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It was and still is generally accepted that control of the foot during the first two stages of the gait cycle, heel-contact and mid-stance, is sufficient to generate stability into the final stage, known as propulsive stage of gait. Early researchers recognized that an extension of traditional orthotic design that went under the metatarsals would in fact improve the function. Since that time an ongoing debate as to how to control foot function has perplexed many physicians. The essence of the debate was do you attempt to control the rear-foot or do you focus on the forefoot. Although most physicians and orthotic labs have mostly endorsed the concept of rear-foot control, new research in the last 20 years has supported the forefoot theories of control.
To this day most foot control devices use a wedge placed in the center of the foot to control arch collapse and pronation. Effective foot and leg control with decreased clinical symptoms can be observed in most patients. Often however there are patients whose daily activities cause them to function “up on the balls of their feet”, spending diminished time in either heel contact or mid-stance stages of gait. These patients are said to function primarily in propulsive stage of gait.
Athletes including runners and cyclists function primarily in propulsive stage of gait. This eliminates any significant contact with the wedge in most rear-foot control devices. For a patient whose activity places foot contact directly on the metatarsal heads, it makes sense that the effect of traditional orthotics would be minimal to none. Although foot and leg control is still changed during regular walking and standing activity, no significant change is observed during athletic activities. If the athlete spends enough time in their propulsive stage activities they will continue to be symptomatic even with optimal control during all of their normal activities.
Runners and cyclists often experience chronic over use syndromes associated with improper foot alignment and function. Their symptoms may occur in the foot, knee or low back and are generally only minimally responsive to physical Therapy and Anti-inflammatories. The problem is that with every stride you take, or spin of the pedals, wear and tear associated with imperfect alignment is present. Enough strides or spinning will produce symptoms even with full time use of traditional rear-foot control orthotic devices.
The bottom line is that unless the angular correction is place directly between the ground and the point of contact with the foot little to no change in forces and function will occur. Forefoot angular control, with a wedge placed between the ball of the foot and the ground is necessary to effect any significant change in function.
Research over the last 6 years has defined the specifics as they relate to optimal angular control during propulsive stage function and we now offer our Total-Control orthotics that clearly address the forces responsible for the abnormal biomechanics associated with running and cycling.
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