motion about the long axis of foot so that
the
> sole faces laterally.
> Definition B: 10% of the respondents came up with a similar definition,
but
> limited movement to only part of the foot. This definition states that
> Inversion is the result of motion about the subtalar joint so that the
sole
> of the rearfoot faces medially, and that Eversion is motion about the
> subtalar joint so that the sole of the rearfoot faces laterally
> Definition C: 6% of the respondents also limited their definitions to part
> of the foot, but this time it was the forefoot. Inversion was defined as
> medial movement of the forefoot in the plane of the sole; and Eversion as
> lateral movement of the forefoot in the plane of the sole. Definition C
> appears to be the exact opposite of definition B.
> Definition D: 4% of the respondents stated that Inversion/Eversion are
> inappropriate terms, or "lay" terms, that should not be used in scientific
> discussions of foot movement.
> Definition E: 30% of the respondents fall in to this category. Definition
E
> is not really a single definition, but a conglomeration of the 12 other
> definitions that were received. The phrase "other" probably fits bets for
> this group
>
>
> PRONATION/SUPINATION
> Definition 1: 38% of the respondents defined Pronation as motion about the
> subtalar joint involving forefoot Eversion, Dorsiflexion and Abduction.
> Supination was defined as motion about the subtalar joint involving
forefoot
> Inversion, Plantarflexion and Adduction. Note that the words Eversion and
> Inversion are included in these definitions. Not all of these respondents
> agreed on the definition of those terms. So, this definition needs to be
> further refined as:
> Definition 1A: 22% of respondents used definition A for
> eversion/inversion.
> Definition 1B: 12% of respondents used definition B for
> eversion/inversion
> Definition 1D: 4% stated that Eversion/Inversion are
> inappropriate terms. This response was particularly interesting since
these
> terms were used in the definition of pronation/supination!
> Definition 1E: 4% used a definition that was included in the
> "other" category. So, for this group Eversion was defined as movement at
the
> Talocrural Joint in which the sole of the foot is rotated in the coronal
> plane to face laterally. A component of Pronation. Inversion was defined
as
> movement at the Talocrural Joint in which the sole of the foot is rotated
in
> the coronal plane to face medially. A component of Supination. This
> definition of eversion/inversion is essentially the same as Definition A,
> except that it specifically states that eversion/inversion are components
of
> pronation/supination. The main reason I counted this as a separate
> definition is because of Definition 2 listed below.
>
> (Yes, I know these numbers don't add up. Some people gave me multiple
> definitions.)
>
> Definition 2: 16% of the respondents defined Pronation as motion about
long
> axis of foot so that the sole faces laterally, and Supination as motion
> about long axis of foot so that the sole faces medially. Based upon
> Eversion/Inversion Definition A, this response would imply that supination
> is a synonym for inversion, and pronation for eversion. However, these
> respondents would not agree.
> Definition 2B: 4% used definition B for eversion/inversion.
> Definition 2C: 4% used definition C for eversion/inversion.
> Definition 2E: The remaining 8% were spread out over
> definitions in the "other" category as follows:
> 2E-a: 4% stated that Eversion is a combination of
> Pronation, Abduction and Dorsiflexion, while Inversion is a combination of
> Supination, Adduction and Plantarflexion. Notice that this definition
claims
> that pronation/supination are components of eversion/inversion, which is
> contradicted by the next group.
> 2E-b: 4% stated that eversion/inversion are
> movements about the long axis of the foot (similar to definition A), but
> that these are not physiological movements and must be viewed as
components
> of pronation/supination. Effectively respondents that use this definition
> are saying that pronation/supination are synonyms with eversion/inversion,
> although they don't seem to realize it.
> Definition 3: 14% stated that pronation/supination are incorrect or
> inappropriate terms for describing motion in the foot.
> Definition 4: 32% of respondents fall into the "other" category, which
spans
> 20 different definitions.
>
> INTERPRETATIONS
>
> I start with what now appears to be the understatement of the century:
> "Terminology of pedal movements is somewhat confused amongst
orthopaedists,
> kinesiologists and others." Gray's Anatomy (British) 1989 p. 538
>
> It would seem that while each one of us may have a clear idea of what we
> mean by eversion/inversion and pronation/supination we run the risk of
> conveying no useful information when we use those terms in communications
> with our colleagues. In some cases, we will actually convey information
that
> is exactly opposite to what we mean.
>
> In response to my first survey summary, some people balked at the high
> percentage that appears for "Incorrect or Inappropriate term." These
people
> would often ask - how could someone deny that this movement occurs? I
think
> that the people that asked this question are missing the point. No one is
> denying that any particular movement is occurring, or at least it would be
> incorrect to infer that from these survey results. Instead, they are
> disputing the proper use of a term to describe that motion. In science
there
> is the dictum that if it exists, we give it a name. But, it is not logical
> to assume that something does not exist just because we have not given it
a
> name.
>
> I asked respondents to supply some basic information about their academic
> background, to see if there is any pattern of definitions that can be
> associated with one group more than another. I didn't find one. A few
> respondents made me aware of an attempt by the Physical Therapy
association
> to formalize the use of these terms. I also note that physical therapists,
> at least the ones that responded to the survey, are just as variable as
the
> rest of us in how they use these terms. So much for the efforts of a
> professional organization. Still, I do not believe that any one
organization
> can impose a solution on this problem. Who owns the rights to name
> movements? And if one organization claimed that right, what would compel
the
> rest of us to follow their dictates. For example, the Federative Committee
> on Anatomical Terminology has asserted the sole authority in coming up
with
> the official name for parts of the body - yet how many of us still refer
to
> the "peroneal" muscles that were replaced by "fibular" muscles almost 20
> years ago? However, this is not quite the same problem, for even when the
> old terms are used we all still understand the meaning.
>
> I noticed that my survey fell short in several areas, and I thereby
learned
> a few lessons. First, some people wanted to make a distinction between
foot
> movements and ankle movements. The definitions of pronation/supination and
> inversion/eversion may differ depending upon what you are talking about.
> While I agree that there can be important differences here, I assumed that
> "foot" was the more generic term that would include the ankle. First
> mistake/lesson - do not assume that generic terms are generic for all.
Next,
> people responded using terms I had never thought about or considered with
> regard to foot movement. For example, adduction/abduction were commonly
used
> terms. To me, these terms do not and cannot apply to the foot/ankle,
unless
> you are talking about an injury, a pathology or movement of the toes. You
> don't need to tell me that most of you would disagree. However, a quick
> survey of responses, and the start of my survey of journal articles,
> indicates that meanings of adduction/abduction when applied to the foot
are
> as variable as the meanings of pronation/supination or inversion/eversion.
> Also, a number of respondents used the terms varus and valgus to describe
> foot/ankle movements. To me, these are terms of morphological condition
and
> not terms of movement. I found that Biomch-L actually had a heated
> discussion on the use of these terms about two years ago - but failed to
> resolve the issue. I really should have done some homework first and
> included these terms in the survey. Second mistake/lesson - do not assume
> that you know all the different terms that researchers use to describe
foot
> movements. Much of this has rocked my confidence in my ability to describe
> movements of the foot/ankle. At this point, I am not entirely sure that
> plantarflexion/dorsiflexion mean the same thing to me as they do to
everyone
> else.
>
> I also note that we, as a community of individuals, are very wedded to our
> own set of terms. So much so that we seem to take offense when someone
> suggests that our use of these terms is different from the mainstream, or
> that our definitions are different from that of our academic group. I
noted
> this reaction in several private communications, and I also noted it in
> myself. I therefore suspect that any solution to this problem is not going
> to be simple or quickly adopted. I think a new set of terms, ones that
carry
> no historic meaning in the context of foot movements, will eventually be
the
> most useful solution. Until that time, I encourage everyone to define
terms
> in their communications - no matter how simplistic or "textbook" those
> definitions may seem. And, resist with all your strength the efforts of
> reviewers and editors that may try to pressure you into removing those
> definitions. I suspect that with your definition in place, many reviewers
> will try to convince you that you are using the term incorrectly, when we
> all now know that you are merely using it differently.
>
> So, in closing, I give you the sage advise of the philosophers Lennon &
> McCartney:
>
> "Try to see it my way, only time will tell if I'm right or I am wrong.
While
> you see it your way, there's a chance that we may fall apart before too
> long. We can work it out."
>
> Who would have ever guessed that they were talking about the terms of
> foot/ankle movements?
>
>
> Thomas M. Greiner, Ph.D.
> Associate Professor of Anatomy
> Department of Basic Sciences
> New York Chiropractic College
> Seneca Falls, NY 13148-0800 USA
>
>
>
> Thomas M. Greiner, Ph.D.
> Associate Professor of Anatomy
> Department of Basic Sciences
> New York Chiropractic College
> Seneca Falls, NY 13148-0800 USA
>
> Office Phone: (315) 568-3183
> Gait Lab Phone: (315) 568-3150
> Fax: (315) 568-3017
> Email: [log in to unmask]
>
>

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