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The Formthotics System

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Charlie Baycroft, Jul 1, 2006.

  1. Charlie Baycroft

    Charlie Baycroft Active Member

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    If no-one has any great objection, please permit me to introduce a clinical model for examining the foot and leg that I have been working on.
    I call it the Formthotics System because it has been developed to help people use our products more effectively but this method can also be applied to using other devices.
    I hope that no-one will object to the "commercial" nature of the name for the system, I did say it is applicable to other products including custom hard devices.
    I do not claim to have discovered the elements of this model but belive that I am the 1st to put them together in this way.
    It is not at odds with Dr. Root's "Podiatric" model but rather an attempt to augment it with some other useful assessments.
    The basic assumptions are:
    1. FO's should improve the function of the foot and leg.
    2. The function of the foot and leg is not totally biomechanical.
    3. Our assessment and treatment needs to take into account neuromuscular factors.
    4. The method needs to be clinical and clinicians do not have gait analysis labs in their practices to verify the biomechanical effects of the devices.
    5. There is no proven model for explaining the efficacy of FO's.
    6. The clinical model that we use should be compatible with current research and theories.
    7. The patient should be able to understand and appreciate that the devices are having a beneficial effect on their function.

    The basis for this model is that we should be able to observe and verify some changes in function as we fit and adjust the devices and the patient should also appraciate these changes.

    There are 6 clinical tests.
    1. Alignment.Test. Biomechanical assessment. A FO should improve the alignment of the lower limb (static and dynamic), but does not have to make this biomechnically perfect. The device should not make alignment worse.
    2. Subtalar motion. Each subtalar joint has it's own "normal" range of movement. Many people have restricions in the joints of their feet, which prevent the joints from functioning physiologically. These restrictions should be identified and corrected by mobilization before FO's are prescribed. FO's should be made in relation to the neutral subtalar position. FO's do not have to reduce the range of motion of the STJ (pronation) to reduce the velocity and duration of STJ pronation.
    3. Supination Resistance Test. As described by Craig Payne. The force required to supinate the STJ can be clinically assessed and reduced by appropriate posting. The patient can also feel this change in resistance to manual supination.
    4. Jack's Test. Again well described by Craig. The device should reduce the force required to activate the windlass. The patient can also feel this reduction of force.
    5. Balance Test. Stand on 1 foot, establish balance, close the eyes. Observe stability, duration, and loss of stability. Most people lose stability medically but some fall off the lateral side of the foot (usually those with low supination resistance). The device should improve balance but NOT induce lateral instability. The patient can feel the improvement in balance.
    6. Forefoot Stability Test. Patient stands on one leg, establishes balance and then rises onto the toes. Observe ease, height of heel lift, stability of forefoot stance, medical or lateral instability (inversion). This relates to the efficiency of propulsion and also theories like the windlass and hi/lo gear. The device should improve forefoot stability and reduce the tendancy to inversion. The patient can confirm this.

    1. Do the tests and document.
    2. Make a NST shell and repeat the tests. It could be a good idea to let the patient get used to the unposted shell for a week or so before carrying on.
    3. Reassess and post to improve the test findings (function).
    4. Put the posted device in the shoes and retest.
    5. Continue to reassess and readjust as required as the patient adapts to using the devices.

    I would like to recieve your feedback about this in order to modify or improve it to be a better model.
    Please post comments either here or by email to me at fsicmb@attglobal.net.

    Charlie Baycroft
  2. Actually, Charlie, I was the first to describe the Supination Resistance Test in my and Don Green's chapter on treating pediatric flatfoot deformity back in 1992 (Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992). I created this test in the late 1980's when I was trying to find a manual method to determine the force required to supinate feet with different STJ axis spatial locations. I think you will find that the first place it was ever described in the medical literature was in our 1992 chapter.
  3. Charlie Baycroft

    Charlie Baycroft Active Member

    Sorry Kevin. Thanks for correcting me on this. I will be sure to give you the credit for discovering this test from now on. I like how it provides good information about the loading on the muscles that supinate the STJ and how this leading can be altered by posting, as well as its relation to the orientation of the axis.
    Charlie Baycroft
  4. PodAus

    PodAus Active Member

    Hi Charlie,

    Good system which will make it easier for your clients to use - however the use of these tests/obsevations (and several others) has been used for many a moon by a multitude of practitioners i have worked with.

    All the best.
  5. PodAus

    PodAus Active Member

    Sorry; meant to say used as a particular system that is...
  6. bearfootpod

    bearfootpod Member

    I agree with PodAus, all of the tests/observations mentioned are commonly used by Podiatrists and many seminars/lectures I have attended have presented this material so you must be on the right track for your model!

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