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Prefabricated vs custom made foot orthoses

Discussion in 'Biomechanics, Sports and Foot orthoses' started by admin, Nov 16, 2004.

  1. Here is my Precision Intricast Newsletter from March 1990 that describes where I first heard the terms shank dependent orthosis and shank independent orthosis. Thanks to Precision Intricast Orthosis Labs for allowing me to share it with you all on Podiatry Arena.

     
  2. Jbwheele

    Jbwheele Active Member

    Here Here chazcheh

    Hi Everyone.


    I have no allegiance to any Insole / Orthotic / Shoe or other product. If a product is working well, use it, modify it and help your customers.

    I "heat mould my insoles / orthotics (what ever you want to call them) and like chazcheh, bolster them with various eva densities to achieve the load bearing and resilience required (after I have discussed "wear' factor and value for money with my customers.

    I think that there is too much negative discussion about who's shoes to wear and too many biased opinions.

    Most 'Working Clinicians' can't spare the hours to sift through all the rebuttals and find what should be a very useful information / discussion site.

    Have a Nice Day
     
  3. DaVinci

    DaVinci Well-Known Member

    I still can't figure out why people think that the heat molding of an EVA or PE prefab actually changes the shape of the device when the patient stands on it. Its a scam :D
     
  4. admin

    admin Administrator Staff Member

    Thats why its called a forum!!!!
    That sort of information is available elsewhere. This is a forum .... ie a discussion site!!!
     
  5. Atlas

    Atlas Well-Known Member



    Unfortunately, the 'blur' is not restricted to podiatry students. The fog extends across other allied health fields I dear say. I would have felt sorry for you if you were one of my patients in my early days as a physiotherapist.

    But I agree with quite alot of what you are saying. IMO, it all comes back to our salivation over EBP. For memory, Sackett suggested an equal weighting between the research and clinical experience. My guess is that tertiary promotion does not value clinical experience over research experience. Would Root (Podiatry) or Maitland (Physiotherapy), if they were young and healthy today, get a gig at your typical university today? Probably, although the lack of RCTs in the cupboard might keep them at an associate level.

    Students of today are graduating with an academic mindset, not necessarily a clinical one. They don't know about 'trial and error' let alone consider it. Is it a fear of litigation? Partially perhaps. As you suggested, Abbie "explained in the course and I am sure many other lecturers do the same, if something doesn't work for you - think laterally and try something new because it doesn't necessarily mean it is going to work all the time for all your patients." How refreshing.


    The other thing that I cannot understand, is that, if "we" have moved on, why do orthotic devices, in the main, still look like they did decades ago...minus the forefoot varus wedge?
     
  6. achilles

    achilles Active Member

    Because they're foot shaped?? ;)
     
  7. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Prefabs have not changed much (except they now come in a prettier range of colours). I do know of a couple of prefabs in development/testing by two different companies that are quite a radical design. Orthotics might look the same as many years ago (because of what Tony said - ie foot shaped), but what has changed (for both custom and prefabricated) is we have got a much better understanding and a wider range of the different prescription variables and, more importantly, when to use what. ie the rational for different variables has changed and evolving substantially in recent years --- my beef is that the "weekend" "learn it all" courses have not caught up with it.
     
  8. pgcarter

    pgcarter Well-Known Member

    And my....my...can't we all just become the most amazing legendary experts from what we learn in a week end....or 3 hrs per week for one semester?....who are we kidding apart from ourselves? It is only a process of years of observation, assessment and attention to detail that will really get some one to the level that I would expect in a practitioner if I was a patient.
    regards Phill
     
  9. bunion

    bunion Member

    jmorthotics

    Jm orthotics heatmoldable devices intrinsic/extinsic posting superior product. High degree of Patient satisfaction relief of symptoms .Direct patient model much more accurate anatomically than traditional orthotic fabricated from modified plaster model.
     
    Last edited: Oct 19, 2006
  10. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    The difference here is that the JM orthotics are not shank dependant- as was said above, the heat molding of the shank dependant prefabs is a scam.

    Do you have a commercial connection with JM?
     
  11. bunion

    bunion Member

    no commercial connection but high rate of patient satisfaction from pediatric to geriatric population. It's like building a house- any one can buy materials but if you don't have the carpentry skills you'll be unsuccessful. Jm orthotic provides the material and it's up to the practitioner to provide the finish product- various posting ,topcovers,grinding,adjustments etc. Very affordable for patient and provider . There is a learning curve. No other orthotic comes close to the versatility of this material . I've refabricated my own 30 + times over 3 years with out stress risers/fatique and maintain good structural integrity. TRy them.
     
    Last edited: Oct 21, 2006
  12. Smilingtoes

    Smilingtoes Active Member

    HEAT MOULDED DETRIMENTAL!

    I believe inaccurate orthoses (heat mouldable and off the shelf) to be DETRIMENTAL and create structural deformity with prolonged wear.

    I discourage heat moulded and off the shelf devices as long term treatments. The nature of these treatments is to “improve the arch”.

    My concern is that they do this by indiscriminately placing a dorsal pressure on the 1st metatarsal, in effect dorsiflexing first ray and encouraging HAV, functional Hallux Limitus, midtarsal collapse and the dreaded forefoot varus etc. (I of course have no proof, it seems common sense from a physics perspective).

    Custom orthoses on the other hand are not arch supports. They are joint specific in nature and can improve the appearance of foot posture without an upward force being placed on the medial arch.

    I would appreciate critical comments of my theories by the wise.:deadhorse:
     
  13. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    This is an old thread and we been round this before .... the heat molding of shank dependent prefabricated foot orthoses to change there shape is a myth. Period.
     
  14. Atlas

    Atlas Well-Known Member

    There is a guy on the net that sells over-the-counter false teeth for 1/10th of the cost. They function well (you can chew off a bit of supermarket steak with masseter contraction and cervical rotation), and they look OK if you close your mouth when you smile.
     
  15. Secret Squirrel

    Secret Squirrel Active Member

    I can never understand why people don't get this. I had this discussion with many a collegue. It does not mean that prefabs don't work.
     
  16. Smilingtoes

    Smilingtoes Active Member

    While we have been around this before, perhaps it would be a progression to shift our research focus to the detrimental effects of or structure changing effects of prefabs and the structure benefits of custom orthoses.

    I have seen prefabs lead to rigid dorsiflexed 1st rays causing a reliance on the prefab., while custom orthoses can reduce this 1st ray position generally within two-weeks. By reducing acquired structural deformity and combining postural rehab. We are reducing patients reliance of treatment and injury recurrence. Surly this is the most ethical outcome.:bang:

    My primary concern is public (other profession) perception of custom orthoses and how we can be so clear yet neighbouring doctors and physios continue to harm patients!
     
  17. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    A Comparison of Rearfoot Motion Control and Comfort between Custom and Semicustom Foot Orthotic Devices
    Irene S. Davis, Rebecca Avrin Zifchock and Alison T. DeLeo
    Journal of the American Podiatric Medical Association; Volume 98 Number 5 394-403 2008
     
  18. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    The Short-term Effectiveness of Full-Contact Custom-made Foot Orthoses and Prefabricated Shoe Inserts on Lower-Extremity Musculoskeletal Pain
    A Randomized Clinical Trial

    Leslie C. Trotter and Michael Raymond Pierrynowski
    Journal of the American Podiatric Medical Association; Volume 98 Number 5 357-363 2008
     
    Last edited: Oct 3, 2008
  19. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    This is the first study to show that; all the others show no differences ......:confused:
     
  20. Smilingtoes

    Smilingtoes Active Member

    Are any of the wise aware of a study’s that compare Posterior Tibial muscle and or Peroneus Longus firing times/ function between custom and prefab. orthoses.:morning:
     
  21. PodAus

    PodAus Active Member

    Are these 'orthoses' prescribed specifically for each individual, by an experienced Practitioner?
     
  22. leslietrotter

    leslietrotter Member

    Hi and thanks for asking.

    Yes, each set of orthoses were prescribed based on biomechanical issues of the feet and the accompanying MSK symptoms. Both needed to be present for inclusion in the study.

    The orthoses were fabricated from a 3D cast of the foot taking into account each subject's body mass, natural arch characteristics and forefoot-to-rearfoot flexibility.

    As for experience - 18 years and counting.
     
  23. PodAus

    PodAus Active Member

    Any other parameters? Any other details relating to the specific individual design?

    This is where we often find an enormous disparity in Functional Orthotic prescription between Practitioners, which negates firm evidence in the the 'custom cast orthoses' v 'OTC' studies.

    (Not to say this is the case here though. Just interested at learning more...)

    Cheers,

    Paul Dowie
     
  24. Griff

    Griff Moderator

    Hi Leslie,

    This looks like an interesting study - any chance you could post up a pdf of the whole article for those of us who dont have JAPMA subscription?

    Thanks in advance

    Ian
     
  25. :D

    Is there another way to cast ?

    Sorry.

    This abstract demonstrates the need for reading a study carefully.

    Craig said

    I wondered this as well, so i had a quick scan through it over my ham sandwich.

    I quote from the study


    "
    Its our good friend Ed again. So not like the other studies because the "custom" was completely different to the ones used in the other studies?

    I always get suspicious when the controll group shows NO significant improvement! Especially when other studies have shown that they DO!

    So what was the pre fab used?

    Wow. A whole 4 mm of foam. Did it even have a valgus filler? Can this really be said to be representative of pre fabs? In context of comparison to "custom"? I think not! If i was looking for an OTC alternative to a polyprop cast i would not be using flat squidgy foam!

    Credit to them they did say:-
    So 4mm foam stops the custom insole working ?!:confused::wacko: That seems a bit odd to me

    They also stated

    I just glanced over the thing quickly but i spotted more than a few methodological flaws here! I'm sure a more careful read would provide many more but i'm a bit busy at the mo. Anyone else want a go?

    Regards
    Robert

    PS
    Its probably not my place to say this but i'm surprised that this got past the peer review process! Comparing a 4mm open cell foam insole to a custom casted calling it a "typical pre fab" seems more than a bit cheeky to this humble reader!
     
    Last edited: Oct 3, 2008
  26. I too should welcome a copy of this paper, from the abstract alone a number of issues arise, for example:

    "42 participants wore custom orthoses and prefabricated inserts in their regular footwear for 4 weeks each, consecutively. Twenty-seven participants received prefabricated inserts first and 13 received custom orthoses first."

    I'm no mathematical genius, but I do know that 27 + 13 = 40 not 42 as stated.

    "A numeric pain rating scale (possible score, 0–10) was used to measure participant pain."

    Pain from what? I guess the answer is in the full text, but who suffered what kind of pain and to which group were they assigned? Would it effect the outcomes if all those who received the custom orthoses first had pain associated with plantar fasciitis, while those who received the "prefabricated" devices first all had pain associated with peroneal tendonitis? Just how random were the randomized groups?

    From the results it seems that the custom orthoses only worked if they were given to the patient first, why should this be? This is to me the most interesting part of this study. Perhaps this is due to some sort of nocebo effect whereby the patients had received the flat foam first, lost any belief that the insoles would help and so didn't?

    Perhaps another way of looking at it is that overall the custom devices only worked in 13 of the 40 participants, about 1/3. Would we expect a one in three success rate from a placebo?

    Statistical power?
     
    Last edited: Oct 4, 2008
  27. admin

    admin Administrator Staff Member

    Changes in Gait Economy Between Full-Contact Custom-made Foot Orthoses and Prefabricated Inserts in Patients with Musculoskeletal Pain
    A Randomized Clinical Trial

    Leslie C. Trotter and Michael Raymond Pierrynowski
    Journal of the American Podiatric Medical Association; Volume 98 Number 6 429-435 2008
     
  28. admin

    admin Administrator Staff Member

    This thread has been substantially edited and posts removed - they were getting personal, so lets start again. Please keep discussion to the topic of the research projects (theroy debates can be debated in other threads; personal attacks are not welcome anywhere).
     
  29. Glad this one made it back into the world:drinks. It was too useful a resource to lose.
     
  30. Just had a look see.

    Like Dr Trotter's pre mentioned paper this one compares the MASS orthotics to 4mm flat foam. this time using gait economy as a measure. It could be argued that these latter cannot be properly described as "orthotics" or even "pre fabricated shoe inserts" (what is a non Pre fabricated shoe insert?!). She also mentions

    And i would dispute that these results can be comparable to those she references where more functional pre fabs are used.

    This aside though, i found this a significant and interesting study. Taken as a Placebo controlled trial for eg (yes i know there's no such thing as a "placebo" orthotic), it shows some interesting and good results. Also credit must be given for the honesty in reporting. The 4mm flat foam actually had the SAME initial effect as the insoles, but then the effect tailed off, this inconveniant truth was not shied from as one might have expected, but fully recognised.

    This perhaps, has interesting implications in consideration of Kevin's "spikeorthotic" model.

    Here is a question. If Leslie is lurking i would honestly like to know her thoughts as i'm sure she has mulled on this. By what mechanism did the 4mm foam inserts affect the gait parameters measured?

    Kind regards
    Robert
     
  31. Surface stiffness. May explain why change was lost with time as the foam bottomed out.
     
  32. Ah so.

    Be interesting to see what happened if you put in a new piece of foam. Or indeed poron which is supposed to be bottom out proof for a few years!
     
  33. Why not try it, you could use various 4mm thick foams of different stiffness. Not sure how they measured the path length variable was it 2D or 3D?
     
  34. joejared

    joejared Active Member


    Let me add another mine to the already overly populated minefield on this topic. I'm thinking that there is often confusion in how to bill devices, and in particular, how to bill a 'modified' prefab. I regret one change I made years ago, giving my customers the ability to manipulate rearfoot and forefoot widths and lengths of the device and adding a few other features that allowed orders to be templated, or effectively, prefabed with little effort. Insurance claims and modified prefab orthotics I see as a dangerous territory but fortunately there's a good deal of distance between me and an actual podiatrist in most cases. I personally think if possible there should be communication with the podiatrist purching a product from a lab when extreme measures are taken to fill an order, and especially, a custom prescription order. Another question that comes to mind in this area is how many might consider an orthotic that was produced without real 3 dimensional data, either by way of a cast or a 3D scan of a cast?

    Okay, that's enough mines for me. I'll go hide in a bunker somewhere. ;-)
     
  35. ptpatroller

    ptpatroller Member

    does anyone have this article? could they email it to me or any others that contain information about this topic?
     
  36. Steve The Footman

    Steve The Footman Active Member

    That is a good question about billing. Most health funds think that modified prefab are not at the same level as a casted orthotic. More effort can be put into a modified prefab then a casted orthotic and they could arguably be just as functional a device. A non modified prefab on he otherhand really is not worth much more than their cost. We charge about twice as much for a casted device as a modified prefab but in the rare occasions that we use a non modified prefab it is about a fifth of the cost of a casted device.

    With the respect to the second question you could heat mold the prefab and reinforce the new shape and this is a form of 3D capture. Craig has a strong opinion on the value of heat molding.;)
     
  37. jerseynurse

    jerseynurse Member

    The real question is not whether prefabs or customs are better but why so many orthotics (custom or prefab) are neatly living in patient's underwear drawers because they don't give them pain relief for the problems they got them for in the first place or they cause other strains to other body areas ie back, knees so they are unwearable or they don't fit in enough shoes to make them worn enough hours to make a difference. A custom device that lasts 20 years is worthless if it isn't able to be worn.
     
  38. Charlie Baycroft

    Charlie Baycroft Active Member

    Orthotics that do not fit the shoes, are too uncomfortable to wear, don't fix the problem or cause other problems are more common than a lot of people would like to acknowledge.
    The problem is not the diagnostic and technical skills of the people that prescribe and make the devices but the hypothesis and model on which this diagnosis, prescription and fabrication are based.
    When someone stands on a flat surface what would you expect their foot to do except pronate in an attempt to adapt itself to that surface. The majority of people are normal and have normal, healthy anatomy well suited to providing fitness for locomotion and survival in the natural environment of Homo Sapiens. Unfortunately, we don't live there any more and now have to walk on paved surfaces and in footwear that create adaptive stress in the body. When the resilience of these structures is insufficient to withstand the loading imposed on them they hurt.
    Current research clearly indicates that orthotics do not predictably alter kinematics but people are still prescribing them as though they can predictably "control" excessive pronation resulting from "structural deformities" in the lower extremity. These "deformities" are just the way normal people are made.
    Orthotics do alter kinetics or moments of force acting on structures on the body and making any random change under the foot is very likely to alter kinetics enough to shift some loading off of the overstressed structure and reduce pain. Altering moments of forces changes the tension in tissues and therefore changes the stimulation of mechanoreceptors. This changes the neuromotor function of the lower extremity in ways that need more investigation.
    Logic and reason would incline a thinking clinician to make his/her best effort to make the surface under the foot as "normal" ie, natural as possible so that it is more compatible with our structure and physiology than the flat hard surfaces we have to walk on today. Habit and scientific disinterest perpetuate the prescription of expensive devices by an illogical hypothesis (that the majority of normal people have deformed lower extremities) and an invalid model (Biomechanics and kinematic control).
    Clinically prescribing orthotics on the basis that they will control motion that they do not control because someone who did not know any better taught it to you is illogical and possibly dishonest and unethical.
    There are ways in which one can clinically assess the function of the lower extremity and I have documented them in the 6 tests of the system that I recommend for fitting and adjusting Formthotics (which, by the way, were designed with the sole intention of creating a more natural surface under the foot).
    If anyone is interested to look, the information is on the Internet at
    HTML:
    http://medical.formthotics.com or by clicking the Formthotics System logo on the homepage at [HTML]www.formthotics.co.nz
    . These tests relate to foot posture, body alignment, resistance to efficient locomotion (which overstresses muscles and their attachments and tendons) and also balance, forefoot postue and stability for propulsion.
    Yes, here are definitely patients with congenital or acquired deformities in their feet and the eventual effects of having to adapt to unnatural modern surfaces and footwear are deformities and disability. In such cases a strong, custom prescribed device is probably essential.
    However, for the majority of people under the normal part of the distribution curve with common lower extremity conditions using a comfortable resilient device, custom formed to the wearers foot and shoe and adjusted to improve posture, reduce resistance to supination, enable the windlass mechanism and to improve balance and forefoot stability seems to be sensible and can be relied upon to provide patient satisfaction.
    In selecting the product to use, you should be aware that prefabs made by the common insole manufacturing process of heat (150 C+) and compression of the material (50+ KG per sqcm) are theoretically re-moldable under these factory conditions but are unlikely to custom form to the patients foot and the internal environment of the shoe. This is because the manufacturing process irreversibly alters the chemistry and cellular structure of the materal. Products that are made by the more exacting and expensive process of milling and from materials that are able to be thermoformed to a new shape at temperatures below 100 C provide consistent good results and not end up in the bottom of the patients sock drawer.
     
  39. joejared

    joejared Active Member

    Funny you should mention that. I'm in the process of adding specific features to my own product, and one of those features is an insole scan, to match the orthotic to the foot and th e shoe. When the lab or doctor scans, they select a type of object to scan 0=cast,1=biofoam,2=foot,3=positive,4=insole

    In this way, without the shoes ever leaving the patient's possession, the insole of the shoe and patient's foot go to a laboratory for processing. More important, however, than matching the shoe is matching the foot, as far as I'm concerned. A patient can always get the correct size shoe, or as often occurs, the podiatric professional can always grind (belt sand) the product's perimeter to size where warranted. I'm hoping to eliminate the latter step.

    Whoops. You lost me on this word, hypothesis, which implies less of a basis in fact than theory, and actual research supporting said theory(s). I'm assuming that a good deal of effort is put into the education a practioner is required to have, and would hate to be the one that just said what they do is all wrong. While my only 'education' is that of electronics, I have to respect the knowledge that my customers, who are both lab owners and podiatrists have, and lean heavily on their experience and expertise.

    From much of your website images and 'sizes', I'm assuming you sell prefabs and modify them, probably remolding them with a heat gun or oven and pressure. Granted, this is only a theory, but to say that prefabs are better than orthoses made by competent podiatric professionals is laughable at best. A prefab may be of benefit to a patient, but it's not my business to decide that. It's the practitioner, and has its basis being the patient he or she is working with right there to work with and that tumor between their auditory receptors with which to make that assessment.
     
    Last edited: Dec 21, 2008
  40. Charlie Baycroft

    Charlie Baycroft Active Member

    http://medical.formthotics.com

    Yup, it's just theory, speculation, hypothesis and best guess. If you go and read the medical literature on our website you may be dismayed to discover that expensive hard custom foot orthoses do not "correct structural deformities of the foot and control excessive pronation at all". The effects of orthotic devices are not systematic or predictable in any way and there is no evidence to support the contention that custom devices made on 3D models of the foot are more efficatious than off the shelf insoles of various types.

    I am just a MD who specialized in Musculoskeletal medicine and sports medicine and has been involved in using and studying orthotics for 30 years. I do read a lot.

    If you correspond with Craig Payne, Kevin Kirby or any knowledgable academic Podiatrist they will tell you that the kinematic theory of orthotic function is invalid. The problem is that too many practitioners and orthotic manufacturers don't like the literature and ignore it on the assumption that it applies to other people and not them.

    Think about it rationally.
    1. How can evolution, which preserves traits that provide fitness for survival (read locomotion and mobility) result in the majority of the dominant species on our planet having lower extremity structures that are functionally defective and need expensive plastic insoles to work poperly?
    2. How can a 3D model be superior to a real foot? If you applied this to your sexual practices you would be despised, ridiculed and called a pervert.
    3. How can wearing a rigid lump of plastic in your shoes be considered natural or healthy?
    4. Is the human body really just a passive mechanical system that can be "controlled" by a little wedge under the foot. Read about the 6 determinants of gait.
    5. Why is Podiatry and orthotics the only area of medicine that has not abandoned a mechanical basis for understanding function in favor of a neuromotor or biochemical one?
    6. What happens to the relevence of posting when a person walks on surfaces that are not level, flat and horizontal. People mostly walk outside on inclined pavements, what are the orthotics doing then? (ooops wrong prescription).
    7. What sense does a theory that the majority of people have abnormal feet and legs make? Why aren't the other parts of their body abnormal as well?
    8. Is the analogy between foot orthoses and eyeglasses sensible or valid? Do we see with our feet or walk on our eyes? Is this just convenient way of justifying the price of custom orthotics?
    9. The genes that determine the structure of our body are almost 2M years old. Is excessive pronation a consequence of poor structural genes or are our feet just trying to adapt to modern footwear and walking surfaces (pavements) that are completely unnatural and have only been present during the last 200 years?
    10. If the STJ is meant to function in the neutral position how come there is so much available movement and it so does not want to stay in this position?
    11. If the clinician takes the cast and measurements and the lab makes the devices on an altered facsimile of the patient's foot, what validates the assumption that the patient will get any improvement of function?
    12. Pain/discomfort is our body telling us that something is wrong. Why are patient's told to ignore this and perservere for months making their body get used to inserts that feel uncomfortable? Is there any logic or understanding of human physiology associated with such advice?
    13. How cum 85% of people have normal hearts, lungs, eyes, ears, etc but structurally deformed feet and legs? Who thinks this stuff up anyway?

    Taking a cast of the foot and some measurements in one position and getting someone at a remote site to make foot orthoses is like getting measured for custom tailored pants that only fit when you are standing in one position. When you bend over you will probaly rip the seat of them. Are these trousers better than off the rack ones that let my body move naturally?

    I am not saying any one product is superior to another. All have their advantages and disadvantages.

    I consider a foot orthosis to consist of a shell that is custom thermoformed to the sole of the foot in a desirable posture (there is no validation for it to have to be the NSTP) and some wedges that will have a beneficial effect on function (otherwise why use them?). The literature strongly suggestes that a total contact shell is as good or potentially better than one made on a modified cast but then if the material is rock hard people cannot tolerate a total contact shell.

    The term "prefabricated foot orthosis" is an oxymoron. An orthosis should refer to a custom made product that fits the individual shape of the person's body and improves its function in some way. A pair of insoles in a bag is a pair of insoles. Most of these "prefabs" are made by the same process as normal insoles. A sheet of EVA is heated to over 150C and then compressed into shape in a huge press at about 50KG per sqcm (sorry for the metrics). Then they say they are re-mouldable. But they forgot to say remouldable in the Asian factory that made them. This heat-compression process destroys the cellular structure of the material and irreversibly alters the chemistry. Thers products are just insoles that will fit pretty well to an average shaped foot (average actually applies to a lot of people though) and can have some wedges added. If the foot is pretty average then these products can work very well.

    Our company is providing a new hypothesis, model and method for understanding and providing patients with foot orthoses and a product, which is milled to shape instead of compressed and can be thermoformed to both the foot and the shoe in the clinicians office. We call this the Formthotics Medical System. It is based on the paradigm that people are OK but our modern environment is unnatural, abnormal and induces the feet to adopt a pronated posture to adapt to it. So we are seeking to improve function of the foot and leg by putting a more natural interface between the normal foot and the abnormal environment (pavement and shoe).
    The model used is an adaptation of Panjabi's one that is universally accepted and preferred to a mechanical model in musculoskeletal and physical medicine. The papers are on the website.
    The method consists of a functional assessment (6 tests) that relate to posture, alignment, balance and postural stability and the resistance to efficient progression from midstance to propulsion (supination resistance and windlass establishment). I made the tests simple and clinical on pupose so that people do not have to buy any expensive "technology" (which is mostly just marketing and illusion anyway) to assess the function of the lower extremity.
    The devices are fitted and modified on the basis that people adapt individually to changes of the surface under the foot (adaptation takes up to 72 hours). Repeating the assessment indicates to and reassures the patient and the clinician that function is being improved. Do Something! Feel something! Hear Something! The focus is on making changes that feel good to the patients (how unusual?).
    The material that the Formthotics are made of is resilient yet soft enough for the foot to alter it to accommodate dynamic as well as static situations. No, it does not collapse under the arch.

    If fitted and adjusted in this way, Formthotics provide a really good "interim" or "temporary" device and a model for the harder custom device that the therapist and doctor may agree to progress to.

    Please drop me a line if this interests you.

    fsicmb@attglobal.net

    Have a Merry Christmas and a fantastic New Year.

    Charlie
     
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