Pedorthist shares foot type identification algorithm for adolescents teens

ORLANDO, Fla. — The identification of foot type, which aids in pedorthic diagnosis for adolescents and preteens, can be completed in four simple steps thanks to an algorithm presented by Roberta Nole, MA, PT, CPed, at the Pedorthic Footcare Association and American Podiatric Medical Association Combined Meeting, here.

Roberta Nole


Nole is the owner of Stride Inc. Custom Foot Orthotics and president and chief product developer of Nolaro24 LLC. Along with Louis J. DeCaro, DPM, podiatrist at DeCaro Total Foot Center and director of medical relations for Nolaro24 LLC, Nole created the Quadrastep System to help pedorthists identify foot types to aid in the creation of custom orthoses. The system categorizes feet into 24 types — organized into six quadrants — and includes possible clinical symptoms, common adolescent problems and key orthosis features for each quadrant.

The system is useful in working with preteens and adolescents because it helps pedorthists know when flat feet need to be treated, according to Nole. Many families are hesitant to purchase custom orthoses for adolescents and preteens who can outgrow the product; in addition, Nole said, sometimes flat feet are not painful. Identifying a young person’s foot type can help the pedorthist determine the problems he or she will have in the future.

 “It is really amazing what a little bit of correction will have on a child instantaneously, because they are flexible,” she said. “Unlike our adults, who come in and they might have some fixed deformities or surgery or obesity, usually kids are pretty easy to manage.”

The six foot quadrants are organized into a chart with types A and B on the top row, left to right; C and D in the middle row; and E and F on the bottom row.

Nole’s four-step algorithm begins with identification of medial arch height. High arches belong to the three groups on the left side of the system chart (foot types A, C and E), whereas low to flat arches are on the left (foot types B, D and F).

“The way your foot is shaped will dictate how you stand and how you walk, and how you stand and how you walk will lead to injuries,” Nole said.

The second step is identification of foot and leg alignment, which are grouped by row. The top row, types A and B, contains valgus feet; the middle row, types C and D, contains neutral feet; and the bottom row, types E and F, contains varus feet.

Step three is identification of gait style.

“Each [group] will have a distinct walking pattern,” Nole said. For example, type A feet walk like they are on a tightrope; type C feet walk “like a duck;” and type B feet walk with their toes turned in.

The fourth and last step is to check for a callus pattern.

“The way you walk will lead to distinct calluses on the forefoot,” Nole added.

Once a foot type is identified, pedorthists can help patients choose the right shoes and / or orthoses to protect against injury and even help prevent future foot problems.

“Throw away the goniometer; this is so much easier, and it is a lot more fun. You can see people and predict where their calluses are going to be,” Nole said. – by Amanda Alexander


Nole R. Common preteen and adolescent pathologies. Presented at: Pedorthic Footcare Association and American Podiatric Medical Association Combined Meeting; July 23-25, 2015; Orlando, Fla.

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Disclosure: Nole reports she owns the patent for the Quadrastep System.

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