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  • Quote:

    He starts off the book talking about research while he was a grad student at Harvard in the Psychology dept.  He uses other sources to conclude the 9 no.  I have also read that the number is higher in the 50-200 range in other sources.  Of course its debated as well.  Either way there seems to be an issue.


    A friend that's watching here sent this info.  He himself is very respected.  I have no reason to doubt this here is what he sent me today.


    Don

    6000 published articles per month,. unique visits 100000, 12.4 million downloads by academic institutions 50 million overall vs. 12x6000 articles 2011 means downloads/view of abstract of around 170 (I used 12,4 million here), of course, that doesn’t count articles not published in that year, so the average read count of a single arxiv article is probably lower than 170 and more touching the 20-50 mark I explained above. But here you have IMO a reasonable and quite objective minimum and maximum limit for a scientific article other scholars are really interested in, 50-170

    Smithsonian.com recently noted that there are about 1.8 million scholarly articles and scientific papers published each year in 28,000 journals. About half of these are not read by anyone other than the author, a journal editor, and a couple of reviewers. They report that 90 percent are never cited by other papers.

     



    Don, this is not meaningful - we don't know what articles or what specialisms or what subgroup of readers. We cannot extrapolate useful information and the '9' is nothing more than a sound bite.

    I have no idea of the purpose of this assumed expose and it does not validate the position that anyone should abandon the scientific paper or the scientific process or shun the peer review mechanism.

    And I sure hope my PCP and surgeon takes care to stay up-to-date with the scientific literature and takes great care to evaluate the veracity of a new treatment before choosing me, or my loved ones and friends, to experiment on. Who wants to be #1 on the bucket workers list of guinea pigs?

  • The Happiness Advantage: The Seven Principles of Positive Psychology That Fuel Success and Performance at Work by Shawn Achor

     

    It is widely accepted that academic papers are rarely cited or even read. But what kind of data lies behind these assertions? Dahlia Remler takes a look at the academic research on citation practices

    Don,

    The term 'academic papers' covers a tremendous spectrum of professional publications in the world. I haven't ready the 'Happiness' book, which I glean is a psychology book about how to become happy in business.

    I'm not planning to read this book, but perhaps you can tell me: which arm of science is cited here. 

  • Don:

    No, the reference about the infamous "9" quote is not required.  I doubt it's anything more than conjecture and hyperbole.

    Since you kindly agreed to hang around, I want to refer you back to the blog posted: October 13th, 2016 @ 2:55pm. Perhaps you can address those specific questions.

    Also, since there are, already, commonly accepted assessment protocols for the hindfoot, forefoot and 1st ray, I am especially interested to understand better why you believe that Dr. Scherer's foot typing, which Dr. Shavelson adopted (this work was abandoned by Dr. Scherer) can provide a better assessment. I do not find a significant advantage and detect only a change in terminology to describe what is already performed. There is also the awkward issue of error in this clinical assessment but I will put this aside for now.

    I want to ask if you also subscribe to the arbitray linkage between Scherer's foot typing, and Kapanjii's static anatomical model of the vault of the foot skeleton (which incidentally is identical to the educational material propagated by the Footleveler group - if you are unfamiliar with Footleveler I want to encourage you to check that out).

    I also want to, but cannot reasonably ask you to comment on the orthotic that might be fabricated as a product from the preceding. This is entirely a mystery and no explanation was ever offered to know how such a device might differ, if at all, from that of conventional orthotic manufacture.

    In answering the questions please be mindful of the fact this detail of the Shavelson method, is predicated entirely on hypothesis and conjecture and theory of it's key protagonist, Dr. Shavelson. The significance of all of the foregoing has been marginalized, in this debate, as 'unimportant'. In addition, Dr. Shavelson posits that a foot orthosis can alter foot kinematics; this is contrary to conventional knowledge, research and understanding. No convincing evidence was ever presented to confirm this assertion.

    Lastly, know that I also spent time with Dr. Shavelson, in his office, and also debated his theories over a meal.  Dr. Shavelson was kind enough to evaluate my foot and to provide me, gratis, with his version of a foot orthosis. And that we have debated the premise & application of foot typing / vaulting etc for several years now. I hope this can provide a framework of parity, in our understanding of what it is, that we are discussing.

  • Quote:

    Eric, 

     

    I appreciate your response and I follow many of your points.  However you're taking some of my mythological examples too seriously. Of course we have very innovative and deserving surgeons and biomechanics experts  in our history and we have papers that influenced the way we practice. What I am saying is the people that wrote these papers didn't do this by sitting around discussing and defending their points etc. They came up with this by treating patients and perfecting their craft and thats real bucket work thay did.

     

    What I'm basically saying is that it is more important  to be doing a job than to be reading about it. For example, you can buy Arnold Schwarzenegger’s Encyclopedia of Bodybuilding and know everything in it and you can tell every body else all the things within the book. However, you will never build a physique unless you go to the gym and workout.  Arnold did not read books about bodybuilding  in his early days.  He learned it from others. This is all I'm basically saying. 

     

    Spending enormous time defending ideas on Internet site is useless. What is more important is to spend your time treating patients and perfecting your craft. The born to run comment was directed at Bruce Springsteen song.    It is unlikely that a tenured music professor at the university could  write born to run. The bottom line is: getting good at anything you have to do the work. This is what Dr. McGlamry did.  And yes my copy of his book is very worn.  That being said I lerned what I do surgically from other men and by expanding upon their teachings myself.


    I certainly respect and value writings and I wrote an article on the MIS Akin in this months PM mag.  I hope more than 9 read it.  However, research clearly shows that an average of 9 people read a peer reviewed article.  Probably a few more read the non peered stuff like my article this mont or at least skim it. 9 is the no. Thats sad but its true.  Some are read more than nine some are 0 but the average is 9 and like you I find that disturbing. Ask yourself how many of the article in the last Foot and Ankle journal did you read?  (Be honest.)   I am not telling my answer to this.


    Don

    Dr. Peacock,  

    Debate & discussion on a forum such as this is not a mutually incompatible characteristic with active practice.

    The majority of regular contributors on PRESENT, and other forums, such as Podiatry Arena, are very much engaged in practice. Forums such as this provide an unparalleled opportunity for global information exchange. The opportunity to debate, challenge and question what we do. It is this very fact, active engagement with our patients that propells the discussion.

    As for articles. I will gladly tell you that I browse every edition of the major journals for articles of interest and will examine more closely those articles particularly relevant to my work. That is, of course, after first analyzing the quality of the article for its' worthiness. Not all articles deserve close attention. A peer review is a worthwhile first test of merit. It is not a fail proof process and the reader has a responsibility to evaluate the article.

  • Dr. Peacock,

    Dr. Peacock, I enjoy very much your videos and perhaps even more so your exuberant enthusiasm.  Once again I thank you for taking out time to contribute. You will forgive me when I now address your commentary. I will be very blunt.  

    You risk a serious loss of credibility with statements and pronouncements such as this, aiming to undermine the role and function of the inquiring mind and scientific process.  

    You assume an extraordinary anti-scientific position. I could not agree less with the statement that a peer reviewed article is read by only 9 people, but I am seriously interested to know who provided that erroneous statistic. Every week in many podiatry residency programs, doctors pour over peer reviewed articles. Every day in many, many countries, foot health professionals pour over and discuss peer reviewed articles. This is a self evident truism. 

    If theory & publication serve very little purpose, I would challenge you to explain why you are currently working on two papers to publish and expound your theories and experiences.

    I accept fully that academia and study is a component part of being a good doctor and a good surgeon. But it is a vital component. So happens you need to be proactive in both, to be a good doctor. This lies at the very heart of CME, progress and innovation. I doubt the FDA would agree with your baseline position of what is safe and effective.

    I applaud your admiration and faith in foot typing and your perception of Dr. Shavelson's understanding of biomechanics. I (and most others working in the field of biomechanics) remain unconvinced and have, many times over, provided a rationale, to explain why the foot typing / vault theory and foot orthotic system is flawed. I can perhaps understand your leanings, given your candid admission that you do not claim to have expertise in podiatric biomechanics practice & theory. In such a case, the simplification of a complex system will seem appealing. Dr. Peacock, you do not know well the contributors on this forum yet hail Dr. Shavelson as a superior presence. Can you explain on what grounds and evidence you can make this statement?

    You will be aware that people who do bucket work are not necessarily divorced from those people who also perfom bucket work and then proceed to examine their findings utilizing the best system available to humanity: the scientific process. Why? To separate fact from fiction and wishful thinking. And to protect our patients and advance our art & science, to serve better our patients. 

    Once the bucket worker is done, the scientist takes over. The people before us, who did bucket work also once promoted leeches for blood letting and drilling holes in the skull to release bad 'humor'. Not so very long ago the bucket worker removed children's tonsils by the thousands, when in fact this was neither useful, and potentially harmful. This historical bucket list is long one, and can be found in every medical and surgical endevour.

    One example of the Podiatric bucket worker who advocates excision of both sesamoids for the treatment of hallux rigidus. His claimed results: absolutely wonderful. Yet those who followed him, failed to replicate the outcome.  The bucket worker who insulates himself from critical appraisal, peer review and a healthy sceptisism is one that is charged with the potential of medical malevolence thus isolated in the vacuous void of scientific study and analysis.  To claim otherwise is to take a huge leap backwards to the days of magic and voodoo.

    It will be a pity if you choose to leave this topic. There are many questions left unanswered and your position statements remain to be defended.

  • Quote:
     
    Don in 10pt and black
    Eric in 12pt and blue

     


    I have noticed that in your rebuttals you rely on well documented and published peer review journals. There is nothing wrong with being academic and studying these journals up to a point. That being said these journals will not make you a good surgeon or doctor. There exist unfortunate facts that are usually not discussed regarding peer-reviewed journals. These writings have a large negative shadow attached to them. Allow me to explain just one un-nourishing dark side we are not accustomed to examining. An odd characteristic regarding peer-reviewed journals reveals effects and subsequent sociological and psychological outcomes to be very poor.   It has been estimated that only nine people on average will read a particular peer-reviewed article. This number would also include the author’s mother. So one of the many issues related to peer-reviewed journals is that very few read them.


    I disagree that there is a large negative shadow to papers in peer reviewed journals.  I also take exception to the importance of idea that the average number of readers of a journal article is nine.   Yes, bad articles will not be read very much.  However, some articles can be very influential.  For example, my article on the windlass mechanism has been cited 132 times (source google scholar).   That is 132 authors, who read it, thought the information was good enough to include in their papers.  Some journal articles are good enough to change the way you practice.


    Truth be told,  the people that have made great strides in our endeavors read very little with respect to publications and many were not foremost academic or experts. This is true in all fields. For example, the Wright brothers were not experts and did not rely soley on publications in aerodynamics or aeronautics before flying an airplane. They simply did bucket work.  Such events are too numerous to even consider listing them. The fact is that most experts are expert only within the defined parameters of a field. Most true innovations are stumbled upon by those in the trenches. No expert could have written Born to Run.  This particular characteristic is extremely difficult to get around. For example there are top-notch nutritional scientists that can discuss the compositional macro-nutrients of food and still do not bother with eating proper themselves. We can imagine them proof-reading their work as they lay the paper’s edge on a pot belly they are forced to take ownership of.  Disturbingly, the actual contribution of our so-called experts are somewhat meaningless with respect to making patients healthy.

    You might want to think a little about your statement that people who make great strides in our endevors read very little...  E. Dalton McGlamry.  Have you read any of his textbooks.  All the chapters have quite a few article citations.

    I would agree with you that no expert could have written Born to Run.  That book is just bad.  

    "Experts don't contribute to making patients healty"  Do you prescribe medications?  Experts checked to make sure those medications worked and don't harm patients.  

    The reason that experts cite journal articles is that knowledge has to have a common base.  When you do something for a patient, you should be able to explain why you chose a particular treatment.  "It works, in my experience" is an importnat one. But is not the best.  There may be other treatments that work better.  Someone may have done a study to see if one treatment is better than another.  Don't you think that would help make patients healthy?

    There is a problem in this country with the undermining of experts.  If someone has studied an area of knowledge their opinion should be better than someone who hasn't.   Global warming is a good example of this.  There has been a concerted effort to undermine experts in this field.   If experts disagree we should be able to examine why they think what they think.   For podiatry this would be to go back to basic sciences and the podiatric literature.  If an "expert" can't explain why they think something, then they shouldn't be considered and expert. 

     

    The question is how do we learn surgery or biomehanics? The most obvious answer is that we learn techniques directly from other surgeons and practioners  in our training  and from our peers afterward. From this we venture into the wild and have to perform the dirty work that really teaches us through wounds to the psyche and our pride. This is what is meant by bucket work.


    Yes, we have to learn for ourselves. We have to consolidate what we were taught with what works for the patients in front of us.  This includes questioning what our teachers taught us.  If some expert makes some discovery that could help all of us, how are we going to find out about it?   Yes, in a journal article.  We certainly need to evaluate all new discoveries to see they are indeed helpful.  Knowledge has to built on a foundation.  We need to understand why we beleive what we believe.  If we were taught blood letting was a way to heal patients, whe have to be able to change our minds in light of new information.   Some doctors, just stuck with some of my patients got better with blood letting and those that died were just too sick to cure.   If we understand why we believe what we believe, it is easier to change what we do in light of new information. 


    You see,  the answer to most of our treatment protocols lies deep at the bottom of a dark pond. No one is going to take you there.  Nothing will come to your rescue including: publications, books, Internet forums, meaningless discussions, weird theory, Gurus, rigid paradigms or even wishful thinking. We have to walk up to the pond with a bucket and begin to bucket out the water. The answer can only be found at the bottom of the pond and can only be obtained by bucketing out the water painstakingly one bucket at a time. This is very hard work and requires humility, effort, and learning from the mistakes mixed in with the water.


    In terms of knowledge, reading books and publications, internet forums and discussion of theory is the bucket work we need to do build knowledge.  Sometimes discussing what gurus think will further enlighten us and improve our knowledge.  Sometimes not.  But we still need to make the effort to evaluate what we know.

     

    With respect to getting confused with biomechanical nomenclature this is simply a matter of knowing the underlying meaning of the words.  I use the terms as they were described by the inventor or at the very least the recognizer. I have chosen to use Dr. Shavelson’s foot typing system and have applied this to my own practice. I simply use his nomenclature because it makes sense now that I understand it. The first time I heard it and read about it I didn’t know what he was talking about. In fact I felt more confused than enlightened. 


    Yes, if you use new words for old ideas you will eventually become conversent with those terms.  However, those that are still using the old terms will have no idea what you are talking about.  The old terms were perfectly well understood. 


    With his system, it is easier to quantify the first Ray for example. When someone says we have a hyper mobile first Ray that means very little. But when they say we have a mild SERM-PERM flexible forefoot and a flexible rear foot we now have a real nice starting point. This mental picture is good.  I can see it in my mind. 

    Dennis' system in no way quantifies.  It does not put a number to a measurement.   It does group, but that is not quantification.   If we say that in the frontal plane, the first met rests dorsal to the second met then we are saying something much more clear than the foot has a .... foot type.  Adding more words, or changing the words does not add to the amount of knowledge.  It just makes things more confusing.


    After years of bucket work I found his system at the bottom of the pond along with other things that have helped my patients. His system is not in any way perfect and like all things we should be grateful that it is not. However, down in the crevices of the dark there always exist a nurturing aspect. That is what I found in his system. I do not know whether his system will achieve mainstay and I really am not concerned about that. This may be due to people unwilling to step out of their comfortable paradigms or it may be that the system appears to be presented by a wild-man or beast because something about giving up their maps is scary. That judgement  is for anyone interested to decide. For me, I prefer looking at the negative and the outliers to understand their nourishment.  There is gold down there. I have found it and I am not alone.

     

    I have enjoyed this topic and will move on to something else.


    Your colleague,


    Don Peacock DPM

     

    Don,  I watched your video.  Here is what I got from it.  When you see a first ray that does not get to a plantar flexed position (relative to the second met,  well a line connecting 2-5 mets, you did say 5th) you do a procedure that will keep the first metarsal level with the 2nd met.  If you see a foot with excessive eversion you will prevent the excessive eversion with an arthroresis.   If you have an overloaded metatarsal, you will follow that guys metatarsal osteotomy formula.   If I am in error in describing what you do, please correct me.  If I am correct in interpeting what you said, you could more clearly say, with more people understanding you, using the above wording than using Dennis' foot typing system.  I still don't see what you gain by using his terminolgy. 

    Eric

     



  • Quote:

    My questions are not relating to any theory. My questions are related to what is actually being found when the procedure is being done. I did notice that you reverted back to the serm perm lingo..which always brings confusion.

    Jeff, I don't know how to divorce theory from practice. We all have a working theory of how something should work out. We put that into practice and get a result. Problem is we never can be sure if our theory works and the result is genuine, or if the theory is coincidental to the outcome. That's when the trials come in useful, i.e. is the result predictable and replicable. Unfortunately we can only know for certain after throwing statistics at the problem. That's why the n=1 argument is so lame. You might convince yourself of just about anything based on n=1. In any case, I agree about the SERM-PERM. Anytime the terminology comes up I spend time translating this into conventional, agreed & accepted terminology.

     

  • My questions are not relating to any theory. My questions are related to what is actually being found when the procedure is being done.

    I did notice that you reverted back to the serm perm lingo..which always brings confusion.
  • Quote:

    Effect of medial column hypermobility and effect of GR

     

    1. Downey MS, Schwartz JM. Ankle equinus. In: McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery. Wolters Kluwer Health/Lippincott Williams & Wilkins; Philadelphia; 2013: 541-584
    2. Thordarson DB, Schmotzer H, Chon J, Peters J. Dynamic support of the human longitudinal arch. A biomechanical evaluation. Clin Orthop Relat Res 1995;(316):165-172.
     

    Don,

    Thanks for the references. McGlamry's chapter relies on the discredited theory and explanation of the MTJ 'two-axis concept' / MTJ locking and MTJ compensation. This portion of the text is in dire need of an update. 

    I happen to agree that soft tissue AE is a significant factor in foot pathology and there are other references outlining a theoretical model of pathomechanics.

    What is missing, in all of this, are papers (prospective studies) demonstrating the effect of correction of the AE on 1st ray function. In other words, if the tight achilles complex is to blame then logically an isolated AE release ought to correct the MPE. I have yet to see evidence that can corroborate this theory.

    I suspect (and might be wrong) the second reference also fails to deliver, in this regard. I tried to source the article but this dates back to 1995. My library service does not archive that far back.

  • Quote:

    Dieter - I know of colleagues who perform the procedure bilaterally. I don't think it's wise because your moving the foot into a supinatory direction compared to where it was and when doing this bilaterally you could potentially cause the implant to back out.


    Jeff,

    That's what I hear too, but if two stents might pop out one might pop out just the same. I figure if STJ is controlled post op with ankle restraining strapping in STJN or mildly pronatory, it would likely be ok. I do wonder if a displaced stent is more a problem of incorrect insertion. 

    Splitting up the surgery does create some problems for a patient with an effective 12 weeks of reduced / impaired function for what is, sometimes, touted as a quick fix.

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