GAITSCAN™, CUSTOM ORTHOTICS and AFO BRACES

TOG Gaitscan™

Feet are complex 3 dimentional structures that need to fuction on flat, 2 dimentional surfaces. To work properly, the foot needs to turn in, turn out, move in three different planes of motion, absorb shock as well as be a loose bag of bones then a rigid level. Walking or running on hard surfaces in spent or inappropriate shoes only compounds and hastens problems.

When the feet don’t work well, evenly, or absorb shock, the whole body suffers, this includes, knees, hips and backs.

The study of the way feet and body parts move is called Biomechanics and is the foundation of preventative medicine. Preventative medicine does not just mean stopping problems before they occur. It also means arresting or retarding problems that are already of note. For example, many people with high arch foot types get contracted toes. Early discovery and treatment most often leads to a slowing of contractions and helps prevent bone fusions, corns and callouses. However, diagnosing and treating these problems even later in life can reassign pressures and retard the progression of contraction to corn to fusion at any point in the line.

The diagnosing of pathomechanics or walking in a way destined to create or enhance musculoskeletal problems is the start. The TOG Gaitscan™ is an amazing acquisition we made at Segel Podiatry to quantify foot function and its effects on the upper body. It is a pressure plate with over 4,000 sensors, capable of recording data at milliseconds, while standing, walking, squatting and running.

Read "TOG’s GaitScan™: For Powerful, Reproducible and Practical Computerized Gait Analysis" article by Dr. J.D. Segel

We gain such important information as:

• How hard a segment hits the ground.
• The order with which the foot loads & pushes off.
• How soon a particular area hits the ground and its relative pressures on impact.
• How long a segment stays on the ground and when it reaches its peak pressure.
• How much time is spent on each foot relative to the other.
• Analysis of time spent on the heel relative to the arch and to the forefoot and toes.

This knowledge is great to have but more importantly, it’s practical. This is the very information, along with patient comments and physical exam, used to create a device to help you walk better. This device is called an orthotic and is a custom engineered corrective plate that fits into shoes and works similarly to the way glasses correct your eyesight. I have also heard others refer to orthotics as seatbelts that benefit your whole body by easing the burdens of upright function.

CUSTOM ORTHOTIC

Orthotics have been effectively used by Podiatrists to treat a variety of foot problems including :

• Arthritis of all types
• Plantar Fasciitis
• Heel Spur Syndrome
  
• Excessive Pronation
• Diabetes
• Bunions
• Corns and Calluses
• Unstable ankles
• Unsteady or Abnormal Gait
• Shin Splints
• Short Limb Syndrome
• Morton’s Neuroma
• Parkinson’s Disease
• High Arches
• Flat Feet
• Contracted toes
• Polymyalgia
• Chronic Pain

I have also received referrals to make orthotics to treat knee, hip and back problems as well.

KIDS ORTHOTICS and OTHER SPECIALTY ORTHOSES

Have you ever noticed that most people in nursing homes have foot problems?
It’s not something in the water, on the admission orders or that happens when you reach a certain age. It is the end result of microtrauma. For example, let’s say that a patient worked on their feet with unequal limb lengths. The malalingment results in joint and muscle imbalances and in turn little trauma that happen during motion.Now let’s go back in time and put that same person in an appropriately posted orthotic and that child is less likely to have the same microtraumas that lead to joint wear, weaken bones and eventually pain, falls and joint replacements. An orthotic is really just an adapter from a 3 dimentional foot to function on a 2 dimensional flooring surface. Now, if I can give that’s childs’ foot that conversion before the foot is fully formed, one could argue that the foot, and so the child, would have a less harsh interaction with his 2 dimensional walking surface. The kids orthotic provides support, protection, and a deepen heel cup for fat pad accomodation and increased proprioception.

Just as children’s orthotics require addition consideration, the same is true of diabetics, runners, in-toers, golfers, tennis players, people who are carrying extraweight, and our midstance sportsmen who ski and skate.

Each has specific biomechanical challanges that benefit from additions and/or modifications above those seen in what I call “boiled chicken” orthotics. There are many ways to improve and further customize orthotics just like chef’s use spices and sauces to improve one’s culinary experience.

Often during the course of patient care comes the discussion of orthotic therapy. First I try and discern whether this is a new thought or a previous orthotics wearer or maybe someone who has seen these devises on some tv ad selling foot love in a box. To these folk I say that any monkey can make an orthotic and to my mind there are three important concideration; the method used to obtain foot structure, the materials used and the modifications applied during manufacturing or after the orthotics has been dispensed. For educational purposes and to create realistic expectation, I invariably steer the conversation around to just a few central point; the issues of accomodation versus correction, the concept of making an adaptor to manage the effects of a three dimentional foot interacting with a two dimentional surface such as unyielding flooring and the orthotics process itself. But how much thought do we give to materials and modifications.

This section is meant to identify some pearls, tips and tricks during the creation and subsequent modification of custom presciption orthoses.

1. The benefit of using a full length padded top cover helps to reduce shifting of the orthotic in footwear, add cushion and prevent that feeling of the forefoot falling off the end of the world. The practical use is that now you have an integrated plantar platform for forefoot modifications like Morton's extensions, metatarsal pads and neuroma bars you may wish to add in office. Using a light colored smooth leather top cover will also provide the most useful data you can get in that the top cover stains with wear. You can use that as objective data to off load or otherwise judge and modify orthoses.

2. Perhaps the most under utilized orthotic is the UCBL. It's deep heel cup and hard flanges give you maximum support, fat pad gathering and proprioceptive cueing, constantly reminding the brain and body of the foot's drift from neutral position. Ordering a deepened heel cup on a semi-rigid orthotic will also stiffen up the orthotic plate yielding that improved support and propriocetion often called for in neurologically impaired patients though you may also have to ask for additional top padding with poron or plastizote.

3. Perhaps the most overused orthotic modification is the heel lift. Whereas it may be beneficial to raise the heel in situations that include equinus, knee pain and those times you want a bit more arch without actually sending the orthotic back to the lab, remember that you are now placing more burden on the forefoot. So in patients who present with forefoot issues and assymetry, consider a graded sole lift.

4. "Software Upgrade". Change covers, padding and posts. Given that these additions and modifications are made of materials know to deform and wearout over time, they should be checked and replace when necessary.

AFO BRACES

The letters AFO stand for Ankle-Foot-Orthosis and is a combination of a lower limb brace and foot support. These are a family of devises used to control motion and provide stability for any number of bioechanical problems stemming from Cerebral Palsy, Posterior Tibial Dysfunction, Spina Bifida, Parkinson’s Disease, Multiple Sclerosis, Drop Foot, Trauma, as well as the host of other neurological and arthitic problems which cause instability, pain, and dysfunction.

We here at Segel Podiatry have teamed up with the folks atLanger Biomechanics to fashion a number of function specific, custom AFO’s