05/13/2013    George Trachtenberg MS, DPM

Dr. Lidtke's Remarks (Roy H. Lidtke, DPM)

I do not recall you making the website
ncbi.nlm.nih.gov/pubmed available in your posting
in PM News for the readership to refer to. I only
recall you only made a statement that would
amount to an abstract of your conclusion. Also, I
never expressed any issue that the shoe in
question in your study reduced loads on the knee
up to 20%. I simply pointed out that practitioner
should be aware that that load in a closed
kinetic chain can have an effect on another body
region if not dissipated external to the body.

I have not gone to the website above to see if
you demonstrate what happens to that load when
you remove it from the knee but I got the
impression that is not something that is yet
know. In fact in your response today you
indicated that you “did not yet know the
mechanism of action.”

You also went on to say: “The conservation of
energy theorem is probably not the correct
analogy for cell destruction in osteoarthritis as
much of the external energy of gait is taken up
into joint motion and internal muscular
contraction and has not been proven to
be an acceptable biomarker for osteoarthritis.
The external knee adduction moment has been shown
to be a good biomarker for knee OA and is
dependent on the magnitude and orientation of the
ground reaction force vector”

I have difficulty in applying this to what I
said. I think you are a little bit off the
reservation here. I am not truly addressing the
conservation of energy as much as I am the
redistribution of the load that is removed from
the knee. If that force stays within the closed
kinetic chain and affects a joint that moves, the
repetitive motion of that joint can use an
improperly redistributed force thereby causing
damage to that joint.

I am not talking about inherited osteoarthritis,
but “traumatic arthritis” from improper use of a
part. If the front end of an automobile is not
properly aligned and tires not properly balanced,
when the vehicle is moving, this will create
abnormal torque that will wear the tires
unevenly, then wear them more quickly and if
still left unattended, that torque that is
redistributed can eventually have an effect on
the struts, tire rod etc.

Therefore, for the record, your 20% decrease
outcome was never in question, just that without
knowing more about where that force/torque goes
is in question…..buyer beware!

George Trachtenberg MS, DPM, Vestal, NY,
doctor@georgetrachtenberg.com

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