An Approach to Foot Orthopedics

Journal of the American Podiatric Medical Association • Vol 97 • No 4 • July/August 2007 299Celebrating100years of continuous publication:1907–2007

Merton L. Root’s vision for the podiatry professionwas precision. Precise definitions. Precise quantifica-tion of deformity. Precise individualized treatment de-signed to nullify the forces that cause pathology. Inthis brief article, Root for the first time addresses hisentire profession with his vision. Although the con-cepts in this essay may seem commonplace now, hisideas were revolutionary at the time.

Before Root, the fields of orthopedics, physicaltherapy, and podiatry used jargon that was ill-definedat best. Subsequently, communication among podia-trists and among professions around the world im-proved as his definitions were accepted. Precise defi-nitions may have been Root’s greatest contribution.

Root envisioned creating a unique treatment plan,including surgical and mechanical modalities, specif-ic to each individual patient’s morphology and asso-ciated abnormal forces. A parallel can be drawn withthe ophthalmologist’s quantification of nearsighted-ness or farsightedness and then prescribing a lens orsurgery to correct the deviation from ideal vision. Itis very difficult to have the discipline to evaluate andtreat patients with the precision necessary to exe-cute Root’s vision. Thus detractors were born.

On the other hand, many researchers have embel-lished Root’s concept of precise quantification andindividualized treatment. Kevin Kirby quantifiedground reactive moment arm length to the subtalarjoint, and he also developed the medial heel skive totreat variations from ideal.1 Howard Dananberg2 de-veloped the kinetic wedge to address the abnormalforces created by functional hallux limitus. E. DaltonMcGlamry advocated addressing the cause of plan-tarflexed metatarsals by straightening the respectivetoe rather than directly altering the metatarsal. Mc-Glamry’s concept was later quantified by Scot Malayand Howard Hillstrom.

With regard to quantifying foot deformity, a studypublished by Jinsup Song and colleagues3 has been

frequently cited by members of a variety of profes-sional disciplines as a breakthrough for quantifyingfoot morphology and for predicting gait and associat-ed forces in a consistent fashion.

Root developed foot orthoses that move. Theamount of motion prescribed for the patient depend-ed on the foot’s ability to influence leg rotation as de-termined by the deviation of the subtalar axis fromthe horizontal plane. The actual motion was deter-mined by the flexibility of the plastic and the rearfootpost. Gilbert Hice4 described a technique for treatingfeet with above-average deviation of the midtarsalaxis from the transverse plane.

When reading this article, it should be remem-bered that most of the concepts were new, and thatthe established concepts were presented as part of anew vision. Root did not accept that one treatment fitall patients and their pathology. His vision was thatthrough precise communication, precise quantifica-tion of deformity, and precise individualized treat-ment and evaluation of that treatment, treatment re-sults would improve. If the podiatry profession hadexecuted the vision described by Root, perhaps retailfoot-care products would be no more prevalent thanover-the-counter corrective lenses.

WILLIAM H. SANNER, DPMOchsner Clinic Foundation of Baton RougeBaton Rouge, Louisiana

References

1. KIRBY KA: The medial heel skive technique: improvingpronation control in foot orthoses. JAPMA 82: 177,1992.

2. DANANBERG HJ: The kinetic wedge. JAPMA 78: 98, 1988.3. SONG J, HILLSTROM HJ, SECORD D, ET AL: Foot type bio-

mechanics: comparison of planus and rectus foot types.JAPMA 86: 16, 1996.

4. HICE GA: Orthotic treatment of feet having a highoblique midtarsal joint axis. JAPA 74: 577, 1984.

Journal of the American Podiatry Association, February 1964

An Approach to Foot Orthopedics

Merton L. Root, DSC*

FROM PEDIC SOCIETY ITEMS TO JAPMA: 1907–2007

Reprinted from Journal of the American Podiatry Asso-

ciation 54(2): 115–118, February 1964.*Podiatry Staff, Valley West General Hospital, Los Gatos,

CA; Surgical Staff, California Podiatry College Hospital, SanFrancisco, CA.

300 July/August 2007 • Vol 97 • No 4 • Journal of the American Podiatric Medical AssociationCelebrating100years of continuous publication:1907–2007


302 July/August 2007 • Vol 97 • No 4 • Journal of the American Podiatric Medical AssociationCelebrating100years of continuous publication:1907–2007


Documents

An Approach to Foot Orthopedics