ORLANDO, Fla. — Orthotic changes that correct the foot also will
improve problem areas elsewhere, according to William J. Smith, MSPT, CPed, and
Art Smuckler, CPed, OST. Corrections such as these affect that person’s
body up the kinetic chain.
It is important for pedorthists to realize that “the foot is not an
exception to the rule,” Smith said.
At the 2010 North American Pedorthic Congress, Smith and Smuckler
presented the case of a 59-year-old man complaining of arch pain. After
questioning this particular patient about his medical history, they found that
he was about to have his right knee scoped because of meniscal pain; he also
experienced left hip pain and right low back pain. The foot and ankle surgeon
who initially referred him had done so as a last resort to postpone posterior
tibial tendon reconstruction.
|William J. Smith|
Despite all of these issues, however, both the patient and the referring
physician had yet to make the connection to his foot position.
“Interesting enough, he didn’t equate a lot of the pain he was
having with what was going on with his feet,” Smith said.
Proper orthotic design will not affect only the foot, but its alignment
to the rest of the body. Since the hip, and foot and ankle pathologies are
connected — and each affects the knee — Smith recommended reviewing
this alignment while the patient is young to prevent hip surgery in the future.
When testing the patient, the orthotist should ensure a complete
evaluation of the issue by doing a physical manipulation of the foot, Smith
He and Smuckler evaluated the patient’s condition through measures
such as gait analysis and non-weight bearing assessments, and developed an
orthotic device to suit his pathology. Their device made a sagittal plane
correction for postural control, as well as a transverse plane correction, by
using a combination of both frontal and sagittal posting techniques.
Smuckler’s overarching message to presentation attendees was
simple: “You’re changing the body, not just the foot,” he said.
“Your patients will tell you [they] feel straighter, more upright.
You’re going to hear all sorts of good things when you use the triplanar
orthotics. It’s a wonderful way of making your patients go outside and
tell other patients.”
Image with this
It’s an important topic for pedorthics. Triplanar function is
well-recognized in other professions and integrating the physical therapy
perspective with pedorthics, I think, is invaluable. I migrate to that
philosophy because that’s where I came from, and I’ve seen the
benefits of what they’re talking about. So absolutely, I think their
approach is right on.
I don’t necessarily agree with everything they said — nor will
any clinician in this room, because we all have our own experiences. But
it’s very pertinent to our profession and I think that this component will
make everybody in this room better.
—Larry Urben, MS, ATC, LAT, CPed
custom orthotics division, Covenant Hand Therapy