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Biomechanics and Orthotics

I was called to the phone by the Receptionist to take a call from a potential client who wanted to hear from me in particular, “what is Biomechanics?” since she was told she had biomechanical problems, and needed orthotics. She was not clear about it, and felt I would be able to help her better understand the issue/s involved. Interestingly, this is not an isolated case. Many clients react in confusion when told that they have biomechanical problems, with the “aha” coming when it’s explained.

Biomechanics is defined as the application of that branch of Physics known as Mechanics to the human body structure. It’s about identifying potential problems, some of which may be caused by these natural variations of wear, design and function. It involves static and mobile joint examination techniques and gait analysis.

Biomechanical Tests

The first test done on a patient should be a check of the patient’s foot type. It is well-established that there are three different foot types (low arch, medium arch, and high arch). With a low arch or in some instances flat feet, or pronated feet, a motion-control shoe is recommended. This is the foot type of approximately 70%–80% of the population.

Those with a normal, medium arch (about 10% of the population) would benefit from a stability shoe. A high medial arch, or a supinated foot, constitutes about 10% of the population, and it works best with a cushioned shoe, as a supinated foot typically will be rigid and more sensitive.

There are two basic tests that can be performed when checking body-weight distribution and foot type. The first is to manually check standing arch height by getting down on your knee and inserting your middle and index fingers under the patient’s medial arch.

The second method for checking foot types and identifying weight-distribution imbalances is with a foot imprint or a digital scan of the feet. With proper software, you will see the difference in the patient’s weight, right versus left, and front versus back; and this visualisation is extremely important in helping to motivate the patient to take action.

Range of motion, muscle-tension tests, deep tendon reflexes, leg-length measurements, and spinal-compression tests are all part of biomechanical testing. In addition, and most importantly, standing biomechanical x-rays should be taken on all patients, to rule out pathology and look for biomechanical findings.

When biomechanical imbalances and joint dysfunction occur for a prolonged period of time, the degenerative process increases. Trauma, repetitive motion, structural imbalances, and joint fixations lead to accelerated joint degeneration. When degenerative changes are found on the x-ray, the practitioner should determine the history behind the degenerative change.

Prevention

Prevention is better than cure. Think of the savings in the health care field if we can help people to preserve their neuro-musculoskeletal system. And these savings would be based upon individuals proactively doing what is necessary to preserve their structure.

The first step in providing assistance would be to recommend custom-made orthotics. There are different reasons why these supports are recommended, and there are various types of custom-made orthotics that we need to understand.

First of all, any structural imbalances, centers-of-gravity imbalances, rotations, or dysfunction of joints need to begin correction with the fitting of custom-made orthotics. Unless that medial arch is addressed so that it is bilaterally even, there will be an ongoing imbalance in the structure. As the aging process continues, premature degenerative changes will occur.

When someone pronates (the ankles roll inwardly), it becomes obvious why custom-made orthotics are needed, especially if right and left are different. Imbalance will lead to premature wear and tear of joints. This obviously sets the person up for an increased vulnerability to injury.

If the person presents with degenerative changes in any joints, the need for custom orthotics increases, as there is clear evidence that a certain joint has been under an increased level of stress for a prolonged period of time, and the outcome is premature degeneration.

Orthotics

Orthotics are used to correct or reduce the effects of these problematic features. By inserting a prescribed bone-position-correcting foot insole into the shoe, the compromised foot can be helped to return to optimal function.

Podiatric and orthopaedic professions recommend rigid, non-weight bearing orthotics to their patients. This type of orthotic addresses foot imbalances, but is not in any way designed to address the biomechanics above the ankle. A flexible orthotic, measured in the weight-bearing position, on the other hand, is more appropriate for the entire human structure. Additionally, shock-absorbing qualities in these orthotics are critically valuable to the longevity of the structure. As I tell my patients, “The more shock absorbed in the orthotic over the course of your lifetime, the less stress that goes up your structure.”

A rigid orthotic is designed for an imbalanced foot; however, it offers no shock absorption for the entire structure. These orthotics last an eternity, but their restriction of normal foot mobility, their overcompensation of joints and muscles above, and their absence of shock-absorbing qualities make flexible, weight-bearing orthotics preferable.

Happy New Year to all! I trust that more of you would be taking time out to care for your feet in 2012, especially with the upcoming Carnival season in mind…

Your feet mirror your general health . . . cherish them!

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