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Quadrastep Foot Typing Orthotic System

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Simon Spooner, Jun 25, 2010.

  1. Members do not see these Ads. Sign Up.
    I was delighted (yeah honest- not) to read the article in this months Podiatry Now regarding quadrastep rx 24. It read somewhat as an advertorial (I wonder how much was paid for it's inclusion), regardless, it referred to research demonstrating its most excellent efficaciousness. I wonder if anyone could point me toward this research, so that I may mock it (or bask in its glory)?

    PS I'm thinking of applying for a fellowship, but apparently first I need to find an existing fellow to support my application (existing fellow of a faculty that has only just been set up- hmm??? Or just an existing fellow??). What do you think my chances are- zero to very slim, I should imagine?

    No, for the 13th time- The wonderstuff.

    Heaven help the man that said,

    "Help me, I think I'm dead,

    but wait a while, I'm not completely sure."

    But then he didn't speak up

    so we laid him down, buried him 6ft underground,

    so what on earth did he think his mouth was for?

    Don't talk to him about life and death,

    we know a part but he knows the rest.

    Hat's off to the man that said he could,

    when he couldn't.

    But he didn't get away with it,

    never hurt anybody but his face did fit

    the frame in which he was set up.

    Running out of time, running out of luck.

    So what on earth did he think his mouth was for --- ?

    Don't talk to him about truth and lies,

    if he's 6ft tall he's half the size.

    And damn the man that said he was right, (I'm right)

    (not quite)

    Hairy arms and sweaty palms

    never had no trouble turning on the charms.

    Heaven help the man that said,

    "I know it's in my head,

    but wait a while, I'm not completely sure."

    But I know what's mine's me own,

    and what's your's is mine.

    And I'M telling you NO,

    no, for the 13th time
  2. Craig Payne

    Craig Payne Moderator

    Re: Quadrastep

    It just another one of those reductionist foot typing approaches. Like Dennis's Functional Foot Typing, the typing system behind the quadrastep system is also patented (discussed here in one of the Functional Foot Typing Threads).

    We all know who the reductionist approachs appeal too ....
  3. William Fowler

    William Fowler Active Member

    I just read the article and was going to come here and post about it!
    I would love to know what research they are claiming demonstrates this as well. Is this for real or are they making up the research like the barefoot runners?

    I do recall Craig discussing this system at one of the Boot Camps.
  4. I thought I'd picked up the daily mail by mistake!!

    "Scientists have proved." My arse! Whatever the merits of the system to publish it as "news" with an air of such certainty no author, no recognition that this is a sales pitch and no references is incredible!

    It's not April. I checked.

    Perhaps someone from talar made would like to comment on this infomercial. Know we of such a person?

    I feel a letter coming on!
  5. What's Talar Made's involvement, I thought it was Roberta Nole?

    I know Greg Quinn takes the opposing view in that he seems to believe that there is continuous variation exhibited in foot morphology, so this reductionist pigeon-holing doesn't seem to fit with his philosophy.

    Addressed to whom? The article was anonymous.
  6. I don't fully understand all the divisions within the company but I'm pretty sure Quadristep is a Talar made product.


    Page 20, bottom left corner.

    It seems to be aimed more at the orthotist market. I first heard of it when it was presented recently at a european Orthotists conference (I forget which one) and I beleive Greg spoke of it when he presented it at the IOCP AGM.

    Talar made sponsered Greg and Roberta Nole at the BAPO conference.

    I was surprised myself! I was very interested by Greg's presentation of the foot as a 4 point pivot and the use of the SNA angle (feiss line to the old school) as an assessment tool to fit with the talar made range. This seems a bit of a radical departure from that! I'd be interested in Gregs view on the system and how it compares to the SNA system as a tool for the Pod who needs a simplified system.
    Addressed to the editor! I have no problem with using journals to share opinions as well as research (obviously), but only if they are opinions advertised as such. And If you're going to say "new research has found" its kindof important to tell us which research.
  7. Got ya'. I like option c. a foot orthosis designed for a "neutral foot".

    What's the difference between the other devices in terms of their geometry and material properties?
  8. Here is some of the "research" on the system.


    unfortunate although it states
    It did not give a reference :craig:

    There are a few here from publications I'm not overly familier with.


    and here are the vital stats




    The colours are pretty.

    Material wise it seems like similar stuff to the salford insole.
  9. Thats here in full size if you want to avoid eye strain. Sorry, I shrunk it too small and buggered the text.

    A few questionable statements there. Shall we play spot the dubious claim.

    I'm curious about the forefoot alignment. C is "normal" D is "neutral" and both seem to be perpendicular to rearfoot which is of course, not "normal".
    And to answer your question Simon, type C, the neutral foot has poor shock attenuation and restricted STJ pronation. Thats why it needs an orthotic.

    I know I've harped on about this in yet another pod now column this month but I really can't see how an insole can be based entirely on a foot type, shape or function with no reference to what is actually wrong with it, viz what structure is damaged.

    Anyway. What say you all to the pretty pictures?
  10. Oh and here's the patent which goes into a fair bit of detail. Besides that I can't find anything on Google scholar by roberta Nole on foot typing.

    The old cry. Yes we have research. No you can't see it. Its secret.

    While I hesitate to raise Dennis from his slumber I wonder if he looked at the 6 type groups, would they match to any of his types? Can't be bothered to look at it that closely myself but has his patent been breeched? For all that the patent has lots of techy sounding RF > 7 EV Cavus torque and such, and for all that the types are derived from a full 24 types, it looks to me a lot like Pes Cavus - Pes Planus stopping at 4 stations of moderateness on the way. Interestingly they've mixed up the order but the types are

    Severe pes planovalgus
    Moderate pes planus
    Mild pes planus
    Abductovarus Forefoot
    Severe pes cavus.

    Or, if we drop the latin,

    REALLY Flat feet
    moderately Flat feet
    slightly flat feet
    not flat feet

  11. I like D,: "propels off the 2nd and 3rd metatarsal (due to transverse metatarsal arch reversal)" Now, what the **** does that mean?

    I also like their lists of "possible clinical symptoms throughout", for example: B "often unilateral" is listed as a clinical symptom... mercy, mercy me.
  12. So this device increases shock attenuation and increases STJ pronation then?
  13. You mean it smells of cyanide and nothing adheres to it, just like the Salford insole?
  14. Must do. Neat huh?

    So thats a no from simon. Amanda? Piers?
  15. It's not necessarily a no, I've not seen these devices, they might have their place for some feet some of the time. But as I'm not a retard, I don't need a foot-typing system and pictures of feet to help me select the design features I want in a device for a specific patient.

    You, on the other hand, Mr Isaacs clearly watch too much crap TV (took me a couple of minutes to work out who Amanda and Piers were), I'm off to watch the footie; more crap TV? We'll see.
  16. Nope. But a sizeable majority of the profession are when it comes to prescribing orthoses for structural and functional abnormailities and I guess that's where these products are marketed for. Switch off brain, tick boxes, supply product. Easy.

    Might have to buy The Sun tomorrow, just for the headlines.

    Maybe not....
  17. Griff

    Griff Moderator

    I am not even shocked to see this sort of sh!t in Podiatry Now anymore - it seems to be getting progressively worse. I know it's not a peer reviewed journal or anything but its literally turning into a magazine. I have friends/colleagues who do not even bother reading it anymore, and I'm slowly going that way. With each month that passes I am more convinced my time would be better spent reading Viz.
  18. Starter for ten:
  19. Yeah, Rob's corner was a stinker this month, completely missed the point of my "stiffness is the new black" one-liner...;):D:D

    BTW, it is a magazine. Out of interest % pods on the editorial team?
  20. A show where a bunch of no talent arseholes humiliate themselves on live tv and are jeered by a merciless mob who should have known what to expect...

    Could be either. Maybe both.

    yeah they let ANYONE write now don't they ian ;)
  21. Griff

    Griff Moderator

    It seems any old clown can get something printed in there nowadays ;)
  22. Hi Folks This made me laugh abit. If the transverse met arch is a myth insert research papers here ...... ( we have done it to death) , how do you reverse it ?
  23. I believe a reversed tma is what you refer to in a model with no reference to the windlass. Seriously, I see one mention of HL and that doesn't mention whether it's structural or functional. If reduced windlass function is the new collapsed transverse arch then a model with no reference to the windlass has to go retro.
  24. Greg Quinn

    Greg Quinn Active Member

    Podiatry Now Article. July 2010

    Interest in this article has provoked some understandable comment. This is an editorial piece from the journals staff and has not involved Talar Made Ltd. at any stage. The article is not attributed, contains errors and refers to concepts such as reversal of the transverse arch, with which we do not agree. Nevertheless, it is a brand that now sits within a range of products available from Talar Made. Some impressive work has been done by Roberta Nole to produce these models and we believe that the range has legitimate applications. Differences in the explanation for the design parameters do exist but are being worked out between the podiatric advisors of both companies.

    We have suggested a clarification in describing the morphology for this system and proposed a new morphometric study for validation of data. I must say that I am very pleased to be working with such an enthusiast like Roberta and her team. They are keen to work towards an evidence base and do not suggest the replacement of custom products with this range and research is now planned to test claims of correlations with forefoot loading patterns.

    Quadrastep offers an opportunity to test a hypothesis that links morphological variance with functional trends. The results, once available will hopefully shine more light onto this fascinating area of study. Once tested, any claims about Quadrastep made by Talar Made will be attributable and referenced.

    Whilst commercially available Quadrastep workshops will be available later this year, presentations made by myself at professional conferences will not (as always) reference any product unless it has been specifically cited within a peer reviewed journal.
  25. William Fowler

    William Fowler Active Member

    Greg, thanks. Can you tell us where the research is that the article refers to?
  26. Greg Quinn

    Greg Quinn Active Member

    At this stage I have only received some of the raw inter-observer data. Given the need the to redefine the morphometric scores, I'm not sure how useful this will be to me or anyone else. I know that a large amount of data has been collected but some repeats of the studies need to be carried out. Work to be done but an interesting project.
  27. Thankyou for joining in Greg.

    For myself I can see several benefits and applications for such a system, it's the core concept I mistrust. It seems to hark back to the old concept of "normalising", something I know you mistrust.

    A system which bases prescription wholly on foot type takes no account of pathology. Now the work you allude to correlating foot types to functional patterns may well bear fruit. One may even be able to take it further and correlate foot types / functional patterns to pathologies. But here is the rub. Let's say we found 80% of condition X happens in type Y. Does that mean that the insole designed to "normalise" type Y is always best for condition X.

    Put another way, taking knee pain as an example. Let us suppose we have two patients, same foot type, one with compressive medial knee pain and the other with tensile medial knee pain. Even if we show that that foot type is predictive of compressive knee pain that insole will still be sub optimal for the exceptions.

    To put it in yet simpler terms, a system based on foot type will treat a inversion sprain the same as an eversion sprain.

    That said, as a range of insoles with specific functional effects, I like the concept! I'm just mistrustful of any system which tries to identify pathology based on secondary characteristics and predictive features rather than directly.

    How do you feel this compares with the SNA in terms of outcomes and predictiveness?
  28. I beleive that its a huge step backwards foot typing - It takes the profession away from thinking. Just look at the Athletes foot thread with people complaining about a shoe store giving out orthotics. So everyone can look at a foot use a video type the foot and issue a device

    What will happen is that x amount of people will be treated sucessfully and the Pod will think less and less and then in 15 years, Podiatry will become Robotic again.

    If I´m allowed to use the example of the ´meat pie`its just meat pie orthotics with the extra menu.

    We are individuals who have had different enviromential effects on the body to cause a pathology- The patient should be treated as an individual to remove the stress on the pathology.

    Robert to be honest I find it strange that you like the concept after the amount of time you spend hammering Dennis.
  29. Don't know what you mean:rolleyes:

    Sorry, I could have been clearer. If you read what I said carefully, you'll see I don't like the concept.

    What I like is that it is a range of pre fabs which are not all meat pies, the idea that insoles can have radically different shapes and forms to have different effects. That moves us away from the "one size fits all, ideal position" concept and the "all orthotics are just there to supinate the foot" concept and I think thats a good thing.

    What I don't like is that the suggested selection criteria is based not on the effect of the device on specific tissue in context of the functional change we desire, but rather gross observations of the foot type. Even if the foot type can be shown to be predictive of a certain pathology, I don't see the logic in trying to determine and treat pathology by foot type.

    Released as a range of devices with the idea that insole Type A increases X moment in Y joint and decreases tension in Z ligament, I'd like it a lot. With the idea that insole type A is what you should use to treat ANY pathology if the foot looks like this, I don't.
  30. So the orthtoics you like and idea behind when you should use them you Don´t.

    Ahhh the planets are in alignment again.

    Thanks for making that clear, yes it was that sentance which stood out.
  31. The concept and variety of shapes in the orthotics I like. I've not looked closely enough at them to form an opinion on the nuts and bolts of them. Not sure about the colours or the material. Showed them to the wife and she insisted I immediately diagnose her with mild pes planus so she could have a funky purple pair.:hammer:

    But thats just personal preference.
  32. Greg Quinn

    Greg Quinn Active Member

    As with all ‘Foot Typing’ approaches, Quadrastep is likely to attract criticism that can be broadly categorized as follows:
    1. Reductionist approach. This is a fair point. The term ‘foot typing’ clearly and understandably invites this accusation. In the words of Einstein, ‘Make everything as simple as possible, but not simpler’.
    2. Unsubstantiated research claims. Again fair. Statements made within the published July edition of Podiatry Now lack referenced evidence and are more reflective in nature. Why Pod Now would publish its own material in this format is a separate issue.
    3. Undermining of professional ethos through commercial exploitation. Broadly the subject of biomechanics is poorly understood by the majority of practicing podiatrists. ‘Reliable and user friendly’ systems are attractive for many.

    I did attend a Quadrastep workshop lead by Roberta Nole in the US recently. I was impressed by the product range and the designs resonated with what podiatrists prescribed from Talar Made Custom (now owned as TMC as part of The Langer Group) most of the time. A similar experience for Roberta (a clinician and custom lab owner) is what had lead to her to develop her products.

    I am always keen to support new initiatives. However I do feel that explanations for efficacy should be sound and have spent considerable time discussing alternative rationales with Roberta. Use of the FPI, SNA and other morphometric assessments perhaps can be used to clarify the morphologies that this system uses. This is now underway. Using reliable data such as this to correlate with any functional patterns will need to be investigated to make meaningful product claims. This would position the range closer to that which Robert outlines. It is the effect of the device that matters. In other words the reason the device has the features it has is the effect it has on specific anatomical or functional traits. Correlating that with reliable morphometric data is the challenge here but either way the results should be interesting. Again, such a study is currently being put together. This will hopefully build on the data Roberta has already accumulated. Once this has been successfully completed, the findings (supportive or otherwise) will be published. As for matching this to specific symptoms around the knee: I am discussing how this might be investigated with colleagues and may be the next stage in revisiting indications for use of functional knee and/or foot orthoses.

    I would like to emphasise one further point: To suggest that any range of pre-fabricated products should replace all custom orthoses is plain stupid. Although, producing a range of products like this is far from easy it is driven by a passionate belief that it has something to offer. It is unfortunate that attempts like this are (perhaps understandably) sullied by a less evidential approach.
  33. Greg while it appears that you personally have meet and conversed with most involved in this thread, I would just like to pick on this point if I may.

    While attractive for most, I don´t see this as a step forward. I feel that this some of the problems with education and the CPD after school.

    We should be pushing the profession forward by lifting education standards, not making it simplier. I beleive that with a white board and some time things like SALRE and tissue stress become simple to understand the concepts.

    But it could be I´m becoming a Grumpy old man 30 years too early but simple does not mean better - cut enough corners and you get a circle.
  34. Greg Quinn

    Greg Quinn Active Member

    Just as managers and clinicians share a mutual tension in the provision of clinical resources, commercial clinical advisors and marketing disciplines enjoy similar pressures in delivering clarification of scientific validity whilst increasing brand profile. The very best companies assert credibility through research efforts leaving marketers to capitalise within a better informed market. When colour coding and simplicity is used to market foot care products our professional hackles do tend to go up. Whilst we should always question unsubstantiated scientific claims; it can be a mistake to always assume that an attractively marketed product lacks a credible basis. Simplicity in marketing products should belie a complex understanding of their functionality. Ultimately Roberts’s point about product Type A increasing X moment in joint Y and decreasing tension in Z ligament is entirely valid but a nightmare to follow to all but a few well educated practitioners. I’m sure that we recognise that what sells products is benefit to the consumer. Oversimplification of this can be hugely frustrating. I prescribe NSAID’s to my patients because they understand it stops the pain. I understand how they work and consequentially what the potential hazards are because they are linked; whereas my patients tend not to grasp this. It would be great if, as a profession, we could assume that prescribers understood how and why orthoses might produce their benefits but very generally (and in large numbers) they don’t. If they did, rest assured the marketing would be very different. That we are left with this problem is a matter for educational improvement as you point out. Commercial companies are left with the conundrum of bringing a larger, poorly informed market into play and sometimes fall into the trap of over-reducing the science and yes you’re right, all the EBM practitioners rightly cry foul.

    Educating practitioners to use medical products should always be about referring to the fundamentals of the system in question. The rationale for product features should resonate with this and hopefully build sales that can be used to re-invest in further product development. Do I want to be teaching graduates about basic fundamental principles? Should I be awakening people to the excellent research now available? We are where we are. I wish it weren’t so! But I find podiatrists incredibly thirsty for useful new information and treatment approaches. If they buy products because they are purple… well I share all of the frustration that brings and sometimes it’s my job to point out that it might not be such a good idea!
  35. As Greg points out, what you see depends on where you stand.

    With my theoretical hat on this system (as offered) has holes you can drive a bus through. With my educators hat on it troubles me that people might take the model as gospel and reverse engineer theories to fit it, and that people will learn this... then stop. However If I were wearing a lab owners hat I might well argue that this sort of thing is a huge leap forward from the idea of a single "cure all" insole and that we must be pragmatic about those of our colleagues who do not have the wit or motivation to look at biomechanics in more depth.

    Lets face it, there are a huge number of those. They WON'T learn biomechanics the hard way. They WILL jump on one lab driven bandwagon or other.

    So I guess the question becomes, if that is the case, should we be encouraging models which are CLOSER to what we would like, or should we stick to the hard line, our way or the highway approach.

    Because as much as this sort of thing, as presented here, is theoretically unsound, It is a vast improvement of some of the dross out there.

    Perhaps this is the biomechanical equivilent of Methadone. We don't want you taking it, but its better than the hard stuff.
  36. Sorry just having a rant, bit tired after moving the lab yesterday, plaster powder gets into everything.

    It would be good to play with the whole prefab group, but I just don´t get why it can not be explained used mechancial principles and designed using these principles.

    Ive written this post 5 times, not making any sense,
    I´ll let it go now.
  37. Let's say I release a new range of prefab devices. The first one I release has an medial heel skive of X mm Y degrees, a medial longitudinal arch height of Z mm. What is the function of this device in mechanical terms?
  38. Greg Quinn

    Greg Quinn Active Member

    I’m not sure about this analogy to methadone. Pre-fabs do have a presence in the research that often reflects positive outcomes, but I think I get what you mean: Whatever individual system of assessment is used it must reflect the continuum of morphological variance within the population. We are treating malfunction and forces, not necessarily abnormal position. On this basis a single product’s design rationale must make some kind of sense. Proof of a correlation between morphology and functional tendencies has so far proved elusive though efforts to realise this are not necessarily without merit, even from a pre-fab company. Any commercial laboratory trying to reduce costs to the prescriber and maintain efficacy must eventually fix upon a finite number of orthotic features that have a clear functional intent. This should produce clearer indications and contra-indications of use. Having a single product design with one combination of features is reductionism, but marketed responsibly with clarification of purpose is to be encouraged. After all, to incorporate an infinitely variable number of features requires the constant use of a more expensive custom option (for some caseload profiles this is necessary of course). Designing several pre-fab products for one range that reflect commonly occurring anatomical & functional traits and thereby custom prescriptions, begs a logical explanation. I believe that such an explanation is slowly emerging and further Quadrastep research may offer some helpful insights either way. Having a rationale does not prove anything and scientific testing of those features helps us all. BUT, research which tests a ‘pre-fab’ against a custom device all too often fails to describe the precise features of the pre-fab and the precision to which it has been matched with the cohort of patients (using the rationale of the product). Generally this is because pre-fabs have lacked specific application criteria.
  39. Short answer : Mostly likely To increase the external Subtalar joint supination moment, depending on STJ axis position

    Long answer Mostly likely To increase the external Subtalar joint supination moment, depending on STJ axis position the changes which occur will be different from individual to individual. As will the magitude of the vector is dependent on many things such as Subtalar joint axis position, internal subtalar joint pronation moment, cadence, muscle fatigue, pathology, foot strike position angle of Ground reaction force vector, surface stiffness and much much more.Infact it could be argued that the function of the device will be different form foot strike to foot strike.
  40. Greg Quinn

    Greg Quinn Active Member

    That's a really good answer Michael. Are there any circumstances when you would be tempted to use Simon's suggested device? Or, are there any circumstances when you would absolutely not use it?

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