Dave,
I think we need to discuss a proper rocker platform shape. I don't know
anything written on it, so I will give my thoughts. I am sure Kevin K.
will give us a litany of references.
Distally, I think we all have know that the rocker should start at the
MPJ, and taper to nothing distally. The shape should be a Fibonacci
curve, to go along with the shape of the MPJ's.
Proximally, I think we can have a discussion on the shape. I would end
the tapering under the center of the calcaneus, because when the
forefoot hits the ground the rolling will stop. The last place to touch
the ground before the forefoot contacts would be the point dead center
under the calcaneus. Proximal taper should also be a Fibonacci curve to
mimic the motion at the calcaneal contact joint.
With this design, the heel lift is not affected.
I am sure there are some out there that will say that the bottom should
be one continuous curve. I would be interested in hearing opinions.
Regards,
Stanley
Morgan Peter wrote:
> Dave
>
> I would send his shoes back to get the heels balanced.
>
> Cheers,
>
> Peter
>
> -----Original Message-----
> *From:* A group for the academic discussion of current issues in
> podiatry [mailto:[log in to unmask]]*On Behalf Of *David Smith
> *Sent:* 14 August 2006 13:18
> *To:* [log in to unmask]
> *Subject:* Re: knee hyperextension
>
> Peter
>
> No Ach ten problem because the ankle joint is completely fused so
> all dorsiflexion moments are resisted by osseous strutures.
> Therefore atrophy of GSC (gastro-soleous complex). Yes this
> patients knee is hyperextended by GRF at the forefoot due to a
> negative heel and fixed plantarflexed position.
>
> Cheers Dave
>
> ----- Original Message -----
> *From:* Morgan Peter <mailto:[log in to unmask]>
> *To:* [log in to unmask] <mailto:[log in to unmask]>
> *Sent:* Monday, August 14, 2006 9:24 AM
> *Subject:* Re: knee hyperextension
>
> A negative heel exists when you examine the shoe, the heel
> sits lower than the forefoot. So when you stand in them, it
> would dorsiflex the ankle joint. But if the ankle joint has no
> ROM, it would potentially hyperextend the knee joint. Does
> your patient report Achilles tendon problems when he wears the
> rocker soles?
>
> Cheers
>
> Peter
>
>
> -----Original Message-----
> *From:* A group for the academic discussion of current
> issues in podiatry [mailto:[log in to unmask]]*On
> Behalf Of *David Smith
> *Sent:* 14 August 2006 08:56
> *To:* [log in to unmask]
> *Subject:* Re: knee hyperextension
>
> Peter
>
> When you say negative heel, do you mean that there is fore
> foot contact first and then a tendency to rock back on to
> the heel before going propulsive.
>
> Cheers Dave
>
> ----- Original Message -----
> *From:* Morgan Peter <mailto:[log in to unmask]>
> *To:* [log in to unmask]
> <mailto:[log in to unmask]>
> *Sent:* Monday, August 14, 2006 8:13 AM
> *Subject:* Re: knee hyperextension
>
> Hi David,
>
> Sometimes a rocker modification to a shoe creates a
> negative heel. If this is the case, the shoes must be
> returned for heel balancing.
>
> Cheers,
>
> Peter Morgan
>
>
> -----Original Message-----
> *From:* A group for the academic discussion of
> current issues in podiatry
> [mailto:[log in to unmask]]*On Behalf Of
> *David Smith
> *Sent:* 12 August 2006 12:25
> *To:* [log in to unmask]
> *Subject:* knee hyperextension
>
> Kevin et all
>
> I have a case study to do and the assignment is to
> analyse and determine particular pathological
> forces (in quantitive and clinical terms) across
> the joint or joints of interest. Design and
> analyse two possible interventions. The criteria
> of the intervention is that it must reduce
> pathological forces but not substantially limit
> the action of useful muscle forces or restrict
> useful motion of the joint and thereby cause
> muscular atrophy or loss of RoM through under use.
>
> An example of this might be using an AFO to
> dorsiflex a drop foot, the AFO is so stiff that it
> does not allow plantarflexion during propulsive
> phase and so there is loss of tone etc of the GSC.
>
> The case (a real case from my clinic) I have
> chosen is a 63yr old male, 5'10" 320lbs /175cm
> 145kg, polio at 13yrs, has a right foot ankle
> arthrodesis, (remodelled 3 times in his life)
> which now allows no RoM in any axis. Muscle
> wastage and loss of strength in the r/leg, mainly
> the flexors of the knee. The Ankle is also
> laterally displaced about 4-5cm and weight bearing
> is extremely painful.
>
> He has been fitted with a poorly designed rocker
> shoe, which hyper extends and abducts the knee
> during stance, he now has 12dgs+ genu recurvatum
> and 10dgs + genu varum.
>
> When asked how he felt about the rocker shoe he
> said, "Yes its very comfortable as there is little
> pain in my ankle but I feel it has transferred the
> problem to my knee", which of course it has.
>
> For my intervention and analysis I intend to
> modify the design of the rocker shoe to reposition
> GRF and / or fit a knee brace orthosis with active
> or passive knee flexor action.
>
> My question is Kevin, Which tissues would you say
> are the main resistors of hyperextension of the
> knee. Hamstrings ie rectus femoris, semi ten, and
> semi mem. Or collateral ligaments and knee capsule.
>
> Cheers Dave
>
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