10/12/2013    Stephen M. Pribut, DPM

1st Annual Richard O Schuster Memorial Seminar (Arthur Lukoff, DPM)

This past weekend's seminar was excellent. It
afforded the opportunity to see many people who
were tremendous lecturers of yesterday and still
are great lecturers today. As D'Amico said, you
won't see everyone there on the same platform
again.

Many topics were covered. Both simplicity and
complexity were on display from studies conducted
by Schuster to one of the most intricate
discussions of computer assisted gait analysis by
Dr. D'Amico. D'Amico far exceeded what most
biomechanists and almost all of those using the F-
Scan in their offices would be capable of
extracting from the data he obtained. (Note: For
years Dr. D'Amico employed the EDG which preceded
the F-Scan. The EDG was developed at Langer Labs
by one Michael Polchaninoff, one of D'Amico and
Schuster's fellows.)

A simple and elegant measurement was mentioned by
Dr. Skliar, early in the day: the "lower Limb
Total Varus". Skliar also mentioned how to place
the foot in neutral and mark the heel as a
reference point for cast pouring.

In his lecture, Dr. D'Amico did state that the
same results were possible without the use of an
F-Scan. If you recall, and look at the notes
provided at the seminar, you'll see that Dr.
D'Amico also did an extremely thorough segmental
biomechanical evaluation.

The results are in the handout and for this
discussion aren't critical. What was critical was
that his one year old orthotics were made over an
18-19 year old image of his foot. The "recent"
orthotics no longer conformed to his foot. They
were then no better than a badly, mismatched OTC
insert.

He also checked Seinfeld's shoes and his
stretching routine. In the handout he stated that
Jerry was 100% funtional and improved at his first
followup visit. So, what did he do before he even
had new orthotics? D'Amico gave Jerry the same
advice that I give my patients. He told Jerry to
stop using the incline board stretch, to stop all
other aggressive calf stretches. He also would
have wanted him to stop pulling up his toes to
"stretch the fascia", to avoid stair stretches,
jumping jacks, forefoot contact exercises.
(According to the handout, he let him continue
using his night splint, which I often advise to
discontinue or use 50% of the time.) D'Amico also
recommended using shoes at all times and avoiding
barefoot. He took new plaster impressions for
orthotics at this initial visit also.

Seinfeld expressed skepticism that the new advice
would work since it went against everything else
he had been told and read on the Internet. D'Amico
related that one or the other advice was going to
be right. (And the other advice had clearly
failed.)

When Seinfeld returned - he felt great. That was
accomplished merely by stopping all of the
destructive and counterproductive stretching,
changing his shoes to better and more appropriate
foot gear, and wearing shoes all of the time. And
by that helpful advice, which may improve many
people by 60% and in this case even more, Seinfeld
was a happy man again, before any biomechanical
magic.

To continue upgrading your knowledge I do
recommend reading all of the articles discussing
biomechanical treatment of foot and leg problems
that appear in Podiatry Management, including the
panels that occur regularly. To get up to speed on
"modern" biomechanics I'd recommend Kevin Kirby's
three volume series of "Foot and Lower Extremity
Biomechanics: Precision Intricast Newsletters" and
his JAPMA journal articles on the STJ axis and
critique of Root. Paul Scherer's "Recent Advances
in Orthotic Therapy" text or e-text reviews
evidence based medicine and therapy for a good
number of clinical entities has much to offer.

To review the tower of Babel models of podiatric
biomechanics read (and it is likely to exist
somewhere on the Internet) the very long and
thorough article "Podiatric Biomechanics: An
Historical Appraisal and Discussion of the Root
Model as a Clinical System of Approach in the
Present Context of Theoretical Uncertainty".

A few practical hints: Learn the new off weight
bearing casting technique in which the first ray
is plantar flexed rather than dorsiflexed during
the casting. Use intrinsic forefoot posting and
quite often minimal cast correction so that you
have good orthotic to foot conformity and
consider learning and using mildly inverted cast
pouring (as Schuster did) and a Kirby skive
instead of old fashioned rearfoot posting. Use a
lab that will answer questions and offer
suggestions as you learn more.

Stephen M. Pribut, DPM, Washington, DC,
dr.pribut@gmail.com

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