05/13/2013    Mr. Jeffrey Root

Dr. Lidtke's Remarks (Bret Ribotsky, DPM)

Dr. Ribotsky wrote “Last Tuesday, we were exposed
to a theory that stability can be bad (sorry, Dr.
Root) to forces and to orthotic therapy when
dealing with arthritis and joint wear”. Although
I didn’t listen to last Tuesday’s Meet the
Masters discussion, I can tell you that Dr. Root
believed that functional orthoses could be used
to do far more than reduce or eliminate excessive
motion.

While it is true that functional orthoses can be
used to enhance stability, they can also be used
to increase motion. Dr. Root frequently lectured
that individuals who functioned maximally
pronated throughout the stance phase of gait
lacked sufficient motion for proper shock
absorption. He explained how orthoses can be used
to create re-supination of the foot so that there
can be an available range of subtalar joint
pronation to assist with shock absorption during
the contact phase of gait.

Dr. Root stressed that subtalar joint pronation
was a critical and necessary motion which can’t
occur without subtalar joint re-supination,
ideally during the midstance phase of gait.

Dr. Root advocated conducting a gait analysis on
all patients who receive functional orthoses. He
and his partner John Weed, DPM would frequently
increase or decrease the angular grind (post
motion) on the plantar surface of the extrinsic
rearfoot post in order to influence the degree of
tibial rotation and subtalar joint motion that
could be observed when conducting a gait analysis
on a patient with orthoses.

As a result, I doubt that an apology is necessary
and I believe that Dr. Root would be very pleased
to see clinicians discussing how critically
important joint motion is and how foot motion
influences motion throughout the kinetic chain,
especially at the knee.

But rather than take my word for it, here is what
Dr. Root wrote on page 151 in his book Normal and
Abnormal Function of the Foot:

“Shock absorption is a primary function of the
subtalar joint at heel strike. The subtalar joint
pronates rapidly to absorb some shock directly.
Secondarily, knee flexion at heel strike absorbs
more shock, but the knee cannot flex rapidly
unless the tibia can internally rotate faster and
farther than the femur. Subtalar joint pronation
allows the tibia to rotate faster and farther
than the femur, thus unlocking the knee so that
it can flex and assist in shock absorption.
Therefore, subtalar joint pronation is
responsible, directly and indirectly, for normal
shock absorption at heel strike.”

Mr. Jeffrey Root, jroot@root-lab.com

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