Kevin,
You wrote:
_/I very well know which camp I am staying in for the rest of my
career. // I am forever the podiatrist that wants to be working with and
speaking the same precise language as the biomechanists and engineers
so that together we can solve a few of the mechanical mysteries of foot
and lower extremity./_
If I mis interpreted this statement, I am truly sorry. True it does not
say that you don't consider the neuromuscular system when we are
discussing the human locomotor apparatus. But placed in the context of
what Kevin Miller wrote, and this being your response, I assumed
something that is not correct. I have found you to be well read, and
knowledgeable. Again I apologize.
This being said, I am sure the entire list serve is curious how you
evaluate the neuromuscular system in regards to the human locomotor
apparatus? I am also sure the entire list serve would like to hear Kevin
Miller's response to this question as it applies to the tensegrity model
he uses.
And by the way, I never said the function of the human body is all about
pronation, equinus, and limb length discrepancy (just that they are the
only things we can treat between the foot and the ground). But that's
OK, you don't know me.
I also never professed to be an expert on anything. I just want to make
sure that the theories being espoused here coincide with what I have
seen and learned, and if there is something inconsistent, then where is
the faulty thinking. In fact in my last post I stated that "maybe I am
seeing something in the wrong light". From the time I became a member of
this list serve, thankfully my thinking has changed several times. So
since you are much more learned than me (and since it has been so many
years since I went to college that I can't even remember the courses I
took), tell me how you use cell physiology, cardiovascular physiology,
renal physiology, endocrine physiology, and neuromuscular physiology in
evaluating the foot.
Sincerely,
Stanley
Kevin Kirby wrote:
> Stanley:
>
> You wrote:
>
> <<I understand that we want to measure and understand the human body
> from a mechanical engineering perspective, but the human body is more
> complicated than just that. We have the brain to control everything,
> and it functions like a computer. Sometimes it has bad output due to
> improperly functioning proprioreceptors (muscle spindle cells and
> golgi tendon organs), and other means of sensory input. So really a
> computer engineering perspective has to be added to the mix.>>
>
> I never said, Stanley, that we should not consider the physiology of
> the neuromuscular system when we are discussing the human locomotor
> apparatus. In fact, I welcome these discussions since my
> undergraduate major at the University of California at Davis was in
> Animal Physiology. In the four years before I entered podiatry school
> I took upper division courses in cell physiology, cardiovascular
> physiology, renal physiology, endocrine physiology, neuromuscular
> physiology and took a few graduate courses in exercise physiology on
> the environmental effects on physical performance and on metabolic
> physiology during exercise. These courses were much more detailed and
> difficult than the physiology courses I took in podiatry school. In
> addition, these courses included laboratory experiments in which I
> personally inserted micropipettes into squid giant axons to measure
> action potentials, performed open heart surgery on anesthetized dogs
> to measure changes in heart volume during contraction, and performed
> surgery on anesthetized chickens to measure muscle force during
> stimulation of the sciatic nerve.
>
> Therefore, for you to assume that I don't consider the physiology or
> function of the whole body when I discuss biomechanics of the foot not
> only irritates me but demonstrates how little you know about my
> academic background. Just because I don't mention everything about
> how the human body functions within my postings on this forum, doesn't
> mean I don't consider it and doesn't mean that I don't think it is
> important. My postings on this forum are concise and to the point on
> these subjects since I need to focus my discussion on one little
> aspect of the workings of the body if I am to get a point across. If
> you think I am not considering something I have not mentioned in my
> postings, then instead of telling me I am not considering it why don't
> you first ask me if I have considered it instead of assuming I have
> not considered it!
>
> If you want to talk about physiology of any of the major systems of
> the animal and/or human body, including respiratory, cardiovascular,
> neurological, endocrine, renal, or the specialized physiological
> processes involved in the exercise, heat, cold, altitude or
> weightlessness, I am ready and eager to hear what you have to say
> about these functional processes of the human body. You know, the
> function of the human body isn't all about pronation, equinus, and
> limb length discrepancy!
>
> Sincerely,
>
> Kevin
>
> ****************************************************************************
> Kevin A. Kirby, DPM
> Adjunct Associate Professor
> Department of Applied Biomechanics
> California School of Podiatric Medicine at Samuel Merritt College
>
> Private Practice:
> 107 Scripps Drive, Suite 200
> Sacramento, CA 95825 USA
>
> Voice: (916) 925-8111 Fax: (916) 925-8136
> ****************************************************************************
>
>
> Stanley Beekman wrote:
>> Kevins,
>>
>> I understand that we want to measure and understand the human body
>> from a mechanical engineering perspective, but the human body is more
>> complicated than just that. We have the brain to control everything,
>> and it functions like a computer. Sometimes it has bad output due to
>> improperly functioning proprioreceptors (muscle spindle cells and
>> golgi tendon organs), and other means of sensory input. So really a
>> computer engineering perspective has to be added to the mix. I think
>> this is what KM is trying to say.
>> I also think that KM is trying to say that most of us are doing
>> beginning tensegrity. If a patient has a long leg, and it is the
>> cause of the pronation, then if we do not lift the short leg, then we
>> will have 1. an uncomfortable orthotic that needs to be under
>> corrected to work 2. a plastic orthotic that breaks, 3. the
>> compensation taking place in another part of the kinetic chain:
>> patella tendinitis, posterior innominate, on the same side, or
>> discogenic pain, Achilles tendinitis, subluxed cuboid, IT band
>> syndrome, trochanteric bursitis, or other more proximal compensations.
>> If a patient has an equinus, and we fail to treat it, then we will
>> have 1. an uncomfortable orthotic that needs to be under corrected to
>> work 2. a plastic orthotic that breaks, 3. the compensation taking
>> place in another part of the kinetic chain: Achilles tendinitis, Fat
>> pad syndrome, Sinus tarsitis, Chondromalacia patella, and other more
>> proximal compensations.
>> What KM seems to be against is the making of an orthotic without
>> paying attention to these extrinsic pronatory influences.
>> It seems that there are many ways to treat this overall body
>> functioning, and orthotic therapy is just one of them. KM being in
>> chiropractic college has a more global approach in the way the foot
>> functions.(Dr. Paul Conneely is also looking at the foot from a more
>> global viewpoint). I think that Dr.Dananberg has started us at
>> looking at other ways to accomplish our goal, and should be commended
>> for taking podiatry in this direction (ie joint manipulation). Dr.
>> Dananberg's use of the F-Scan gives the sum of what is happening. I
>> think that this sum is one of the ways that we can measure what I
>> think KK is talking about.
>> A patient comes in to see a world famous podiatrist with pain in the
>> heel that hurts everytime he takes a step. He performed a
>> comprehensive biomechanical examination, and casted him in perfect
>> position. He sent the cast to a the best lab in the country. The
>> patient did not improve, so he went to a less known podiatrist in a
>> poorer section of town that graduated in 1960. His office is not
>> immaculate, and is in need of an overhaul. This podiatrist has no
>> knowledge of biomechanics and engineering, and if someone has a weak
>> foot, he would tape it like he was instructed by Ralph Dye. The
>> patient is told to take off his shoes and socks, so he can take a
>> look. He sees a red spot on the heel, and takes his magnifying glass
>> and finds a little splinter. He pulls it out and the patient has
>> immediate relief. What is the moral of this story? Treat the patient
>> with all the tools you have, do not limit yourself. .
>> I for one, have limited knowledge and am overwhelmed by the amount
>> that I have to learn yet to treat my patients. Now I can get off my
>> soapbox..
>>
>> Comments?
>>
>>
>> Regards,
>>
>> Stanley
>>
>>
>>
>> Kevin Kirby wrote:
>>> Bart and Colleagues:
>>>
>>> Bart wrote:
>>>
>>> <<The entrance of podiatry in my life gave me plenty of
>>> satisfaction, personally in podiatric practice and professionally in
>>> research. And, though I know I am biased, I will happily continue
>>> along the same path. Why ? Because as far as I know all
>>> biomechanists nowadays use about the same approach to understand
>>> human body mechanics: measuring motion and forces, managing them in
>>> a biomechanical model through free body calculations or the like
>>> (mostly inverse dynamics complemented with all kind of optimizations
>>> strategies). And forcibly I am one of them. So it is easy to guess
>>> what side I belong to.>>
>>>
>>> I also like belonging to the side that can use mathematics and
>>> Newtonian mechanics to prove that certain mechanical relationships
>>> exist within the human foot and lower extremity. However, since most
>>> podiatrists and other foot-health clinicians are not comfortable or
>>> familiar with many of the terms and mathematical techniques (e.g.
>>> inverse dynamics) that are commonly used in foot and lower extremity
>>> research within the international biomechanics community, then more
>>> generalized and less precise methods of explaining foot and lower
>>> extremity mechanical phenomena will always be promoted within
>>> podiatry and other medical professions. I am all for other
>>> individuals teaching these more generalized and less precise
>>> theories especially if these concepts are able to help the average
>>> clinician better understand the complexities of the human locomotor
>>> apparatus. However, as Bart alluded to, I very well know which camp
>>> I am staying in for the rest of my career. I am forever the
>>> podiatrist that wants to be working with and speaking the same
>>> precise language as the biomechanists and engineers so that together
>>> we can solve a few of the mechanical mysteries of foot and lower
>>> extremity.
>>>
>>> Cheers,
>>>
>>> Kevin
>>>
>>> ****************************************************************************
>>>
>>> Kevin A. Kirby, DPM
>>> Adjunct Associate Professor
>>> Department of Applied Biomechanics
>>> California School of Podiatric Medicine at Samuel Merritt College
>>>
>>> Private Practice:
>>> 107 Scripps Drive, Suite 200
>>> Sacramento, CA 95825 USA
>>>
>>> Voice: (916) 925-8111 Fax: (916) 925-8136
>>> ****************************************************************************
>>>
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