Dear Present Podiatry readers:

I am pleased to post this lecture from an AAFAS Cadaver Surgery Conference in NOLA for all with an open mind towards foot surgery to review, edit, comment and use as you see fit.

https://www.youtube.com/watch?v=kFcIi1SKZco

"A high openness score means you're open-minded - you see the world for what it is - whereas a low openness score means you're incredibly closed-minded, and you see the world the way you want to see it, regardless of what is actually going on". Adeo Ressi

Dennis

  • Comments (57)
  • Page 1 of 6 Next
  • Quote:

    I am sure that the foot typing is debated.  However, we already do this as a profession already and have ICD codes for them like:  Cavus foot, flat foot, etc.

     

    My difficulty with as system like Root etc  is the complexity and challenge to apply it clinically in a busy practice etc. The Foot typing Shavelson offers is excellent for a busy practioner.  

     

    Don

    Don,

    This point has been made here on several occasions. Yes, we all likely foot-type in some form. In the context of this discussion when I mention 'foot-typing' I am referencing more specifically Shavelson's method.

    I believe the method is flawed. And the conclusions drawn from the method are then based on a flawed or incomplete assessment. I don't personally have a problem with spending a few more minutes on a thorough assessment, in place of the 'quick & dirty' alternative. Each to their own.

    I look at the whole picture, Don. Too many holes, too many explanations missing, no foundational theory. The 1st ray / 5th ray assessment is an example. This method ignores the fact both segments have an independent axis of motion. One segment may have more, or less, compliance and that can totally skew the assessment. The second metatarsal is a fixed reference point. There are many good papers deliberating on 1st ray ROM. None use the 5th ray as a reference point. Why would anyone use the 5th ray. That's one example. There are many more.

    btw ... your assessment of the 1/5 (as seen on the video) differs to the assessment method I observed, when this was performed by Dr. Shavelson.  

     



  • I am sure that the foot typing is debated.  However, we already do this as a profession already and have ICD codes for them like:  Cavus foot, flat foot, etc.

     

    My difficulty with as system like Root etc  is the complexity and challenge to apply it clinically in a busy practice etc. The Foot typing Shavelson offers is excellent for a busy practioner.  

     

    Don

  • Quote:

    We are putting together associatiations of pathology with foot typing.  We can definitely agree to let it go and move on.  I plan to continue the use of foot typing until something better is stumbled upon on my journey.

     

    Don


    Don,

    That's a whole new can of worms ... the clinical biomechanist will jump all over this in hobnailed boots. I sense I have already made my position clear and will resist the urge and let another pick up that hot potato.  

    I will avoid foot typing and continue using tried, tested and universally agreed assessment protocols, until / unless something better comes along.

  • We are putting together associatiations of pathology with foot typing.  We can definitely agree to let it go and move on.  I plan to continue the use of foot typing until something better is stumbled upon on my journey.

     

    Don

  • Quote:

    Sounds good.  I think in person discussion and using real people to evaluate will be the best way to demonstrate the foot typing.  We do this at the AAFAS meetings.  

    I would be interested in how anyone else examines a patient biomechanically in a quick assessment to help with treatment protocols via a video tutorial.  

    I did not mean to make a hard nosed pitch about removing the post in a week. Its just I would rather compare in a real world fashion as opposed to academically.

    I will keep my comments to the videos I post and to the videos others hopefully post.  Otherwise an academic showdown is not what I want to participate in.  I am not expert enough in biomechanical matters to be real effective that way.

     

    Don


    Don,

    Sounds good to me also. I won't belabor the point any further, except to say: unless I can rationalize why a test is useful i.e. I understand and can explain the mechanical theory that underpins the practice, I cannot logically implement a recommendation that has for it's basis nothing more substantial than a promise of a 'simplified' alternative method.

    Dr. Shavelson also cannot explain why he does what he does, so I guess I cannot hold you accountable.

  • Sounds good.  I think in person discussion and using real people to evaluate will be the best way to demonstrate the foot typing.  We do this at the AAFAS meetings.  

    I would be interested in how anyone else examines a patient biomechanically in a quick assessment to help with treatment protocols via a video tutorial.  

    I did not mean to make a hard nosed pitch about removing the post in a week. Its just I would rather compare in a real world fashion as opposed to academically.

    I will keep my comments to the videos I post and to the videos others hopefully post.  Otherwise an academic showdown is not what I want to participate in.  I am not expert enough in biomechanical matters to be real effective that way.

     

    Don

  • Quote:

    Here is the Foot typing on a patient with a high SERM of the 1st and a high PERM when compring to the 5th met.  When using the 2nd on exam this does not exist and when examing the 2nd it clarly moves with the 1st in Root neutral position.

    Based on the Shavelson foot typing the treatment option would be GR and cotton.  This case is not  appropriate for STJ stenting due to the high SERM and the lack of a high 2nd met talus angle on wt bearing AP.  Her condition is PTTD with inability to work due to the condition and AFO was not effective.

    I will not discuss theory of biomechanics here because that's not what I use the system for.  I use it's practical application.  I have showed this to many top guys in our field.  For example, Richard Jacoby (author of Sugar Crush and past ANES president).  His comment was "I like this way of looking at biomechanics and it makes sense and is easy to follow"

    I will only answer by patient video tutorial example.  I would love for one of you guys to video a patient that comes i to your office and the biomechanical exam you use to decide treatment of the patient.  If your workup is better I will use anything that's real world better than what I am using.  I will do a followup on this patient video testimonial in a few months.  

    https://www.youtube.com/watch?v=1XfQnBTV8yU

    I will delete the post in one week if there are no example videos of biomechanical workup and treatment of patients by other posters.

    Don


    Don,

    Would love to oblige. I am on four weeks Grand Jury duty. I don't understand the time pressure and caveat to delete the post. A one week ultimatum is an unreasonable challenge, and I remind you 5+ weeks passed before you were able to publish your own video lecture (teasing).

    I have yet to watch the latest video and will post again afterwards. I would add that your proposal makes more sense when the assessment protocol is repeated and compared on the same patient, and not a different patient. It is entirely possible another doctor looking at the same patient might come to a different conclusion. Or the same conclusion. The logistics involved is of course a road block. 

    Afterthought: we can square up and pitch our evaluation skills at one of the AAFAS meets ;-)

    Comment: Having watched the video I am reasonably confident I would likely arrive at a somewhat different conclusion from the observations made in this video. Caveat_1: to confirm this will require a hands-on evaluation of this patient. Caveat_2: you can ask 6 doctors and likely get 6 different recommendations. 

  • Here is the Foot typing on a patient with a high SERM of the 1st and a high PERM when compring to the 5th met.  When using the 2nd on exam this does not exist and when examing the 2nd it clarly moves with the 1st in Root neutral position.


    Based on the Shavelson foot typing the treatment option would be GR and cotton.  This case is not  appropriate for STJ stenting due to the high SERM and the lack of a high 2nd met talus angle on wt bearing AP.  Her condition is PTTD with inability to work due to the condition and AFO was not effective.


    I will not discuss theory of biomechanics here because that's not what I use the system for.  I use it's practical application.  I have showed this to many top guys in our field.  For example, Richard Jacoby (author of Sugar Crush and past ANES president).  His comment was "I like this way of looking at biomechanics and it makes sense and is easy to follow"


    I will only answer by patient video tutorial example.  I would love for one of you guys to video a patient that comes i to your office and the biomechanical exam you use to decide treatment of the patient.  If your workup is better I will use anything that's real world better than what I am using.  I will do a followup on this patient video testimonial in a few months.  


    https://www.youtube.com/watch?v=1XfQnBTV8yU



    Don

  • Quote:

    Dieter


    Can you list your question like Dr Kass did so that I can answer them seperately.  It will make it easier for me.  I want everyone to understand my take on foot typing and I want to do this to the best of my ability etc.

    Don, I am waiting for your video before doing so.

    I do believe what I say completely and some of it should be uncomfortable to all of us and that includes me.  My realization of some of these thoughts lead to a feeling of loss when I 1st felt them.  I can sift through  the previous post and create questions from them but it will be cleaner to do 1 question at a time.  I will either answer or tell you I do not know.

    It's great that you believe it. I am hopeful, then, you can provide a cogent explanation to understand why you believe it. A sound explanation of the mechanical theory underpinning the clinical test has been conspicuously missing and is long overdue. As a bare minimum, such an explanation should be logical, biologically plausible and supported, when possible, by available evidence.

    I have long felt uncomfortable with foot typing / vaulting / foot centring exactly because this triad alliance lacks logical cohesion. Since you now fully understand it, you are best placed to fill that gaping void.

     

    Root, Orien & Weed, Kirby, Glaser, Dananberg, Fuller, Scherer (and others) all have made a tremendous contribution in proposing advances in assessment and treatment after providing a logical and plausible explanation. I gladly consider putting into practice their teachings, as well as writing about them on the internet. I am not doing so for Shavelson because his ideas lack substance.

    So, over to you.

    Your Colleague


    Don



  • 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.

     


    Don


    Don,  the problem with mythological examples is that people might take them seriously.  Your examples would make one think that you would beleive that reading about, and discussion on, how to treat patients is not as important observing your own results in treating of patients.  When I was in my residency I read a book on wound healing because I wanted to figure out what was the best way to suture a wound.  Different attendings had different opinions.  It turns out the book listed studies that showed one way was better than another.  The cool thing about the book was that it explained why one way was better than another, using basic sciences like histology and pharmacology.  I have changed what I do in practice based on what I have read in internet forums.  I chose to change because there was reasoned discussion and reference back to basic sciences and prior knowledge (literature articles) in that discussion.  I've read other things on internet forums that I would not try because the presenter could not, or did not, explain the rationale behind what they were proposing.  Discussion about those kinds of presentations is very useful as it can save other people the "bucket work" of finding out for themselves, on their patients, that this new thing has no logic as to why it work.


    Now back to the topic of the thread:


    Don I askedin an earlier post (with slight edit)

    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, then my terminology is better than Dennis' foot typing system.   I don't see how you changed what you would have done because of Dennis' foot typing system.  

    Eric

     

  • Page 1 of 6 Next