In a message dated 98-03-27 00:43:00 EST, you write:
> Eric and Bob wrote:
>
> > >From Eric, talking to Chip
> > <snip>
> > >Take the sentence, this foot's subtalar joint is in a pronated
position.
> > >Let's say this STJ has 24 degrees range of motion. This foot could be
> > >anywhere from maximally pronated to 7 degrees from maximally pronated.
>
> NO! it could NOT! It could only be maximally pronated IF it takes a
> postion at the end range of motion in the direction of Pronation. Geez,
> even our 2nd year Pod students don't have much trouble understanding
> that!!!
Chip, I think you misunderstood what I wrote. If neutral position is 8
degrees from maximally pronated then a foot that is 7 degrees from maximally
pronated is in a pronated position. To make sure you understand what I mean
lets do some measuremsnents. 20 degrees inversion to leg and 4 degrees
eversion to leg. Neutral position is 4 degrees inverted to leg. 7 degrees
from maximally pronated is 3 degrees inverted to the leg in this case. I am
making the distinction between a maximally pronated position and any pronated
position. Taking the definition of Neutral positoin as not pronated and not
supinated. As soon as you evert away from neutral you are in a pronated
position.
Chip continues
>
> > >(A foot that is 7 degrees from maximally pronated, in stance, would
> appear more
> > >supinated than over 90% of all feet.)
>
> ANY FOOT? or a foot with 24 degrees range of motion? In a foot with 24
> degrees range of motion, it certainly is NOT maximally pronated. In
> fact, in ANY FOOT which is 7 degrees from end range of motion it CAN NOT
> POSSIBLY BE maximally pronated. EVEN a TRUE REARFOOT VALGUS, one of the
> rarest of foot types IS NOT maximally pronated if 7 degrees away from
> being maximally pronated.
Yes, any foot that stands in a position that is 7 degrees inverted from its
maximally pronated position will appear more inverted than over 90% of feet.
I routinely ask my patients to evert while in stance. I do this to asssess if
the STJ and MTJ are maximally pronated or if they have more range of motion.
It is extremely rare to see a foot that has a lot of eversion of the calcaneus
available. By a lot I mean four degrees.
Eric wrote:
>
> > >Calling a foot that is 7 degrees from
> > >maximally pronated, "pronated" does not make sense nor is it clinically
> > >useful.
>
Chip continues
> It makes GREAT SENSE to MOST of our students as well as most people who
> use the concept for clinical problem solving. Calling a foot that is 7
> degrees from maximally pronated in a foot that has only 21 degrees range
> of motion RELATIVE TO THE TIBIA does not make sense. In 24 degrees it
> does make sense.
My point is that clinical problem solving (using numbers to calculate neutral
position) does not make sense. You do the calculations and you find a foot
that sits 7degrees inverted from its maximally pronated position and then you
find that this position is everted from neutral position and this a very
supinated foot relative to average and it is still in a pronated position.
(A pronated position relative to neutral Not maximally pronated position)
Calling this foot pronated does not make sense, nor is it clinically useful
and it is confusnig.
some cut
> >
> GOOD GRIEF! C'mon you guys! So, does the bear really poop in the
> woods? Is that what you are saying?
> Let's consider numerous, RESEARCH BASED studies on STJ Neutral!!!
>
> "Efficacy of Patient Position on the Consistency of Placing the Rearfoot
> at Subtalar Neutral" by Pierrynowski and Smith (Kanucks both, ergo no US
> Rootian corruption here) JAPMA 87:9 pp 399-405, 1997
>
> "Evaluation of the Neutral Position of the Subtalar Joint" by Cook,
> Gorman and Morris JAPMA 78:449, 1988
>
> "Sub Talar Joint Neutral, a Study using Tomography" Bailey, Perillo and
> Roll. JAPA 74:59 1984
>
> Interrater Reliability of STJ Neutral, Calcaneal inversion and Eversion:
> by Smith-Oricchio and Harris: Phys. Ther. 68:828, 1988
>
> Proficiency of foot care specialists to place the rearfoot at subtalar
> neutral, Pierrynowski, Smith JAPMA 86:217, 1996
>
> "Differences in X-Ray findings with varied positioning of the foot" by
> Hlavac, JAPA 57: 465, 1967
>
> ALL of these researchers identified a Neutral Position. Granted, they
> did not necessarily agree exactly where it was, which makes it an issue
> of range NOT existence. They DID all accept that STJ Neutral exists, and
> their research supported it. Even our dearest dissenter, Kevin Kirby
> begrudgingly accepts that there is a Neutral Position, although he
> prefers to call it "The Flat Spot".
Just because we all agree that the earth is flat does not meant that it is.
> Every single year, we train over 60
> students at our institution alone to find STJ Neutral on their
> classmates and their patients. Amazingly, every year, just about all 60
> are convinced they have found it, but of course, perhaps they have not
> been properly educated that they are the victims of Tautological
> reasoning. Scientific reasoning is based on Scientific Method which
> means that,if the same conditions are reproduced among different cohorts
> of examiners, they will all find pretty much the same results within a
> given range of reliability. STJ neutral IS reproducible THEREFORE it
> HAS a Scientific basis.
Chip, you've contradicted yourself. You said that all those papers might not
agree where neutral is and then you say that neutral is reproducible therefore
it is. If we could teach the whole world that there was a neutral position
and we had some critereia that we all could use to find it within 3 degrees of
accuracy, then we would have a position of a joint that we could all pretty
much agree on. Nothing more. We could all agree on the maximally pronated
position or the maximally supinated position. We still have not come up with
a reason for choosing to agree on neutral position. Why is neutral position
stable, ideal or needed.
Questioningly,
Eric
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