Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
Our alert system missed this orginally, but it was granted in July:
Foot Typing Method
Quote:
A method for classifying foot types by measuring the position of the Rearfoot Supinatory End Range of Motion, the Rearfoot Pronatory End Range of Motion, the Forefoot Supinatory End Range of Motion and the Forefoot Pronatory End Range of Motion, and classifying the foot based on the results of these measurements is disclosed. Once a human foot is classified and typed according to the disclosed method, a treatment plan can be customized for the specific foot type. The treatment can include the use of pre-orthotic pads and orthotic inserts which are customized according to a patient's specific foot type.
Quote:
SUMMARY OF THE INVENTION
[0008]The present invention is directed to a method for classifying a human foot into a distinct foot type based on positional measurements in the Rearfoot and Forefoot of a foot. The Rearfoot positional measurements include the Rearfoot Supinatory End Range of Motion and the Rearfoot Pronatory End Range of Motion, while the Forefoot positional measurements include the Forefoot Supinatory End Range of Motion and the Forefoot Pronatory End Range of Motion. Once a practitioner determines these measurements based on the present invention, every foot can be classified into a specific foot type. A Rearfoot type is determined according to the two Rearfoot measurements, and, a Forefoot type is determined according to the two Forefoot measurements. Together, the Rearfoot and Forefoot measurements comprise a Functional Foot Type according to an embodiment of the present invention.
[0009]Another aspect of the present invention involves the treatment of pedal and postural conditions based on patients' Functional Foot Types. Because certain conditions can be predicted and diagnosed based on an individuals Functional Foot Type, treatments including pre-orthotic foot pads and orthotic inserts can be customized based on the Functional Foot Type. Accordingly, the present invention also includes Functional Foot Type-specific pre-orthotic pads, and orthotic inserts that are casted and/or posted according to Functional Foot Type-specific guidelines.
Quote:
DETAILED DESCRIPTION OF THE INVENTION
[0020]A fundamental basis of the present invention is premised in the understanding that the human foot contains three distinct dynamic arches, the medial longitudinal arch, the lateral longitudinal arch and the transverse midfoot arch. When discussing the anatomy of human feet certain bony prominences that, when weighted, touch the ground surface and give every foot the potential to lock into a supportive arched configuration needed to insure a lifetime of healthy performance. According to the present invention, these foundational surfaces are known as pillars. The hollow that is created on the plantar surface of the foot by the bones of the three dynamic arches that are not touching the ground surface is known as the Vault of the foot.
[0021]When defining the Vault longitudinally from heel to toe, the Talus bone can be viewed as the "keystone" of both the lateral longitudinal arch and the medial longitudinal arch, but is centered in neither. The medial longitudinal arch is located on the outside of the big toe side of the foot and has two pillars. The posterior pillar is the short pillar, and contains only one bone, the Calcaneous. The anterior pillar of the medial arch contains six bones, the Navicular, the medical medial Cuneiform, the intermediate Cuneiform, and the first, second and third Metatarsals.
[0022]The lateral longitudinal arch is located on the outside of the smallest toe, and similarly has posterior and anterior pillars. The posterior pillar of the lateral arch is the shorter of the two, and is comprised of the Talus and the posterior two-thirds of the Calcaneus. The anterior pillar is comprised of the anterior one-third of the Calcaneous, the Cuboid and the fourth and fifth Metatarsals.
[0023]The transverse midfoot arch, located transversally at the level of Midfoot, is represented by the Cuneiforms and the Cuboid. The Middle Cuneiform is the "keystone" of this arch, and is not centered.
[0024]In each of these arches and the joints that comprise the arch, tendons, ligaments and soft tissue capsules provide support, leverage and flexibility in varied proportions depending on the specific task. If any of the three arches fail to deliver the necessary combination of support and flexibility needed for various tasks such as stance, gait, side to side movement and sports function, conditions including deformity, pain and overuse syndromes of the foot and postural breakdown of the foot can occur.
[0025]When examining a human foot as a whole from heel to toe, the midtarsal joint can be viewed as a keystone joint of one large arch. It separates the foot into two distinct segments or pillars, the Rearfoot, located proximal (behind) to the Midtarsal joint, and the Forefoot, located distal (forward) to the Midtarsal joint.
[0026]The three dynamic arches of the foot must have the ability to adapt to different foundational surfaces and further to assist in functions such as seated support, standing support and walking or running. Ideally, the dynamic arches of the foot change from a rigid lever (support) into a functional adaptor (movement) at precisely the right moment as we stand, walk or exercise so as not to create degeneration, deformity or overuse in the feet and posture.
[0027]In reality, when it comes to profiling feet, some feet are excellent rigid levers and some feet are excellent functional adaptors and many lie in between these two extremes. More specifically, some feet have a Rearfoot that is an excellent rigid lever and some feet have a Rearfoot that is an excellent functional adaptor and many lie in between these two extremes. In addition, some feet have a Forefoot that is an excellent rigid lever and some feet have a Forefoot that is an excellent functional adaptor and many lie in between these two extremes. It is theorized that every functional foot type, for one reason or another, is flawed either as a rigid lever or a functional adaptor, or both, especially when impacted by additional factors such as a body weight, activity level, body type and health state. This pathology, unless compensated, predicts a foot type specific set of deformities, degenerative changes, overuse syndromes and quality of life issues. Once profiled and diagnosed for foot type according to one embodiment of the present invention, functional foot type specific treatment can be introduced in order to prevent, eliminate or reduce these problems from downgrading our quality of life over time.
[0028]Accordingly, one embodiment of the present invention relates to a foot typing method based upon two positional measurements of the Rearfoot, and two positional measurements of the Forefoot. The two rear foot measurements include the Rearfoot Supinatory End Range of Motion position, or "Rearfoot SERM", and the Rearfoot Pronatory End Range of Motion position, or "Rearfoot PERM". The two forefoot measurements are the Forefoot Supinatory End Range of Motion position or "Forefoot SERM", and the Forefoot Pronatory End Range of Motion position, or "Forefoot PERM".
[0029]The Rearfoot SERM position refers to the position the Rearfoot Joint assumes in open chain, i.e., when not weighted on the ground, with reference to a bisection of the lower one third of the leg after applying a strong inversion force upon the Calcaneus until it can no longer move. This is performed by inverting the foot so that it can no longer move, followed by determining whether the position is inverted or everted. If the Rearfoot Joint is tilted toward the medial arch, the Rearfoot SERM position is inverted. If the Rearfoot Joint is tilted toward the lateral arch, the Rearfoot SERM position is everted
[0030]The Rearfoot PERM position refers to the position that the Subtalar Joint assumes in open chain with reference to a bisection of the lower one third of the leg after applying a strong eversion force upon the Calcaneous until it can no longer move. This is done by everting the foot until it can no longer move, followed by determining whether the position is inverted, vertical or everted. If the Subtalar Joint is tilted toward the medial column, the Rearfoot PERM position is inverted. If the Subtalar Joint is vertical to the ground, the Rearfoot PERM is perpendicular. And if the Subtalar Joint is tilted toward the medial arch, the Rearfoot PERM position is everted.
[0031]The Forefoot SERM position is the position the first metatarsal assumes in open chain with reference to the fifth metatarsal after applying a strong plantarflectory force downward upon the first metatarsal from above until it can no longer move. The lateral arch is stabilized and a downward force is applied upon the first metatarsal head from above until the first metatarsal cannot move any further in the downward direction. If the first metatarsal is positioned above the fifth metatarsal, the position is dorsiflexed. If the first metatarsal is positioned below the fifth metatarsal, the position is plantarflexed.
[0032]The Forefoot PERM position is the position the first metatarsal assumes in open chain with reference to the fifth metatarsal after applying a strong dorsiflectory force upward upon the first metatarsal from below until it can no longer move. If the first metatarsal is positioned above the fifth metatarsal, the position is dorsiflexed. If the first metatarsal is positioned level to the first metatarsal, the position is vertical. And if the first metatarsal is positioned below the fifth metatarsal, the position is plantarflexed.
[0033]After making the four diagnostic measurements, the recorded positions allow every foot to be classified into one of four Rearfoot types known as rigid, stable, flexible or flat, and one of four Forefoot types known as rigid, stable, flexible or flat.
[0034]The four Rearfoot types can be described as follows. A rigid rearfoot has an inverted Rearfoot SERM (FIG. 1) and an inverted Rearfoot PERM (FIG. 2). A stable rearfoot has an inverted Rearfoot SERM (FIG. 1) and a vertical Rearfoot PERM (FIG. 3). The flexible rearfoot has an inverted Rearfoot SERM (FIG. 1) and an everted Rearfoot PERM (FIG. 4). Finally, the flat rearfoot has an everted Rearfoot SERM (FIG. 5) and an everted Rearfoot PERM (FIG. 4).
[0035]The forefoot types are described in similar terms as the rearfoot, and are as follows. The rigid forefoot has a plantarflexed Forefoot SERM (FIG. 6) and a plantarflexed Forefoot PERM (FIG. 7). The stable forefoot has a plantarflexed Forefoot SERM (FIG. 6) and a vertical Forefoot PERM (FIG. 8). The flexible forefoot has a plantarflexed Forefoot SERM (FIG. 7) and a dorsiflexed Forefoot PERM (FIG. 9). Finally, the flat forefoot has a dorsiflexed Forefoot SERM (FIG. 10) and a dorsiflexed Forefoot PERM.
[0036]Accordingly, when the four Rearfoot types are plotted horizontally and the four Forefoot types are plotted vertically on a table, a matrix of 16 possible functional foot types are possible, as shown in Table 1.
[0037]Each Functional Foot Type of present invention is associated with a certain profile of features that define that functional foot type. These include open and closed chain presentation, forefoot lesion pattern, x-ray presentation, shoe wear pattern, foot deformities, foot pain and fatigue syndromes and postural pain, deformity and fatigue syndromes. Although more than one Functional Foot Type may share some characteristics, each Functional Foot Type has a profile of characteristics that are foot type specific. As a result, once a patient's foot has been typed and classified according to one embodiment of the present invention, a treatment plan that is foot type specific can be developed that has a higher level of success and a lower failure rate than utilizing previous systems. Functional Foot Type-specific treatment also enables practitioners to be more successful when it comes to prevention and performance issues.
[0038]The dynamic arches of the foot must be strong and supportive at certain times and functional and adaptive at others. This means that unlike an architectural arch, the dynamic arches of the foot, in order to perform, must sacrifice their ability to support in order to provide the flexibility and agility needed in order to stand, walk, work, etc. In the flexible and stable rearfoot and forefoot types it is the repetitive need for the foot to multitask over a lifetime and the inherent fact that the dynamic arches of the foot cannot become a rigid lever quickly enough after becoming flexible and adaptive when performing that creates pathology. One or more of the dynamic foot arches weaken and even collapse over time unless supported externally. In the rigid and flat rearfoot and forefoot types, it is the repetitive need for the foot to multitask over a lifetime and the inherent fact that the dynamic arches of the foot cannot become flexible and adaptive quickly enough after being stable that creates pathology. One or more of these arches need balancing to the ground and each other. Accordingly, a treatment plan according to the present invention is based on supporting and balancing the dynamic arches, wherein support is achieved through a technique called centring.
[0039]Centring of the foot is typically accomplished through the use of felt and foam pre-orthotic pads, and orthotic inserts. Pre-orthotic pads used in accordance with the present invention are called Functional Foot Type pads, and orthotic inserts used according to the present invention are called Functional Foot Type orthotics. Functional Foot Type pads are specific felt and foam pads that begin the centring process. They are placed onto a shoe insole, or directly into the shoe, in order to test for the effectiveness of a functional foot type orthotic for future use. Additionally, Functional Foot Type pads serve to buffer or dampen the foot and postural break-in that corrective orthotics force the body to endure. If Functional Foot Type pads provide a patient with pain and/or symptom relief, or improve gait and posture, then the patient should find increased and/or permanent advantages when using Functional Foot Type orthotics with less failure due to the body rejecting the break-in process. As such, Functional Foot Type pads are necessary but often temporary, and are replaced by an orthotic insert once the patient's custom Functional Foot Type orthotics are fabricated.
Functional Foot Type Treatment
[0040]The functional foot typing system of the present invention allows every foot, once typed to be treated foot type specific by creating a foot type specific custom centring device. Examples of centring devices for treatment include Functional Foot Type pads and Functional Foot Type orthotics.
[0041]Functional Foot Type Pads
[0042]Functional foot type pads are centring pads that are applied in one of three ways in order to begin the centring process. They can be applied to the inside of a shoe. They can be applied to a removable shoe insole that can then be moved from shoe to shoe or they can be applied to an existing foot orthotic in order to upgrade them as a centrum.
[0043]Functional Foot Type pads are applied foot type specific to the Rearfoot, medial longitudinal arch and the forefoot as follows:
(1) [0044]Rigid Rearfoot Types: Apply pre-orthotic half heel pads to force the foot in Varus (inverted) position [0045]Stable Rearfoot Types: No heel pad [0046]Flexible Rearfoot Types: Apply pre-orthotic half heel pads in Varus [0047]Flat Rearfoot Types: Apply pre-orthotic half heel pads in Valgus (everted) position(2) [0048]Apply pre-orthotic arch pads such that they sit underneath the highest point of the medial longitudinal arch to all Functional Foot Types(3) [0049]Rigid Forefoot Types: Apply the pre-orthotic wedged forefoot pad proximal to 2-5 Metatarsal heads in Valgus [0050]Stable Forefoot Types: Apply the pre-orthotic wedged forefoot pad proximal to 2-5 Metatarsal heads in Varus [0051]Flexible Forefoot Types: Apply a pre-orthotic wedged forefoot pad proximal to 2-5 Metatarsal heads in Varus [0052]Flat Forefoot Types: Apply the pre-orthotic wedged forefoot pad proximal to 1-4 Metatarsal heads in Varus
[0053]Functional Foot Type Orthotics
[0054]Foot orthotics of the prior art generally are simple and non-patient specific in regards to postings and other modifications. They are only very slightly arched, are long, wide and the shell is poorly posted and modified. In summary, they lack centring. Functional Foot Type orthotics according to the present invention, on the other hand, are advanced foot orthotics that have a shell (body) that is fabricated from a negative plaster or fiberglass cast which is positive poured and to which custom postings and modifications are prescribed utilizing foot type specific techniques of the present invention. The resulting orthotics has a higher arch and is shorter and narrower than foot orthotics of the prior art. In summary, they provide the Vault of the foot with more centring. In addition, the accompanying prescription that is generated by the practitioner contains custom modifications, postings and corrections to balance the shell foot type and patient specific since there are variations within each foot type.
[0055]Since Functional Foot Type orthotics of the present invention improve longitudinal and transverse splay and spread, they are shorter and narrower than other known orthotics. Since they fill the Vault of the foot better than any other orthotics, Functional Foot Type orthotics are taller and have a higher arch. In addition, they correct for hammertoe influence. They are always posted in both the rearfoot and the forefoot and they contain foot type specific forefoot and rearfoot modifications.
[0056]Casting Techniques for Functional Foot Type Orthotics
[0057]When casting a patient for Functional Foot Type orthotics, techniques of the present invention have been developed that when utilized foot type specific, create an orthotic shell that provides better centring.
[0058]These casting techniques include: [0059]1. Lateral Longitudinal Arch Correction. The practitioner places upward force under the fifth or fourth and fifth metatarsal heads stopping at a point when the rearfoot begins to be influenced. [0060]2. Rearfoot Serm-Perm Balancing. The practitioner moves the cast from an inverted position to vertical under the lower one third of the leg eliminating the need for varus rearfoot posting. [0061]3. Rearfoot Vault Enhancement. The practitioner grasps the back of the Calcaneus of the foot with the palm and the 2.sup.nd-5.sup.th fingers and then utilizing the thumb at the plantar surface of the Calcaneus exerts an upward force elevating the Calcaneus thereby expanding the rearfoot vault. [0062]4. Forefoot Vault Enhancement. The practitioner exerts a downward force at the top of the first metatarsal head until end range of motion. [0063]5. Hammertoe Correction. The practitioner places the second finger across the bases of the toes dorsally and exerts a downward force until the toes are seen to be on line with the metatarsal heads and not knuckled.
[0064]Accordingly, plaster or fiberglass casts are cast corrected according to the patient's specific Functional Foot Type, and Functional Foot Type orthotics of the present invention are constructed as follows:
(1) [0065]Rigid Rearfoot Types: Utilize standard "Root" neutral casting technique. [0066]Stable Rearfoot Types: Utilize Serm-Perm Balancing and Rearfoot vault enhancement techniques. [0067]Flexible Rearfoot Types: Utilize Serm-Perm Balancing and Rearfoot vault enhancement techniques. [0068]Flat Rearfoot Types: Utilize standard "Root" casting technique.(2) [0069]Apply the lateral longitudinal arch correction technique to all casts, regardless of functional foot type.(3) [0070]Rigid Forefoot Types: Utilize standard "Root" casting technique. [0071]Stable Forefoot Types: Utilize Forefoot Vault Enhancement technique. [0072]Flexible Forefoot Types: Utilize Forefoot Vault Enhancement technique. [0073]Flat Forefoot Types: Utilize standard "Root" technique.(4) [0074]Utilize Hammertoe Correction technique for all casts, regardless of functional foot type.
[0075]Functional Foot Type Orthotic Prescription Guidelines
[0076]A foot type specific and custom prescription accompanies the corrected negative cast corrected models to the laboratory. Once the foot centring shell has been fabricated, the laboratory adds balancing materials (Posts) to the back and front of the shell by prescription. In addition, prescribed modifications to the plastic shell in the form of cutouts allow for additional centring to the vault of the foot, depending upon the specific foot type.
[0077]The prescribing techniques are as follows: [0078]1. Rearfoot Posting. The use of angulated or vertical materials and lifts that balance the rearfoot to the weightbearing surface. Rearfoot posts can be Varus, flat (Vertical) or Valgus. [0079]2. Forefoot Posting. The use of angulated or vertical materials that balance the forefoot to the weightbearing surface. Forefoot posts can be posts can be Varus, flat (Vertical) or Valgus. [0080]3. Forefoot Ray Cutouts. Material is removed from the Functional Foot Type orthotic shell to allow specific metatarsals to drop, thus enhancing the centring of the forefoot vault by leveraging the muscles, tendons, ligaments and soft tissue.Prescription guidelines are ordered foot type specific as follows: [0081]Rigid Rearfoot Types: Utilize a Varus rearfoot post. Add additional lift to the rearfoot post as tolerable to the inside of the shoe to accommodate functional equinus. [0082]Stable Rearfoot Types: Utilize a flat (Vertical) rearfoot post. [0083]Flexible Rearfoot Types: Utilize a flat (Vertical) rearfoot post. [0084]Flat Rearfoot Types: Utilize a Valgus rearfoot post. [0085]Rigid Forefoot Types: Utilize a 1-4 Valgus forefoot post with a first ray cutout. [0086]Stable Forefoot Types: Utilize a 2-5 Varus forefoot post with a first ray cutout. [0087]Flexible Forefoot Types: Utilize a 2-5 Varus forefoot post with a first ray cutout. [0088]Flat Forefoot Types: Utilize a 1-5 Varus forefoot post.
Functional foot typing
Threaded Mode
