That time of the year

What to blog about today (especially when not feeling well)?

Maybe go and have a read of this:
Best Podiatry Arena Quotes for 2008 (it really sums up just how gullible and blind with blinkers some people can be!)

All the best to all for the holiday season.

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Critical Thinking

Within the discipline of Critical Thinking, all the strategies that can be used to make arguments are well researched and documented. The fallacies of logic are clear. One of the false types of arguments is know as the straw man argument in which you define your opponents position as something that its not and then argue against that position. Wikipedia defines it as:

A straw man argument is an informal fallacy based on misrepresentation of an opponent's position. To "set up a straw man," one describes a position that superficially resembles an opponent's actual view, yet is easier to refute. Then, one attributes that position to the opponent. For example, someone might deliberately overstate the opponent's position. While a straw man argument may work as a rhetorical technique—and succeed in persuading people—it carries little or no real evidential weight, since the opponent's actual argument has not been refuted.

Here a some Podiatry Arena threads:
Challenging MASS
Challenging SALRE
Claims of Foot Orthoses Superiority

Have a read of them. Guess what? Spot the straw man arguments!

All this sums up the point that Steve the Footman made about Podiatry Arena: "What other profession has a forum that gives its members access to its most significant researchers and clinicians? You can ask any question you want and get informed and experienced replys that include links to multiple research papers. New research is discussed and critically appraised immediately. It is like having a blowtorch applied to the cherished beliefs of the profession. It is like having an academic review panel of 8000 people at your fingertips.And I think it is the major development in sports podiatry in 2008."

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The abductory twist

During gait, in a number of patients, just as the heel comes off the ground, the foot often abducts. There is no doubt this happens and its called an abductory twist.

What is interesting about it, is that two different biologically plausible and theoretically coherent theories can be used to explain it:

1. Foot pronates beyond midstance--> internal rotation moment to leg; the opposite leg is swinging forward and rotating the pelvis --> externally rotation moment to leg on ground --> conflict between proximal external rotation and distal internal rotation moments -- initially the pronated foot causing the internal rotation moment wins the battle and foot does not resupinate to accommodate that proximal external rotation moment ..... eventually as heel comes off ground, friction between the ground and foot can no longer no longer resist the external rotation moment coming from above --> abductory twist

2. As heel starts to come off the ground a functional hallux limitus kicks in (for whatever reason); as the body has to move forward over the first MPJ, it can do so by a number of mechanisms; one of these is to abduct the foot to roll off the medial side of the blocked first MPJ --> abductory twist

This is a classic example of how a fact (the presence of an abductory twist during gait) can be explained by two competing theories (this is what make clinical biomechanics fun).

Lets wee what others think on the abductory twist.

Back to home page For more: http://www.fridayfitnessguru.com/i-just-learned-about-the-medial-heel-whip/ http://www.whatispodiatry.com/questions/what-is-an-abductory-twist/

Recomended Running Shoes

Advising runners what shoe to use is always difficult. Shoes change frequently and what suits one runners does not necessarily suit another, even if they appear to have similar needs. Keeping on top of who needs what and what company makes what is always difficult. This grid is a good step in the right direction to pick up what shoes models fit into what category of running shoe.

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Gout

I use this quote (not sure where I got it from) during lectures to students to suggest just how painful gout is: “Screw up the vise as tightly as possible - you have rheumatism; give it another turn, and it is gout” - Anonymous

Here are a couple of good threads at Podiatry Arena on Gout:

The latest on gout (this one has all the very latest news)

Reason for gout in more peripheral joints (this one looks at reasons why the first MPJ is the most common site for gout.

For this interested in magical cures; or what people with gout are reading; or want some good dietary advice, there are these eBooks:

Cure Gout Now

Gout Natural Remedy Report

The Ultimate Instant Gout Relief Report

Cure Gout Cookbook

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Running Shoe Forum

I have been asked to do some work on a Running Shoe forum. Here are some links to the section that need some work: Running shoes Nike Brooks Best running shoes New balance Adidas Asics Mizuno Spira Saucony Newton Kids Running Shoe Reviews . The forum has not been officially launched yet, but they are looking for people to help out to get the content developed before the official launch.

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Leg Length differences

This can sometime be a hot topic. In orthopaedic circles, what is considered a significant difference between the two legs can be quite large and in chiropractic circles what is considered significant can be quite small. Both sides of the argument can be quite passionate about this.

Reminds me of Payne's Law: "The amount of passion involved in defending a theory and the amount of emotional attachment to a theory is usually inversely proportional to the amount of evidence for that theory"

There is no doubt that having a leg length difference does affect the quality of life and there are many way to measure a leg length difference clinically. There are also just as many arguments about how the body compensates for a leg length difference.

Podiatry Arena has built up a valuable resource of threads that have been tagged for leg length difference, that explores all these issues.

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Functional hallux limitus

I am privileged with the honour of being invited to speak at many conferences. Most recently was at the Podiatric Surgeons conference. When I agreed to speak, I did not think to much about about the topic until I was back from another conference, then I had a OMG why did I agree to talk about that moment ? What the hell am I going to say?

One reason I enjoy speaking at conferences is that it forces me to organise my thoughts and "put them on the line", so I thought I would try and take our traditional understanding of first MPJ dysfunction (ie hallux rigidus; structural and functional hallux limitus) and the windlass dysfunctions (ie no windlass; delayed windlass; high force to establish; disruption during loading) and reconceptualise them in the framework of the mechanical engineering terms of 'stiffness'.

While going through the dot points, I got struck by something: All functional hallux limitus really is, is a temporary increase in the dorsiflexion stiffness of the first MPJ ! It got the thought processes going. (I have written about it here: Reconceptualising Functional Hallux Limitus)

Traditionally we have considered FnHL as being present or absent, when in reality it probably exists on a continuum. If we conceptualise it as a temporary increase in first MPJ stiffness, it then opens the possibility of grading functional hallux limitus (ie a low temporary increase in first MPJ stiffness to a high temporary increase in first MPJ stiffness). Maybe we can measure this !

Should we reconceptualise FnHL as a temporary increase in first MPJ stiffness? What say you?

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Chi Running

Chi running is a "movement" within the running community based a particular running technique based mostly on being more efficient, relaxed and having a midfoot strike. I initially dismissed it as just another one of those fads until I noticed that one of the key Chi running websites had an alliance with New Balance running shoes and they have a shoe that is specific for Chi Running. I wonder where this will go? Will the Pose Running converts get a shoe as well? Chi running is not without controversy, mostly due to the lack of evidence for the claims made by its supporters. I have also written before about Chi Running.

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Research on one foot, two feet, or one person

I have recently reviewed several manuscripts that I recommended that editors not publish due to a fundamental flaw in the methodology. It concerned me enough to post a thread here about it (and will freely admit that I have been guilty of this in the past, but times change as we learn more).

One potentially appealing thing about doing foot or podiatry research is that each subject has two feet, meaning that if you use both feet in the data, you have either doubled your sample size or halved the number of subjects used.

HOWEVER, a key assumption of almost all statistical tests is that the subjects in the sample are independent of each other ..... this means that you can not use two feet from the same person in the sample as they are related (not independent of each other; they are paired) - they have the same body weight; the same blood supply; etc etc ...

The use of the two feet of one subject is no longer acceptable in research due to this lack of independence. This is a common issue in the opthalmologic literature (two eyes or one eye?); the orthopaedic literature (two limbs or one?); the rheumatological literature (eg one knee or two):
"SUTTON et al. Two knees or one person: data analysis strategies for paired joints or organs Ann Rheum Dis.1997; 56: 401-402"

Hylton Menz brought this to our attention in the podiatric literature:
"H . Menz: Two feet, or one person? Problems associated with statistical analysis of paired data in foot and ankle medicine . The Foot , Volume 14 , Issue 1 , Pages 2 - 5, 2004"

Why are researchers still using both feet; still submitting the data for publication using both feet in the analysis; and why are journal editors still permitting them to be published (esp in podiatric journals)?

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Hubscher manoeuvre

There has been some good discussion at Podiatry Arena on the Hubscher maneuver (terminology primarily used in the USA) or Jacks Test (used by the rest of the world!). A poll in that thread showed that 82% of those that responded to the poll used it as a clinical test.

A lot of the discussion focused on it value as a static clinical test used to predict dynamic function and, more important, as a tool that may or may not predict the clinical response to foot orthoses. IMHO, the Hubscher maneuver or Jacks test does have clinical use. When you do this test on different people they respond differently .... that has got to mean something for the way the function! At the end of the day, the disagreements are about what we think it means.

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This is a fun read

At Podiatry Arena, a post was made about some research that should have never been published in the Journal of the American Podiatric Medical Association. It was an appalling piece of research. The inclusion criteria was biased toward getting the result that the researcher wanted. No means or standard deviations of the data was presented, yet the author managed to do a t-test on the data! The results were presented in a categorical fashion in a table. You can not do a t-test on categorical data (chi squared should have been used). I have no idea how or why the research got through the peer review and editorial process.

The fun thing at Podiatry Arena was these criticisms were made of the paper; the author emailed his friends all over the world from several different disciplines who all came along to say way a great guy the author was and how dare we criticise his reputation .... NOT ONE OF THEM addressed the biased inclusion criteria; the lack of presentation of means and standard deviations; the presentation of the data as categorical etc etc .... it don't figure why they blindly accept was this person says without any critical appraisal (mind you a number of contributors to the discussion have a vested financial interest in a product that the author gets royalties from). Anyone smell a rat? (link to discussion)

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