D. Fellner wrote the following:
>I believe any self respecting clinician by now must have realised that
important pieces of the work by Root,Orien & Weed is fundamentally
flawed. Why ? Because the foundation of the work i.e Wright et al - was
misinterpreted at a very basic level by our forefathers. If you haven't
already done so, look up the original work;
Wright, Dg et al
"Action of the subtalar and ankle - joint complex during the stance
phase of walking"
JBoneJoint Surg, 46A: 361-382,464,1964
The stance phase data were misinterpreted by the authors yet their
conclusions have been duplicated in reference texts and accepted as
correct. I have yet to see an acknowledgment by these pioneers of that
error. Indeed this was spelt out only in the 90's and NOT by podiatrists
- it is hardly surprsing that our views are ridiculed by other
professions as so much mumbo jumbo. In addition if I recall accurately
the data was derived from 2 - yes that is two - subjects. Hardly the
stuff of rigorous science. The subjects were not in fact in STJ neutral
at all but their relaxed standing position etc etc. The work is FLAWED
yet an industry has been spawned around prescription orthoses. The work
at best should have been a preliminary study of gait biomechanics.<
Root et. al (1977 may not have misinterpret the work of Wright et.al.
(1964). I think [log in to unmask] that you may not have not understood the
work of Root et.al. There is no doubt that the research by Wright et.al.
(1964) should not have been referenced on p. 137 of Volume II against the
statement "shortly after heel lift the subtalar joint reaches it neutral
position" and recent research (McPoil & Cornwall 1994, Pierrynowski & Smith
1996) suggests that the majority of homo sapiens do not return to Root's
NCSP just prior to heel lift. However, the accusation of misinterpretation
is a serious one that requires full justification. If one comprehends the
theoretical basis presented by Root et. al in Volume I, one can appreciate
that a DIRECT link to the 1964 article was most probably not being made.
The neutral positions of Root and Wright were absolutely exclusive -
Wright's neutral was a generalised position of the hindfoot and Root's was
an ideal articular position where the STJ was neither pronated or
supinated. Root simply used the normative data from Wright's generalised
hindfoot position and superimposed his Platonian neutral position into the
kinematic model. Since the publication by McPoil and Hunt (1995),
anatgonists of the Root paradigm have bashed this "misrepresentation"
argument to death. In fact, it seems to have become one of the major crises
in the Root paradigm (Payne 1997). When one considers the exclusive nature
of the neutral positions described by Wright and Root, one has to conclude
that the accusation of misrepresentation is not only harsh but is
theoreticaly misdirected.
[some edited]
>Here is a question - Root, Orien and Weed misinterpreted the data - ok
thats cool but we cannot be certain the subjects did not in fact stand
in STJ neutral ! Bioengineers and biomechanists around the world seem
disinterested in repeating this experiment. Why is that ? Or has the
experiment been repeated and results could be injurous to the orthotic
industry ? (oh dear another conspiracy theory !)<
You are right, some in our profession are, for some reason, creating a
conspiracy theory. A number of times on the mailbase and in a number of
published papers, the orthotics industry has been accused of wanting to
perpetuate the Root paradigm for purely commercial gain. I find this
accussation personally offensive and I am sure other podiatrists who own
Lab's feel the same way. The accusation also lacks logic for two main
reasons:
1. Laboratories are not the only ones to benefit from the use of custom
foot orthoses. In fact, we benefit financially much less than the
prescribing practitoner. The Lab' will earn around 80 pounds sterling
(gross) for a pair of othoses whilst the practitioner will invoice for a
biomechanical examination, for the taking of the casts, perhaps some more
for video gait and F-Scan (or Pedar) analysis, some more for a fitting
consultation and then for the follow-up sessions. Some practioners even add
a percentatge onto the cost of the orthoses. I don't hear anyone shouting
the odds about vested interests to those in practice, just to the
Laboratories....why?
2. Most Lab's can manufacture orthotics devices to suit any paradigm and
the total demise of the Rootian paradigm would not be "ingurous to the
orthotics industry", it would simply mean that the Lab's would manufacture
devices using processes based on other models. At RX Laboratories we can,
and do, make Blake inverted, Lundeen triaxally modified, Root and modified
Root devices, Kirby skived devices and devices with kinetic wedge type
extensions, or a mixture of all of these manufacturing protocols. If
practitioners can describe what they want, most good Laboratories can
manufacture it. There is no commecial benefit for any Laboratory to
perpetuate a particular paradigm of foot function and to suggest this is
simply ridiculous!
Those who have published articles fuelling this conspiracy, know who they
are and they should either put up (some evidence that research sponsored
by, or carried out by, Laboratories is being deliberately concealed for
their commercial interests) or shut up. The industry exists because there
is a profession demand for commercially manufactured devices and believe me
chaps, no matter what you think we, are not making a killing. I can promise
you that it is more profitable to prescribe orthoses than it is to
manufacture them.
Ray Anthony.
RX Laboratories, UK.
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Subject: prescription orthoses ...fundamentally flawed ?
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