Clinical Biomechanics Boot Camps

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Global Podiatry and lower limb related courses and seminars

Tag archives for foot orthotics

The Supination Resistance Test

In the early days of the Clinical Biomechanics Boot Camps we spent a lot of time on the supination resistance test and the concept of supination resistance, as the concept was so new to so many, but as time went by less time was spent on it as the test has become so widely used and quite pervasive when it comes to prescribing foot orthotics.

The test was first described by Kevin Kirby, DPM and we have done a lot of work on it with a number of studies exploring the concept. Along with that research I used clinically and we did a lot of practical sessions on it in the boot camps – all of this lead to what I think was a good understanding of it and just how useful it was to use clinically when it came to the prescribing of foot orthotics in clinical practice. I think those who did the clinical biomechanics boot camps did get to agree with me just how important that the concept was for the prescribing of foot orthotics and understanding pathology. There are a lot of threads on Podiatry Arena on the topic that get updated regularly.

The supination resistance test is simply a test to estimate just how much force is needed to supinate the foot and then applying that knowledge to how much force is needed to come from the foot orthotic. If the force to supinate the foot is high, then the force needed from a foot orthotic needs to be high. No point using a soft flexible foot orthotic in those with a high supination resistance as the orthotic is probably going to do nothing. If the supination force is low, then a soft flexible foot orthotic is going to be adequate. Using a rigid inverted type of foot orthotic in a foot with low supination resistance is probably going to sprain the ankle.

For our research we used a device that we built to quantify it but that device really has no practical use in clinical practice, so the use of the hands and manually estimating is adequate. There are some devices on the market, such as the Keystone that can be used to put a number on it.

What I used to like saying to people who were unfamiliar with the test is to just do it. Get a feel for it. Find those feet that are high or low and see how that might relate to the pathology that the patient has. Get a feel for how people with different levels of supination resistance respond to different foot orthotic designs. You soon start to see patterns.

I am a big fan of the Archies Flip Flops

We call them “thongs” in Australia. The Archies footwear come with an arch support built into them. We sell Archies in our clinic in Melbourne and they sell well. Pretty much everyone who tries on a pair buys them They are that comfortable. What is useful about the Archies is that they can be used by those who need or have foot orthotics but want to occasionally wear this style of footwear.

The other great thing about these is that can be modifiable. I sometime get on the tools and make what I call a MOSI Archie modification for those with a more medially located subtalar joint axis. I made this video on the technique.

Archies

I also occasionally answer a question online about them!

The MOSI, the Kinetic Wedge, The Cluffy Wedge

I talk a lot during the Clinical Biomechanics Boot Camps about many different design features that get used in foot orthotics such as the MOSI, the Kinetic Wedge and the Cluffy Wedge to name just a few. They are all useful features and have their places depending on what affect you are wanting.

For example, the Cluffy Wedge is deigned to hold the hallux in a slightly dorsiflexed position. This tenses up the windlass mechanism in the foot and brings on that windlass effect earlier. That is only going to be useful if you want to or need to bring it on earlier. If the windlass mechanism is functioning fine, then the Cluffy Wedge is probably not going to make any difference. That does not stop some clinicians using it as a ‘cure all’ and using it in in most orthotic prescriptions. The Cluffy wedge or a similar foot orthotic modification is indicated when it indicated and not indicated when its not indicated.

Arch Support in Footwear When There is Not Room for Arch Supports

So much of the use of foot orthotics is based on compromises. The ideal foot orthotic and the ideal foot orthotic prescription is often modified away from that ideal to take into account the footwear that they are to be used in. This is particularity a problem in things like tight football boots or ballet flats when you need some form of arch support. These types of shoes are not designed for any sort of support or foot orthotic to go into them. They are minimalist by design. Often what I do for these types of patients is use a self adhesive silicon gel arch support which takes up very little room, but does give some support. There is a little bit of trial and error to get the placement in the shoe right for comfort. It is less than ideal, but better than nothing.