Welcome to the Podiatry Arena forums

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, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Extrinsic rearfoot posts- history?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Simon Spooner, Apr 12, 2011.

  1. Members do not see these Ads. Sign Up.
    All, I'm interested to learn of the history of adding a rearfoot post to foot orthoses. Who was the first to describe this addition to the orthosis shell- Root? Also, I recall from my reading somewhere in the past that originally Root didn't add the rearfoot post to the device at dispensation, rather he waited a couple of weeks before applying it- where did I read this? And what was his rationale? From the same source, I recall that Root added a layer of vitrathene between the shoe and the orthosis- I'm sure I didn't dream-up these ideas of Root's methods.... Anyone?
  2. efuller

    efuller MVP

    I don't know who was first to describe. However, the protocol you describe was used at CCPM in 1985-7 by some instructors. I remember for sure that Chris Smith did it that way. As I recall the rationalle was to wait and see if the device controlled pronation sufficiently and that the rearfoot post for additional pronation control. It might be in the course sylabus from the class, which I just happened to have moved to a shelf that I can reach easily. I'll try and look it up tonight.

    Another story that Chris Smith told about the rearfoot post was that initially everything was flat posted and they noticed that with a flat post people were getting sinus tarsi pain. It was attributed to prevention of motion. That is when they started to add the 4 degree of "motion" bevel. I think this is another case of good modification/ bad explanation. It can be explained by a flat rearfoot post shifting pressure laterally at contact in gait. That would increase pronation velocity and be more likely to cause sinus tarsi pain. The 4 degree bevel would decrease the lateral shift at heel contact.

    Mert Root wrote a paper for clinics in podiatry in the 1990's. The rationale might be there as well. I'll see if I can dig up my copy of that as well.

    I don't recall anyone from CCPM ever adding anything between the orthotic and the shoe except for posts.


    STEVE LEVITZ Active Member

    Percy Roberts MD
    I think 1911 NYMJ Roberts Brace/Roberts with inverted heel cup and extrinsic medial heel wedge
  4. From what I remember, either John Weed or Tom Sgarlato had a friend or relative who was a dentist who introduced them to dental acrylic to use on Rohadur orthosis for rearfoot posts. I believe this was in the late 1960s or early 1970s, before my time there. As Eric said, when I was a podiatry student, the patients had rearfoot posts all added about 2-3 weeks later to the orthosis after initial Rohadur orthosis plate dispensing. We stopped doing that during my Biomechanics Fellowship in order to save the patients an extra office visit since I felt this 2-stage orthosis dispensing process was unneccesary.
  5. Alex Adam

    Alex Adam Active Member

    Having studied in the early 80's Weed and Sgarlato implied that as the rear foot makes contact after swing phase the subtalar joint positions itself at a postion that is slightly inverted, the inital 4 degrees allows the calcaneous to be placed in a 4 degree position to the perpendicular, then allows 4 degrees of motion to bring the forefoot to contact at foot flat. The posting reduces the stress in the anterior muscle group in there deacceleration phase.
    The principle of a balanced forefoot is critical at this point.
    If there is significant rearfoot varus, greater than 8 degrees the lateral bevel can be at 6 degrees with 4 degrees of motion with a further tip post of 2 degrees however the later may not be necessary if the midtarsal joint is stable.

    STEVE LEVITZ Active Member

    Sorry for the Incorrect refference
    The Influence of the os calcis on the production and correction of valgus deformities of the foot
    Percy Willard Roberts MD New York
    JBJS s 2-13(12):720 1916

    Attached Files:

  7. Steve, thanks for this. After scanning the text, I'm not sure whether this device had an extrinsic or intrinsic rearfoot post?

    Further, figure 2 is interesting assuming the inferior surface of the calcaneus is basically are segment of a spherical surface- anterior axial projection- Kirby, suggests otherwise.
  8. Alex Adam

    Alex Adam Active Member

    Poor assumption, any anatomist will tell you the inferior aspect of the calcaneous has two tubicles and so can't be related to any part of a sphere.
  9. Here is an anterior axial projection of a foot from our study from 26 years ago showing the frontal plane angulation of the larger medial calcaneal tubercle relatively to the smaller lateral calcaneal tubercle (Kirby KA, Loendorf AJ, Gregorio R: Anterior axial projection of the foot. JAPMA, 78: 159-170, 1988).

    I have also attached a 3D CT scan that Josh Gerbert, DPM, sent me when he and his coworkers did their paper on the anterior axial view a few years ago (Clark JR, Gerbert J, Jenkin WM: The Kirby view: A radiographic view for flatfoot evaluation. JFAS, 43:436-439, 2004.)

    Attached Files:

  10. Ray Anthony

    Ray Anthony Active Member


    I believe you'll find some of the information on the development of the rearfoot post in: Root, M.L.: How was the Root functional orthosis developed? Perspectives in Podiatry. Podiatry Arts Labs, Inc. Newsletter, Fall, 1981. Unfortunately, I don't have a copy.

    Kind regards,

  11. Ray:

    Welcome to Podiatry Arena.:welcome:

    Hope all is well and hope to see you contributing frequently here as time allows.

    For old time sakes, here is a photo of us from August 1999.

    Attached Files:


Share This Page