This is the part 4 of a series that should be read in order.
Key Points:
- Why we need pronation as we walk or run
- Review of 28 problems related to Pronation (and counting)
- Types of Pronation (P) Orthotic Devices
- Why correlation of the present orthosis to gait function and symptom relief important
- Question to Muse: Is Ideal Stability for a Patient Eliminating all Pronation in gait
- Examinations should include static and dynamic components
- Importance of RCSP and NCSP measurements
Achieving added stability for pronators is the most talked about problem in foot orthotic devices. Contact phase pronation in walking and running is vitally important for smoothness in gait (as the limb is still pronating and internally rotating), shock absorption of the limb, and foot adaptation to the variations in the ground (mobile adapter). But, if that pronation is too much (degrees), it places the patient in an abnormal position, too fast and is therefore too hard to decelerate, or lasts too long (past the contact phase), problems will occur. 28 lower extremity problems (injuries or pain syndromes) have been helped by reducing pronation (our way of documenting that pronation was involved as a cause). These problems include: chondromalacia patella, shin splints, achilles tendonitis, plantar fasciitis, etc. These have all been summarized in a previous post.
Orthoses for Pronation are P orthoses and subdivided into BP, P1, P2, P3, P4, P5, and P6 which we will discuss over the next few weeks. However, how does the clinician decide on these modifications to B1 or B2 orthoses? One common method is simply based on the response to an orthosis prescription based on symptoms and gait. If the symptoms are blamed at least partially on pronation, and not improving with B1 or B2, and the patient continues to pronate, it is common to attempt more pronation control. It is crucial that you are correlating sub 100% pronation control with sub 100% symptom relief. This can get a little more important in chronic problems like abnormal pronation causing low back pain, knee pain, or adult acquired flat feet. Here it may be necessary to attempt to achieve ideal stability if you possibly can.
Right Orthotic Device with more Pronation Control with Inversion canting, and Kirby skive.
A higher arch is attained with this P4 device right and B1 device left.
This gets us into both static (first) and dynamic (second) evaluations. We must start with 2 simple measurements with P orthoses. RCSP (Relaxed Calcaneal Stance Position) and NCSP (Neutral Calcaneal Stance Position) are crucial measurements of the stability of the patient. Again, I am back into Root Biomechanics. Here I have found relative consistent agreement between these static measurements and the dynamics it produces while standing or walking. From here you can then talk simply about the kinematics (motion) and kinetics (forces) existing for any patient. Here is the post on obtaining RCSP. From the task of heel bisection, you can take some many great observations.
Once you measure RCSP, place each foot into subtalar joint neutral to see where the same heel bisection line goes in relation to the ground. NCSP may be the same as RCSP, inverted from RCSP, or everted from RCSP NCSP may be more inverted than RCSP as in most cases of pes planus and over pronation, and in my upcoming examples. Yet, NCSP may be more everted than RCSP meaning the subtalar joint is supinating to compensate for something (typically plantarflexed first rays or genu valgum).
The next few weeks I will discuss examples based on RCSP and NCSP.
Review of all the Orthotic Types Being Presented
Corrective Orthotic Devices
↓
- Balancing (B): (B1 and B2)
- Pronators (P): BP, P1, P2, P3, P4, P5, and P6
- Supinators (S): BS, S1, S2, S3
- M/L Instability (M): BML, ML1, ML2, ML3, ML4, ML5, and ML6
- Shock Absorption (C): BC, C1/C2, C3/C4/C5, C6, and C7
- Sagittal Plane (H): BH, H1, H2, and H3
