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Post by robertisaacs on Feb 9, 2008 20:42:40 GMT
This came up on another thread and i thought i'd shift it here rather than derail the other one.
Brian posted
Predictably i have some questions here.
1. You say that "typically" in planter fascitis you will find that they will have suffered from multiple joint pain for years and may well have CPS. Firstly i would disagree with "typically". Most of my patients do not have this "global" presentation. I do not agree that PF is Commonly linked to CPS.
Shipton EA, Tait B (2005). State that chronic pain is pain which "persists longer than the temporal course of natural healing, associated with a particular type of injury or disease process."
The vast majotity of PF can be resolved with "natural healing processes". RICE, MEAT and the removal of the causal tissue stress is adequate in most cases. That would seem muturally exclusive with CPS which is far more complex, involving psychological and biological factors as well. Stanos S, Houle TT (2006) and others have showed that the most effective way and possibly the only effective way to treat CPS is with comprehensive care plans involving medication, physical therapy, rehab and elements of pyschotherapy.
2. In your second paragraph you infer that the Chronic pain syndrome (CPS) is the cause of the Planter fascitits (PF) Whilst i agree that it COULD be, I would contend that in the majority of cases PF has a simple mechanical cause and as such a simple mechanical cure.
3. You say that you consider that the strassburg sock is "as effective as other modalities. Is this based on Evidence or your own experiance. If the latter i would be interested to know your experiance with these devices (as nobody else seems to have used them before!) If the former i would appreciate the references.
4.
I would be interested to know your views on CPS. I'm willing to hazard a guess that you beleive it to be caused in part by poor posture / muscle tonus / muscle function (and possibly aided by posture control insoles?). This is, as you know, directly at odds with the conventionally medical understanding.
Regards
Robert
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Post by rothbart on Feb 11, 2008 7:00:01 GMT
Dear Robert, All very good questions. First, let me state that my comments come both from my own personal experiences and also directly from the writings of Posturologists in France. The most authorative, in my humble opinion, is the Pierre Marie Gagey textbook (considered by many to be the gold standard on the subject). It has been stated by many Posturologists, and by consensus agreed upon (visit their forum and follow their discussions) that PF is a common foot symptom seen in many Chronic Pain Syndrome (CPS) patients. Not my statement, theirs, but one I fully agree with. In fact, I published a paper in 2002 in the Journal of Bodyworks and Movement Therapy that I believe I listed PF as a common symptom I found in CPS patients. I do not believe PF is caused by CPS. However, I stated PF is commonly seen in CPS patients. Two very different statements. Personally, I believe CPS is frequently the result of two genetic foot structures that I discuss in detail on my research website (namely the Primus Metatarsus Supinatus Foot and the Preclinical Clubfoot Deformity). And a very common foot symptom that develops with both of these foot structures is Plantar Fasciitis (PF). To be more specific, I believe PF is the result of abnormal foot twist (pronation) resulting in micro tears of the long plantar ligament - Fully discussed on my webpage Entitled Plantar Fasciitis _ What is it and How do you treat it - See www.rothbartsfoot.info/PFDefandTx.html And, as I have stated on many occasions, I believe abnormal foot twist (defined by timing NOT degree) is one of the most common symptoms seen the PMs and PCFD foot types. My statement regarding the effectiveness of using the Strassburg sock and supportive type orthotics in treating PF, is based on (1) personal clinical experience, (2) experience garnered from my compeers (A Randomized Single Blinded Trial concluded that, long term, both prefabricated and custom orthoses are no more effective in treating Plantar Fasciitis than a sham device. Landorf KB, Keenan AM, Herbert RD 2006. Arch Intern Med. 166:1305-1310.), and (3) research I did while a Research Fellow at ISS. Your conjecture on my viewpoint regarding the etiology of CPS is quite accurate and you are correct in saying my viewpoint does not follow the constructs of conventional based medicine. I have authored a 420 page research website presenting my work on this subject which I believe presents a strong case suggesting that poor posture is one of the underpinnings in the development of CPS. Also, I am authoring a textbook on the subject of CPS. If you are interested, I will let you know when it becomes available. Prof B |
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Post by robertisaacs on Feb 11, 2008 8:29:57 GMT
You know me brian. I'm interested in EVERYTHING. Please do drop me a reference when its published. Fair enough. I can agree there. However you then say so you consider CPS to be the result of the foot type you invented, and then And the source of the problem is... CPS is the implication. Forgive me if i am being pedantic (me being pedantic, big surprise  ) but your first post appears to imply that there is a causal link between CPS and PF and that treatment of the CPS (By treating the Foot types you consider to be the cause of CPS) will treat the PF. If you are trying to imply that your foot types cause BOTH CPS AND PF and that treating with your insoles will treat both problems then my apologies. I disagree but thats ok. Otherwise you appear to be being inconsistant. Here i must disagree most strenously. Whilst i can agree that poor posture can contribute some symptoms to the CPS package and with all due respect to french posturologists, every other author from fields of medicine rather more established than "posturology" state that CPS is multifactorial with strong psychological / psychosocial and biochemical issues. Its a well recognised and much researched medical condition. Most agree that that there are three major areas which are present Biochemical - With the phenomina of "wind up pain" and the like Psychological - Physical Now i can beleive that postural problems can cause multiple joint trauma and muscular problems. However it does not contribute to the other two thirds of the problem! To consider that the mechanical element (the foot type) is the CAUSE of CPS is to ignore the other two elements. To attempt to treat CPS with only the mechanical aspect is to deny the patient two thirds of what all studies published at the highest level by consultant aneathnetists agree must be a comprehensive and multifaceted care pathway. And with all respect (and i mean that sincerely) you know the difference between published works in a peer review respected journal and publishing on your own website. The former is research, the latter is not. As a much published author yourself you are aware of this. I therefore cannot see how you can contend that your unpublished, unreviewed work on CPS on your website can be considered to overturn years of patient published research at the very highest levels of academic medicine. If you are aware of any published works supporting your contention that poor posture (secondary to your foot types) causes CPS, in french or english, please produce the evidence and we can hold it up to the whole gambit of existing literature and see how it matches up. If you are basing your opinion on empiricalism, ie patients who come to you with CPS and are cured by putting insoles in their shoes i humbly suggest that what you are treating is not CPS in the medically accepted way, but rather multiple joint pathology arising from poor posture. And that success rate still remains to be proven by that published research i mentioned earlier. As you are all too aware, anyone can claim a success rate from homeopathy to chi balancers. Respectfully Robert |
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ronm
Full Member
but a simple man working against insurmountable odds
Posts: 141
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Post by ronm on Feb 11, 2008 10:14:22 GMT
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Post by rothbart on Feb 11, 2008 16:50:07 GMT
Dear Robert, Interesting comments. You are correct when you say that I believe CPS is frequently the result of PMs or PCFD. And in all due respect, I take issue with your statement "the foot type you (I) invented". I was the first to report the existence of this foot type to the research and medical community. They are not foot types that I invented. Read my paper that was published in the JBMT. It traces the etiology of these foot types to embryological events that occur in the first trimester of pregnancy. I am very well aware of the literature on CPS. I have been involved in research in this area for nearly 20 years (and have published more than several studies on this subject). I am not ignoring nor depricating the importance of the psychological and biochemical factors in CPS. However, my research has led me to believe that one of the main (read that as, not only) causes in the development of CPS lies in the abnormal foot motion generated by the foot types that I have mentioned above. Since I am considered a pioneer in this area, linking CPS to these two foot structures, when you ask me am I aware of any published works supporting my theories, the answer is - presently several are being conducted to so test my work (a major one with the US Army, as I have mentioned in previous posts). Whether I am proven correct or not in delineating the source of CPS, only time will tell. But many other researchers and experts in this area have told me that my ideas are intriguing, if not compelling (check my webpage "What Other Experts Have to Say" at www.rothbartsite.com/Feedback.html to read their comments). And yes, I am very well aware of the difference between publishing in peer review journals and placing information on my research website. However, because I am well published on this subject, placing more information on my website does not seem to be an unreasonable thing to do. (If I was not well published, your points would be very well taken). Regarding empirical data versus research based evidence, in my opinion both are valid and important. Yes, I have treated many patients using Proprioceptive Insoles with a very high rate of success (again you can access my websites and read the patient testimonials). I have also done the research and published on our findings. (several statistical studies that I am sure you are aware of). And you might be correct when you state that possibly my success rate has been with patients with multiple joint pathology arising from poor posture and not patients with CPS. However, many of the patients that I see are referred to me with the diagnosis of CPS. And finally, I do not claim success rates on my Research Website, I only publish on my findings. I present both EBR and empirical data (including subject outcomes) because in my humble opinion BOTH are important. Incidentally, I do NOT treat CPS patients by merely putting an insole underneath their feet. Proprioceptive therapy involves a great deal more than this. Many times we need to concurrently provide dental interventions, cranial interventions or psychological interventions, depending on the need, patient by patient. Again, thank you for your comments. Most stimulating. Prof B PS Have you ever considered attending one of my workshops? |
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Post by robertisaacs on Feb 12, 2008 15:44:03 GMT
Likewise! Would that be Proprioceptive intellectual stimulation? Increased cerebral awareness of the position of your views in cyberspace. Possibly creating a more accurate 5 dimensional model of where more intellectual pressure needs to be exerted? To acheive the right posture in the broader arena of medical thinking? Might be a paper there.  To business. I will. Which one? No offence intended. If these foot types exist (which as you know is disputed by much of the medical community) then as you say you have merely identified the pattern. I should have been clearer, sorry. I agree that i would not expect you to limit the comments on your website to that which is proven / published. Much of your website is obviously aimed at your customer base (the lay public) and therefore it would not be appropriate to make it all at professional level. However if you are calling it a "research website" it sort of implies that its a website full of research! As it is it seems to be a website full of your (valid) opinion and statistically insignificant but easily accessable case studies. I have no problem with that, however i do feel it behooves us as professionals to respect the razor line between informed opinion based on empirical experiance and proven theory based on publish studies. I sometimes struggle, when examining your work, to see where that line is drawn. A creditable admission. It strikes me that the diagnosis of CPS is a tricky business and as such assessing success rates for same is equally tickleish. You'd be surprised! if we took things as referred as gospel i have cured a "weight bearing Medial malleolus" with an EVA orthotic! Impressive stuff. Pharmicological? I'm curious. When you are referred a CPS case do you become the Case lead? Or are you one of the multidisciplinery team organised by the central care organiser. I would also be interested to know where your patients are referred from. Are you getting them from the local consultant led "pain clinic" (if such a thing exists where you are) or from other mechanical modalities (osteopaths, physios etc) or from GP's. Frquently. Although i'm not sure you'd want me there. There is always the risk of heckling! You'd probably chuck me out after the 17th interruption. Regards Robert |
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Post by rothbart on Feb 14, 2008 21:03:31 GMT
The JPMT paper is: Rothbart BA, 2002. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal of Bodywork and Movement Therapies (6)1:37-46 You can download the PDF file at www.posturedyn.com/references.htmlPresently, I have two websites. One directed towards my potential customer base (laypeople). The other is a research based website directed towards researchers and clinicians interested in Proprioceptive Therapy. This website has, as you stated, many cased studies. But it also has over 35 references to published papers (with abstracts) that I feel are important contributions to this area of research. Again, let me stress the point that my research is expanding the envelop (RE Proprioceptive Therapy). A great deal of the information I provide is based on my clinical experiences, as well as the papers that I have published. Because this area of therapy is relatively new (when treating CPS), there are very few single blind studies (and I believe no double blind studies) currently published. However, I am aware of half a dozen studies being planned or currently underway and several PhD students basing their dissertations on my research. It will be very interesting to see the results of these studies over the next few years. Regarding Pharmacological Interventions (when treating CPS), you have touched on my personal bias. Whenever possible, I stay away from using drugs. However, that discussion would best be done on a separate thread. My private practice is located in a multidisciplinary clinic (over 40 different specialities). Basically I see those CPS patients that have gone through the complete gamut of interventions with disappointing outcomes. Rarely am I one of the first referrals for these patients. In one way this is quite nice for me. By the time I see these patients, most everything else has been ruled out by the allopaths (differential diagnose is simpler to do). Usually I do not take the Case Lead on those patients referred to me within the clinic (but there have been exceptions). Approximately 60% of my practice comes from outside the Rome Area, 40% outside of Italy, and 20% outside of Europe. Half my patients come from other patients, the rest from both allopathic and alternative healthcare providers. Because I have spent some time lecturing to the MD students (I was an Associate Professor at the University of Washington, School of Medicine and a Guest lecturer at the Unversity of Sapienza here in Rome), my work is becoming known in the mainstream area as well as the alternative areas of medicine. Regarding the risk of heckling me in a workshop, I am sure you are just being jocular and waggish. Your attendance and input would be most welcomed. regards, Prof B |
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Post by robertisaacs on Feb 15, 2008 8:42:02 GMT
Where hav people got this strange idea that i am NOT an arrogant evil minded bigot!  Waggish my bum. I would almost certainly get throw out! Would'nt be the first time. Thanks for the info on CPS. I've enjoyed this discussion. As you say, most stimulating. We keep coming back to the literature (which is as it should be.) i know there is some, but the last list i had (from petros) was so long and disorganised it was hard to discuss it and some were not especially relevant to the question of the effect of proprioceptive insoles! Tell you what, its been a while since we chewed over some proper, grown up, published research. If you want to pick a single study (one at a time mind) which you feel best proves the effect of proprioceptive insoles and post me the link to the full text we'll have a look over it together. Lets break this down together! There is a danger that David is going to have to open a new catagory for "debates between Brian and Robert" . Nobody else seems to want to come play! Kind regards Robert |
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Post by rothbart on Feb 15, 2008 12:58:13 GMT
I was hoping other readers would add their comments. A Thread between two participants can become a little dry. However, I do believe it would be most interesting to discuss recent publications (other than my own) on this subject (namely the impact proprioceptive feedback impact has on posture and CPS). When I return from Spain (the end of next week) I'll search for an interesting paper. I have one in mind (which is available OnLine).
best regards,
Prof B
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Post by davidsmith on Feb 15, 2008 21:29:54 GMT
Robert
You ask why no one else has contributed to this thread.
Your own arguments should indicate why.
I first read, with great interest, Prof Rothbarts theories on Proprioceptive insoles back in 99- 2001. Then, I was a bit green and the science looked good, I tried the concept. It didn't work for me except for one patient. Some reported good outcomes at first but later returned with the same symptoms or found the insoles uncomfortable and/or causing proximal or distal pain. This was my experience and I may not have applied the technique or technology correctly. However, at the same time, standard Root type orthsoses and OTC devices worked very well.
It is my opinion that Prof Rothbart while being a very well educated person is also very clever in his business. He plays the numbers game. He puts his theories and products into as many different arenas as possible. He claims that his products will resolve as many and varyious disorders as possible. The cross product is that someone somewhere finds the product works for them. They write in saying how good it was, another letter of appraisal goes on the web but they are never negative appraisals. Like all good marketing.
The fact that he markets himself and his products so aggresively (passive aggressive) does not give me confidence in his research and opinions since they will alway appear to be biased. This has been his strength and his weakness. I have no faith in what the man has to say and find argument pointless since he has a product to protect and so can never conceed to an opposing point of view or theory.
Just one point from your last post Prof Rothbart
Quote
"Rarely am I one of the first referrals for these patients. In one way this is quite nice for me. By the time I see these patients, most everything else has been ruled out by the allopaths"
So, you are the last option of referal? if your CPS treatment is so good why not the first option? And how many of those had improvement? what is your ratio of success?
All you have said is that your are the last one anyone would deal with and most of your patient come from miles away where they know nothing of your reliability localy. And we don't know how many got better. What kind of recommendation is that?
Again this is one of your clever arguments that manipulate the truth to represent your techniques in a good light. Logical fallacies I believe Robert would call them.
"Half my patients come from other patients, the rest from both allopathic and alternative healthcare providers."
So only a quarter, at best, can have come from Medical Doctors and only as a last resort. And you still don't say how many got better.
This is just my opinion and one day I may have to eat my words, but I doubt it.
All the best Dave
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Post by rothbart on Feb 17, 2008 14:18:20 GMT
Dear David, You have raised several points that need to be clarified and answered. However, in so doing, I hope that what I write is not viewed as being contemptuous or even worse, deprecating. If it comes across that way, please allow me to apologize in advance, for that is NOT my intent. Having said that, here goes. I have written many times, and have even posted on my patient and research websites – See www.rothbartsite.com/Message.html, that I strongly advise that my therapy should NOT be used by anyone until they are properly trained and certified to do so. Otherwise, not only will their results be less than desired, they could actually do harm to their patients. When you think about this, it makes perfect sense. For example, would you perform a modified Akin McBride Repair without being trained to do so? I think not. In Australia, New Zealand, Cyprus, and Greece you can not purchase the insoles I invented until you have taken courses in how to use them. I hope this policy spreads across the globe. When you read my research website (or even my patient website), you read over and over again that Proprioceptive Therapy (and specifically Rothbart Proprioceptive Therapy) is not simply placing an insole underneath the foot. It involves (among other things) analyzing both Ascending and Descending Postural Distortional Patterns, to determine what type and strength of proprioceptive insole to use. Without so doing, the results can be very disappointing (as you have written). Most Podiatrists are not trained to analyze Descending Patterns. This has traditionally been viewed as the domain of the Osteopathic Physician or Cranial Sacral Specialist. Incidentally, I teach both workshops and courses, training healthcare providers in the use of my therapy, specifically looking at both Ascending and Descending Patterns. The fact that you were disappointed in your results using Proprioceptive Insoles is not surprising, for the very reasons I have expressed above and in my websites. Thank you for the complement, stating that you believe I am very clever in my business. However, those that know me best would fervently disagree with you. In my own humble opinion, I believe I am an excellent clinician and researcher. But my business and marketing skills “suck” (if I may be so crude). By the way, I have no idea what you mean by “passive aggressive”. To me, it sounds that an oxymoron, like an “accurate estimate”. The fact that you have no confidence in my research (and publications) is certainly your prerogative. However, many experts in the field of chronic pain would disagree with you. (I have posted some of their remarks on my website – See Feedback from Experts at www.rothbartsite.com/Feedback.htmlAnd lastly you ask, if my CPS treatment is so good, why am I the last option of referral? I ask myself that very question, many times each day. It has been suggested to me that in a large clinic (similar to the one that I work in), politics and bureaucracy, determines to a large extent, which practitioner sees which patient and when. In my heart I would hope this is not true. However, after nearly 40 years of practicing medicine, I can not disagree with that statement. Just how good is my approach in eliminating chronic pain? I am probably the last person to ask that question because it can be difficult to critique one’s own work dispassionately, without unintentional or inadvertent bias. However, fortunately, there are many other health care providers using my approach. I suggest you ask one of them (Nigel Brooke DO, Petros Kattous DO, Dinos Xydas MD, Gerald Smith DDS, Alex Catto DPM. George Georqiou ND, PhD, and Mark Hainsworth MD are just a few you could start with, from the countless number of health care providers that are currently using my work). Lastly, I respectfully suggest you consider matriculating in one of my workshops or courses. This will provide you with a great deal of hands on experience (taught directly by me) where you can 'first hand' critique my work. The next one is being given this April in London England. You can contact Alex Catto ( alexcatto@blueyonder.co.uk ) for details. Best regards, Prof B |
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doug
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Post by doug on Feb 17, 2008 17:37:21 GMT
I have been watching the exchange about Dr. Rothbarts work. I have studied personally with him in Italy. He is meticulous about his research and as far as I'm concerned he has NO hidden agenda except the truth. We have combined our talents enough to establish the fact there are many components to the chronic pain picture. It really bothers me to see so called professionals wearing their egos on their sleeve. We are all in this together,and I think it would behoove each of us to look out side our individual box. We might find some thing available to help the end user, the patient! Doug
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Post by rothbart on Feb 17, 2008 21:04:13 GMT
Dear David,
I feel it is very important to answer several other statements you made on this thread:
(1) You said, " have no faith in what the man {Prof Rothbart} has to say and find argument pointless since he has a product to protect and so can never conceed to an opposing point of view or theory."
Apparently you are not aware that in 1994 I obtained a US patent on an insole that I felt would resolve many chronic pain issues. I spent over $100,000 USD to obtain this patent (If you want the link to this US Patent website, let me know). Two years after I received the US Patent, I STOPPED using that insole. Why, because it didn't work! (Only realized this after following these cases over a prolonged period of time). My point is, I do not use or advocate using technology that doesn't work!
(2) You said, {Dr Rothbart} He claims that his products will resolve as many and varyious disorders as possible.
In all due respect, you have misunderstood my message. I state my insole should ONLY be used when treating the PMs foot type. It is true that many pain issues are resolved with patients having the PMs foot type. This occurs, in my opinion, because these pain issues are secondary symptoms. The foot structure is the primary source of chronic pain (in patients with PMs). Treat the source, the secondary issues disappear.
And finally, I am not sure I understand what you mean when you say, "They write in saying how good it was, another letter of appraisal goes on the web but they are never negative appraisals. Like all good marketing." Are you saying patient testimonials are inconsequential and unimportant? If so, I strongly disagree with you. To me, subjective outcomes are very important.
Regarding negative appraisals, if you go to my research website, you will read about negative outcomes when the wrong type of proprioceptive insole is used - I will supply the links upon request.
Prof B
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Post by robertisaacs on Feb 17, 2008 21:05:42 GMT
WHOA there boys. Thats a big fat TIME OUT. NOW HEAR THIS! Firstly, Doug. This is a UK forum. Brian gets special dispensation because... Well mainly because i enjoy splitting hairs with him and because the discussions have thus far stayed relevant and academic. If you had come on with a relevant and Evidence based argument on one of the MANY threads we've shared I might have overlooked the fact that you are not English. If you are just coming in as a cheerleader, sorry, no dice. Bye. If you want to discuss this issue can i recommend www.podiatry-arena.com As the BEST international forum. Start a thread there. You'll find it most stimulating. Re Dave's Post and Brians reply, I will NOT allow this to turn into the usual i don't likem, why don't you likem thread. God knows theres enough about them scattered over cyberspace. Back to discussion of the research, thats the ONLY basis upon which i will allow this to continue. Brian, if you supply a reference we'll talk about IT. OK? Brian I will say this one time more and one time only. The peppering of your posts with links to your websites must stop. We've all been there, we all know whats there. The only reason i for repeatedly putting the links on is for marketing to lurkers and passers by. Enough, No more. If you must, say "look on my website" But no more links or this game ends. Zero tolerance from now on. For a point of accuracy and mediation i will say this. Brian you said Possibly the reason that people have this misconception is that Alex catto, your representative in the uk who organises your seminars and sells YOUR licenced product on his website w w w . Back2feet . net states So you see the source of the confusion. If you truly beleive that your insoles can do harm in some cases might i suggest a chat with your esteemed colleague? Enough. I call upon the forces of the almighty admin to close this thread. Anyone wants the last word send it in by PM. Regards Robert |
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Post by Admin on Feb 18, 2008 8:49:15 GMT
For the resaons given above (thanks Robert)
This thread now closed.
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) but your first post appears to imply that there is a causal link between CPS and PF and that treatment of the CPS (By treating the Foot types you consider to be the cause of CPS) will treat the PF. 
Yes, I am an agent of Satan, but my duties are largely ceremonial 
Waggish my bum. I would almost certainly get throw out! Would'nt be the first time. 
