Quadrastep Foot Typing Orthotic System

So if my range of devices included 5 devices:

1. designed to increase external STJ pronation moment a lot
2. designed to increase external STJ pronation moment a bit
3. designed to provide increase shock attenuation
4. designed to decrease external dorsiflexion moment on the 1st metatarsal
5. designed to increase external STJ supination moment a bit

How would you design these devices? It's a rhetoric question really.

So if we had a list of the design features of any range of prefabs, we can interpret what those design features might achieve in biomechanical terms for some of the people, some of the time.

If Greg lists the design features of the Quadrastep devices here, we can provide a translation. That way those not interested in foot-typing but interested in applying foot orthosis therapy can select the device which may be best for a specific client.

It comes back to the clinician being able to identify the goals of orthotic therapy for a specific patient and then understanding how and which design parameters should be best to meet those aims.

 

Which was Roberts point (and a good one) and I started once writing a list of prefabs and what features I would like to see and when they might be used but stopped.

I agree that it comes back to clinician and if we sat down with 10 different people we might get 10 different reasons, but my point is rather than make it more simple is it not better to instruct and educate, like you have done with me and to many others on here.

That would be great

 

Hi Greg, I would use Simons device anytime I want to increase the STJ Supination moment from the Orthotic reaction force, in conditions such as Tibialis anterior overuse, Posterior tibial tendon disorder,and would not use it when I wanted to create a STJ pronation moment in conditions such as Peroneal brevis overuse, chronic lateral ankle sprains.

 

Carl Rogers http://www.infed.org/thinkers/et-rogers.htm

 

What a great quote.....

 

Sorry for the delay in posting a response. Have just returned from the pub having watched the Spanish beat Portugal. Good idea about discussing features of models and may help others to make informed choices. I would be interested in any comments. I will post them when I return to the office.

Thanks to all for now.

 

I'm sure there was a thread which mentioned the quadrastep system before and I think it may have been me(I could be wrong) that used the phrase "biomechanics painting by numbers".

Although this sounds rather derogatory, I think what it refers to is what Greg is saying. The majority of practitioners using this forum have no requirement for painting by numbers type of art. They are likely to use principles of design as described by Mike. However, the average practitioner does not have this knowledge and probabaly has a limited desire to learn this knowledge. These are the people for whom painting by numbers creates better results by following "instructions" as opposed to doing it freehand

I can't paint and the only thing I am capable of drawing is a shoe. If I wanted to paint a landscape that I could feasibly put into a frame, I would get a far superior result by doing painting by numbers. If I went to some classes, that may change but it is not that important to me, so I won't be going to any classes. I would guess there are plenty of practitioners feel the same way about biomechanics. They get good enough results from using "follow the instructions" biomechanics, so why change.

This is the market to which the quadrastep will appeal. Like the Somnio running trainer(discussed on other threads), having more customisation has got to be better than none and this set of prefabs offers more possibilties than others. I don't like the system for some of the shortcomings already mentioned but it has a place and I wouldn't rule out using it if the pathology and related tissue stress warranted it. I wouldn't use it as a "cure all" system.

My 2p

Robin

 

As promised here are the features that are incorporated into the Quadrastep models.

Model A:
5° Intrinsic Medial RF Posting
4° Extrinsic biaxial Lateral FF Posting
1st Ray channel and full cutout
5th ray channel
0.125” Equinus heel lift
Deep heel cup with lateral heel clip
Flexible Shell

Model B:
3° Intrinsic Medial RF Posting
3° Intrinsic Lateral FF Posting
Standard heel cup Depth
Semi-Rigid Shell

Model C:
5° Intrinsic Medial RF Posting
No FF Posting
Normal heel cup Depth
Semi-Flexible Shell

Model D:
Medial Arch Flare & Flange
3° Extrinsic Medial RF Posting
Deep Lateral Column Relief
Cuboid Support
Moderate Medial Skive
No FF Posting
Deep Heel Cup
Rigid Shell

Model E:
Medial Arch Flare
5° Combined Intrinsic & Extrinsic Medial RF Posting Moderate Medial Skive
5° Combined Intrinsic and Extrinsic FF Posting
5th Ray Channel and Cutout
Partial 1st Metatarsal Head Relief
Standard Heel Cup
Semi-Rigid Shell

Model F:
Medial Arch Flare & Flange
3° Extrinsic Medial RF Posting
Large Medial Skive
7° Combined Intrinsic and Extrinsic medial FF Posting
1st Ray Channel and Cutout
Deep Heel Cup
Rigid Shell

 

OK, I'm going to put myself out here for some potential drubbing - and I'll like it mind you - since I have been working with these for about a 12-15 months now.

First off let me say that I also fabricate my own customs and spend a great deal of time working out what the root cause of the problem / pain is and then allow that to drive how my device is designed.

However - let the jeering begin - I like the Q24 inserts and here is why:
˚As a prefabricated / OTC device they are a time saver for me with patients that have not been prescribed a custom foot orthosis. They have many add-on mod's built in that I would otherwise have to spend time and materials to create. It is a time / $ thing but that said, if I (i make the decision with input form the patient) decide it is not a quality fit or doesn't meet all the needs I want, I will contact the prescribing doc and discuss moving to a different OTC insert or up to a custom.
˚For many patients, since their insurance won't cover a custom device, these allow me to get them in a much more aggressive OTC without breaking their bank.
˚For many of my younger patients (elementary - middle school (k-8th here in the states)) these are a $ saver for the parent since we may be refitting numerous times over the childs years in them.

As far as the fitting criteria goes, I've tweaked it and use my biomechanical eval to develop a criteria for the necessary modifications and then work backwards into the device that has those built into it.

The material itself is a PU and, yes, it's hard to get anything to stick to it.

As far as the 6 types go, I've used the A, F and E most often and the patients I've fitted in them have been very pleased and more comfortable than prior to wearing them when we've conducted follow ups.

I think that one of the important things to remember about these is that they are prefabs and are what they are. Will they work for some people? Yes. Will they work for eveyone? No. Are they intended to replace a custom device when necessary? I don't believe so. And Roberta and her group at In Stride make some very nice custom devices.

So. There's my 2 cents - fwiw - from someone that has hands on with them.

:sinking:

Stephen

 

Quality improvement study into the effectiveness of the semi-custom, prefabricated shoe insert program (Quadrastep System) at reducing complaints of discomfort in an industrial setting.
Jeffrey Dow, RPT, CEASIII, Pauline Lewis, MS, CPE
Proceedings of the Human Factors and Ergonomics Society Annual Meeting November 12, 2021

 

Interesting. More and more labs are now incorporating the medial column wedge that I introduced in my 2002 patent.
When I first introduced this concept (a wedge underneath the 1st metatarsal and hallux), my esteemed colleagues erupted (like a volcano), stating this insole would destroy the function of the 1st MPJ. We now know that isn't true.
So, how do I feel about other labs using my research without citing it, I am very pleased that so many people are being helped as a result of my published research.
Nolaro, keep up the good work!