What is Your Child's Foot Type?

Our sports medicine society puts far too little importance on the issue of foot-type. Each and every foot has a unique personality, and can be defined in one of 3 categories; pronator, neutral (normal) or supinator. The running shoe industry has created shoes specifically for each foot type, and it should be part of every young athlete’s examination profile to know what shoe type is appropriate for the best injury prevention program possible.

Figure 1

Figure 2

In an effort to improve our “reactive” sports medicine industry (only treating athletes after they become injured), it’s important to look at all athletes, regardless of age, from a biomechanical perspective and make corrective recommendations in an effort
to reduce future injuries.

Each foot has 3 arches (Fig. 1). If one or more of these arches have “fallen”, or are not doing their job, there will be a domino-like effect up the entire structure (Fig. 2) producing increased demands on one or more areas of the body (muscle, tendon &/or joint). Secondly, the standing foot type can be different than the dynamic foot type (running), therefore, it’s important for a trained shoe specialist to determine what the dynamic foot type is so that the proper shoes can be recommended.

The standing foot type can be determined through digital scanning (Fig. 3) and appropriate recommendations will be made with regard to custom orthotics. As you can see in (Fig. 4), there is a difference between optimal foot support (strong arches) as compared to a foot with one or more weakened arches. In almost all people, there will also be a difference and imbalance between the left and right foot.

Standing foot type can be addressed and corrected rather easily. As we can see, there is a tremendous difference in full body alignment once custom orthotics are recommended. There is a mere 2 minute difference between picture one (without orthotics) and picture 2 (with orthotics).

CONCLUSION

Understand the importance of a full biomechanical exam (including foot type) on all athletes, regardless of age. Biomechanical x-rays are recommended for those 12 and older, but custom orthotics are recommended for those 7 and older. Specific shoe types should be considered for all athletes 7 and older, and bring custom orthotics to specialty shoe store when purchasing shoes (running, basketball, soccer, etc.).

100% of My Patients Get Custom Orthotics What about Yours?

Click here to read this article that was published in the American Chiropractor August 2011.

Orthotics for Everyone?

by Timothy J. Maggs, DCIssue:December 2005
Chiropractic Products

Whether to function under a medical or biomechanical model is your choice

This afternoon, I met with eight-time National Basketball Association all-star Michael Ray Richardson. Michael Ray is taking over the head coaching position of the Continental Basketball Association’s Albany Patroons, while I’ll be providing Structural Management® to the team. In our meeting, I was asked exactly what it is that I do:

“The traditional services provided by a team doctor are to wait until a player is injured, then make the best recommendations possible,” I answered. “That makes no sense, especially when there is a wealth of biomechanical information available on all players right now that will help to determine their unique weaknesses and imbalances. Once we determine each player’s weak spots through our Structural Fingerprint®™ Exam, we can then set up a good proactive program to get all the players doing things that will help their balance, joint mobility, and muscle flexibility. This will dramatically reduce injuries during the year.”

His response was one that every sports-minded chiropractor would love to receive: “I need to set up a meeting with Kiki Vanderweghe and get this program into the Denver Nuggets’ locker room.” Now, for those who don’t know, the Denver Nuggets are a National Basketball Association team, and Kiki Vanderweghe is its general manager.

I can’t imagine any fewer words a chiropractor could say that would get a response as electrifying as that. If chiropractic had the ability to excite key people in sports and industry the same way I happened to in this conversation, we certainly would be in loftier positions in the health care food chain and would be seeing a whole lot more than 6%–8% of the population.

The response from Michael Ray is the same one we get from almost all parties we now meet. The need for Structural Management® is critical, yet it is absent in our modern-day health care system. The medical model is everywhere, despite the fact that everyone would love to learn how to preserve their structures so they can enjoy their lives injury free.

Where to Begin?
I’ve written quite a bit about the need for chiropractors to stop functioning under the medical model of care, especially if we want to fully realize this profession’s potential in our lifetime. Adjustments should not replace pills. Adjustments should be a spoke in the wheel of the necessary tools to keep a person healthier. Our profession truly needs to learn how to articulate this message to our community, because if we do, we will be busier than we have ever wanted to be.

Just last week, I was the guest speaker at a sports information night at one of the larger local high schools. Approximately 800 parents were present. I emphatically told them of the void in good-quality structural care for middle- and high-school athletes in this country. These kids go through medical tests (eyes, ears, nose, and throat) to determine if they are healthy enough to go into the weight rooms and participate in their sports.

The response was overwhelming. I ended the talk telling the parents that their school is now endorsing our Structural Management® Program, and it all begins with our Structural Fingerprint® Exam. This exam consists of a foot exam for foot type; a knee exam for Q angle; range of motion, stressing the key joints of the body; muscle tests, and standing x-rays of the neck and low back. The final test is a digital scan of the feet to determine if the body weight is evenly distributed right versus left. This information is invaluable for determining where the vulnerable and weak spots are on an athlete. We invited parents to fill out an application, and then we would contact them to set up this exam for their children. Within 24 hours, we heard from more than 30 families.

The exams were set up, and the appreciation by the parents was exactly what we’d hoped for. These parents have begged to have someone tell them something that makes sense regarding the injuries their children are suffering. Most of the kids examined have foot imbalances, knee imbalances, and many biomechanical abnormalities that will certainly predispose them to a greater likelihood of injuries, as well as a greater vulnerability to degenerative changes as they age.

How to Use the Test Information
In our office, we offer two products: The Structural Fingerprint® Exam and The Advanced Conditioning™ Program. A patient can purchase either one or both of these programs, but there is no obligation to purchase both. We encourage people to go through the examination, because understanding their structural status is invaluable in many ways, whether they elect to do anything about it or not. Once we have this information, we then design a plan tailored to their needs.

The very beginning of this plan includes the use of custom-made, stabilizing orthotics. Our goal in this program is to improve structural balance, joint mobility, and muscle flexibility. Many doctors use pain and symptoms as their benchmark; however, that superficial goal provides an artificial “correction” to the patient, as most people believe if the pain is gone, they’re healthy.

Most imbalances begin in the feet. We’ve found that approximately 80% of the population pronates (flat foot) with one or both feet. Either way, this produces a postural distortion pattern every time the patient stands up. We’ve also found that 10% of the population has reasonably normal arches, while the final 10% has supinated, or high, arches. This doesn’t take into consideration any of the other biomechanical measurements we look at on our exam, such as Ferguson’s gravity line, the sacral base angle, pelvic balance on the A-P L-S x-ray, femur heights, the cervical lordosis, the atlanto-axial relationship, or the integrity of the disc spaces. Each and every one of these measurements is impacted by the integrity of the medial arches of the feet.

Pronation. This, theoretically, will produce an increased Q angle, but not always. In fact, sometimes we’ll find an increased Q angle with a supinated foot. However, in most cases, the center of gravity going through the knee is abnormal when the medial arch pronates. The human body is a compensating architectural structure, and pronation begins the very “shifts” that accelerate wear and tear at many levels of the structure. Custom-made orthotics begin the balancing process that all structures need to go through.

Normal arches. Many doctors think this is a ticket for dismissing a patient, as “nothing is wrong.” Au contraire. Keep in mind that this patient, if he or she is lucky enough, will go through the aging process, and two factors will influence his or her future.

The first factor is that medial arches of the feet weaken and fall as time goes on. When patients tell you their feet are growing, keep in mind that their medial arches are simply falling. As they fall, the biomechanics of the structure will go through negative changes. Imbalances accelerate degenerative changes, and falling arches will only pour fuel on that fire. Why wait for that to happen? Purchasing custom-made, stabilizing orthotics is a nominal fee to protect against this, and people are desperately looking for this information.

Second, the shock-absorbing qualities of the orthotic reduce the wear and tear going up through the structure. Over the course of one’s lifetime, this is huge.

Supination. These high, rigid arches have very little shock absorption for the structure. It becomes critically important to incorporate some shock absorption into shoes to protect against the acceleration of degenerative changes, and addressing this issue on the front end is always more cost-efficient and logical than addressing it on the back end.

Regardless of foot type, custom-made, stabilizing orthotics are the very beginning of the preservation process of everyone’s structure. The key is for the doctor to learn how to articulate this message to all patients, despite the fact that insurance will seldom cover the cost of the orthotic. Ninety-five percent of all patients in our office are fitted with custom-made orthotics as part of their program, and our area economically is no better off than most other areas in the country. It’s purely a matter of confidence and desire on the part of the doctor as to how much they’re willing to help the patient over the course of his or her lifetime.

Many chiropractors want to argue the fact that our profession should function under medical-model guidelines. Certainly, that system is already in place and available if those are your parameters. However, another “pain reliever” who wears a stethoscope around his or her neck is not what the world needs. Industry, sports, pediatrics, and geriatrics are all begging for someone, anyone, to teach them how to preserve their structures and protect against injuries. The medical-model approach will never be able to do that.

Structural Management® is the key; custom-made, stabilizing orthotics are a tool; and chiropractors are the most qualified to provide this level of care. It’s all about choice and how you want to help your community. And, should I meet with the Denver Nuggets’ Vanderweghe, this may be the entry into pro sports that will provide many more chiropractors with respected roles in pro organizations. CP

Timothy J. Maggs, DC, specializes in sports and industrial injury management and is a graduate of the National College of Chiropractic. He writes and speaks at numerous engagements.

Orthotics and Biomechanics

by Timothy J. Maggs, DCIssue:August 2005
Chiropractic Products

The first step in helping anyone preserve their structure is to recommend custom-made orthotics

Chiropractors who have been in practice long enough quickly learn that the medical profession is doing nothing to endear itself to the aching public. The medical-model approach (looking for pathology) makes little sense to the lay public. The costly approach to solving the riddle of back pain (symptomatic relief) with many worthless tests just never feels quite right to any segment of the population. Ask employers how they like the current system, after paying such high workers’ compensation premiums for an aging, overweight, and out-of-shape workforce.

The sad fact is that no one in the medical community is looking at the patient from a biomechanical perspective. Human beings are architectural structures, yet it is virtually impossible for a person in our country to go into a medical office and ask his or her “specialist” for a personalized structural status report. Mechanics can tell you the status of any car you bring to them, and an engineer can quantify the value of a building or bridge. But try to find a doctor who can give a report on someone's structure, and you will probably have better luck finding a winning lottery ticket that’s been accidentally thrown away.

The Need for Biomechanics

Any human being who is seeking long-term wellness for their structure would do well to locate and work with a professional who can help them preserve their structure. “Preservation of the human structure” is a term not often heard in our current system, but it needs to be heard in an effort to reduce the amount of money currently spent on musculoskeletal breakdown, injuries, and symptoms in this country.

Appropriate 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), and the running shoe industry has even gone so far as to make specific shoes for specific foot types. So wouldn’t it make sense for doctors to alert the patient as to their foot type? With a low arch/flat foot (or flat feet), a motion-control shoe is recommended. This is the foot type of 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.

Two basic tests are 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.

See Figure 1, a DC prepares a patient for a digital foot scan, which will yield digital images of the feet, as Figure 2 illustrates.

The second method for checking foot types and identifying weight-distribution imbalances is with 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 visualization for the patient is extremely important when motivating the patient to take action. As you can see in Figures 1 and 2, digital scanning provides a wonderful visual.

The next test of concern is the Q angle of each knee. An increased Q angle is nothing more than a crooked hinge joint. The greater the imbalance, the greater the wear and tear on the knee. If neglected, over time, the likelihood for a knee replacement increases greatly.

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 are taken on all patients, to rule out pathology and look for biomechanical findings.

Figure 4 shows a center of gravity check using lateral x-rays.

Figure 3 shows a center of gravity check using anteroposterior x-rays..

There are multiple biomechanical findings that we look for on x-rays. First of all, we check centers of gravity, both anteroposterior, as Figure 3 illustrates, and lateral in the neck and lower back, as Figure 4 illustrates. Second, we check for positional abnormalities, such as reversal of the normal cervical lordotic curve, rotation of the pelvis as seen on the anteroposterior lumbosacral, or rotation of the axis in relation to the atlas.

When biomechanical imbalances and joint dysfunction occur for a prolonged period of time, the degenerative process accelerates. Trauma, repetitive motion, structural imbalances, and joint fixations lead to an acceleration of joint degeneration. When degenerative changes are found on the x-ray, the practitioner should determine the history behind the degenerative change. For example, when C5 alone is going through degenerative changes, it is clearly a fixation due to abnormal stresses at that level. When a joint other than C5 or L5 undergoes degenerative changes prior to C5 or L5, it is due to prior traumas that have been unresolved. A joint left “locked” or subluxated for an extended period of time will produce a premature degeneration of that joint space.

Lifetime Preservation

No profession is out there selling “preservation” of the human frame. Yet, think of the savings in the health care field if we can help preserve everyone’s neuro-musculoskeletal system. And, this savings is based upon individuals proactively doing what they need to do to preserve their structure.

The first step in helping anyone to preserve their structure is to recommend custom-made orthotics. In my office, since we do Structural Management® exclusively, 95% of our patients are fitted for such orthotics at the beginning of their programs. Regardless of whether they are covered by insurance or not, patients understand the role custom-made orthotics play in their future. There are different reasons why these supports are recommended, and there are different 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. Un-less 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.

Figure 5 shows that foot imbalances can lead to postural imbalances throughout the body.

If the patient pronates, it becomes obvious why custom-made orthotics are needed, especially if right and left are different. The “crooked man” image (Figure 5) clearly shows why imbalances in the medial arches of the feet have exponential implications in the structure above. In this case, the left foot pronates, leading to compensation in the knee, hips, and shoulders. This imbalance will clearly lead to other imbalances and premature wear and tear of joints. This obviously sets the patient up for an increased vulnerability to injury.

When the patient 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.

Options for Orthotics

The podiatric and orthopedic 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, produces an orthotic 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.

Scanning the Horizon

I use a digital scanning system, which educates the public that symptoms are not the issue; it’s biomechanical imbalances. In industry and sports—in most issues of postural health, for that matter— biomechanics is the key. The chiropractor is best suited to respond to these needs, but the chiropractor must be willing to “step up” outside the normal insurance guidelines to provide such help. In time, chiropractors will realize the benefits of this type of work.

Timothy J. Maggs, DC, specializes in sports and industrial injury management and is a graduate of the National College of Chiropractic. He writes and speaks at numerous engagements.

Up and Running

by Timothy J. Maggs, DCOrthotics Advisor
Issue: January 2005

The first step toward peak conditioning for any athlete is the body’s foundation—the feet

Timothy J. Maggs, DC

Anyone familiar with the running world will recognize the name George Sheehan, MD. He was a tremendous writer, philosopher, runner, and cardiologist who passed away in 1993 in his mid 70s.

During his illustrious career, Sheehan wrote of his many experiences and had the ability to articulate his feelings and emotions better than most. He wrote what all of us thought and felt, but just seemed to say it better.

Sheehan’s running career after college was halted and not considered again until he was 45 years old, when his desire to get back into the sport he loved sent him back to the roads. However, what he experienced was a series of physical breakdowns. From his writings, it is clear Sheehan suffered not only from his injuries, but also from the frustrations of not finding reasonable answers.

“When I began running, I was an educated specialist who concentrated on one area of the body. I was an expert who relied on other experts for advice. Serious running led swiftly to a series of foot, leg, knee, and low back injuries that threatened to end my newfound happiness back on the roads.

“I went dutifully to my specialist friends and found, to my surprise, that they were of little help. They were preoccupied with giving relief to my aching foot, my swollen knee, and my throbbing sciatic nerve. They treated the effect, not the cause. And, when I resumed running, back came my misery and pain. Clearly, I needed someone more sophisticated, some superspecialist. I had not gone high enough on the specialist ladder to find the wise man to help me. I soon discovered, there was no such wise man.”1

Little did Sheehan know there was a wise man. Little did he realize there was someone out there who could make sense of all he was going through and provide him with information needed to get back and stay back. Sheehan needed Structural Management®.

As he continued his journey to find happiness on the roads and solutions to his injuries, Sheehan learned what most are never able to find. He ran right up until his death, and that was only due to his persistence to find answers.

I receive hundreds of emails every month from athletes around the country, all of them looking for answers to their injuries, just like Sheehan. Most of them have gone down the path of conventional medicine, and many of them end up doing a search on Google or Yahoo for a superspecialist. Some end up at my site; others, who knows?

I often reflect back to Sheehan, as his pearls of wisdom would be advanced thinking today. In sports medicine and medicine, not to mention care for the masses, the methodology is based on the medical model of care. Sheehan wrote: “I am a cardiologist, but my relationship to sports medicine has been as an athlete rather than a doctor. What I have experienced as a runner and what judgment I have been able to bring to this experience as a physician has convinced me that traditional medicine is not dealing adequately with athletes’ problems.

“In more than 10 years as a distance runner, I have experienced almost every injury of the foot, leg, knee, thigh, and back. During this time, the medical profession has only been able to provide me with symptomatic relief.”1

Structural Balance
The reason Sheehan wrestled with his medical care was because his desire to run exceeded his loyalty to medicine. He could see firsthand that athletes, and all people for that matter, could not get credible or logical care for their structural injuries. What medicine was offering just did not make sense. So, he looked and looked, desperate at times, and at some point in his life, reached peace, as he found some form of solution.

“The human body is a marvelous instrument. When in perfect alignment and balance, there is almost no feat of endurance the body cannot handle, even on a regular basis. However, structural imbalance of even minor degrees can result in incapacitating injuries and persistent disabilities.”

The Starting Point
As with any structure, the foundation is the key to the overall balance. To address any musculoskeletal issues, the feet must be considered. Knowing that 80% of the population pronate, 10% supinate, and 10% are normal should encourage any health care provider to first look at the feet when addressing neuromusculoskeletal problems.

“It wasn’t until I came under the care of a podiatrist that I was able to run for prolonged periods and be free of foot, leg, and knee difficulties.

“This convinced me that no matter what an athlete’s problem is, we should look first to the feet as the source of the problem. The foot is an architectural marvel—an engineering masterpiece that has 26 bones, four times as many ligaments, and an intricate number of tendons that act as guy ropes or slings for the arches.”1

Sheehan evidently improved greatly with the introduction of orthotics in his shoes. What he was never able to do was combine the use of custom-made orthotics with structural correction. He never had the opportunity of having his biomechanics above his ankles examined. If he had been provided this, he certainly would have minimized all his years of complaining. And, had he been examined prior to any of his breakdown, he might have even eliminated all of his heartbreak and frustration, having to look for that superspecialist.

If Sheehan were alive today, there is no doubt he would be an advocate of structural examinations and corrections. He would be a vocal proponent of this approach to all athletes. In 1975, Sheehan had the guts to tell it like it was. Here we are, 29 years later, and his words still ring true.

“I cannot emphasize too strongly that most athletic injuries are structural, almost architectural, not medical. You would be better off in the hands of an engineer than a medical doctor when this type of injury occurs. At least you would not have your problem complicated by medication that in the long run will do no good. What the runner needs is to be restored to structural balance.”

The Structural Fingerprint® Exam
This exam begins with the feet and considers structural balance, joint mobility, and overall flexibility. The feet dictate the course of action taken. If there are imbalances, areas of increased wear and tear, and chronic injuries that do not respond to care, custom-made orthotics are indicated.

Secondly, the type of custom-made orthotic is important. There are at least two benefits that should be considered with custom-made orthotics: 1) symmetry of the medial arches; and 2) shock absorption. With rigid orthotics, shock absorption and normal foot mobility cannot happen. Flexible orthotics are preferred when full biomechanics are considered.

With this comprehensive exam, it does not matter if patients have symptoms or not. The goal is to evaluate athletes, employees, and people in general long before symptoms occur. Why should we have to wait for people to break down before we see them? And, why should our only goal be to get them out of pain? Our current standards of care are inadequate, and until we re-educate our communities to get structurally evaluated and proactively work to improve, we can never hope to reduce the current suffering that exists out there.

The standards should be maximum structural function, not just the relief of symptoms. This can only happen with structural exams before injuries occur, and the willingness to rehabilitatively improve distortions, even in the absence of symptoms. For this to ever happen, re-education can never stop.

On a final note, the Chicago Bulls, as well as many other professional teams, have all players fitted for custom orthotics at the beginning of each season. Do you think they know something the rest of us don’t know? CP

Timothy J. Maggs, DC, specializes in sports and industrial injury management and is a graduate of the National College of Chiropractic. He writes and speaks at numerous engagements. Maggs can be reached via email . or via his Web site:www.drtimmaggs.com.

Reference
1. Sheehan G. Dr. Sheehan on Running. Mountain View, Calif: World Publications; 1975:204.

Dr. George Sheehan The Greatest Visionary Ever

© 2003 Dr. Tim Maggs

Many runners have gruesome stories of injuries and their nasty “quest back” to running. Me included. It took me 8 years to solve my condition, and I’m supposedly a specialist in sports injuries. Getting injured is one thing, but trying to find a doctor who knows about the injury is another. Today’s industry is so focused on illness, pathology and disease that it’s virtually impossible to find a doctor who understands the importance of structure and the architecture of an athlete. Yet, structure is the key when talking about most running injuries. Just yesterday, I had a runner with low back pain come in and tell me he’s been to 2 chiropractors and 4 orthopedists over the past 6 years, and none of them have yet to tell him what his injury is. Well, none of them have done a structural exam on him either, and he’s still injured. What a surprise.

In 2001, the New England Journal of Medicine published an article on low back pain, stating that 85% of the time it was near impossible to detect the exact cause of low back pain. Therefore, pain killers and anti-inflammatories were the best that could be done. In 2002, the Annals of Internal Medicine did another story on low back pain and imaging, and stated that less than 3% of all low back pains were due to pathology (disease), and 97% were due to mechanical distortions.

Well, if this is the case, (and it is), then why are our pathological doctors suggesting they are the experts on mechanical disorders, which they know nothing about? The very thought that 28 years ago, Dr. George Sheehan wrote his thoughts on running injuries loud and clear in his book, Dr. Sheehan on Running, pleases me to no end.

Over 2 years ago, I wrote an article on building a national sports doctor network. That dream is becoming more of a reality everyday. My vision of having a structural specialist in every community in this country is getting closer. When this day arrives, the overwhelming incidence of injury in runners will go down drastically, as well as the costs that are spent on needless tests looking for pathology and symptomatic treatments that hide the real cause. Race directors, get ready. When this day arrives, you’re the ones who will have to handle the massive crowds. What a great day that will be.

And, to think, Sheehan knew all of this back then. What a genius.

“When I began running, I was an educated specialist who concentrated on one area of the body. I was an expert who relied on other experts for advice. I soon needed it. Although my ancestors could run forever, my limits were quickly reached. Serious running led swiftly to a series of foot, leg, knee and low back injuries that threatened to end my new found happiness on the roads.

I went dutifully to my specialist friends and found to my surprise that they were of little help. They were pre-occupied with giving relief to my aching foot, my swollen knee and my throbbing sciatic nerve. They treated the effect, not the cause. And, when I resumed running, back came my misery and pain. Clearly, I needed someone more sophisticated, some super-specialist.

I had not gone high enough on the specialist ladder to find the wise man to help me. I soon discovered, there was no such wise man.”

“I am a cardiologist, but my relationship to sportsmedicine has been as an athlete rather than a doctor. What I have experienced as a runner-and what judgment I have been able to bring to this experience as a physician-has convinced me that traditional medicine isn’t dealing adequately with athlete problems.

In more than 10 years as a distance runner, I have experienced almost every injury of the foot, leg, knee, thigh and back. During this time, the medical profession has only been able to provide me with symptomatic relief.

It wasn’t until I came under the care of a podiatrist that I was able to run for prolonged periods and be free of foot, leg, and knee difficulties.”

“This convinced me that no matter what an athlete’s problem is, we should look first to the feet as the source of the problem. The foot is an architectural marvel-an engineering masterpiece that has 26 bones, four times as many ligaments, and an intricate number of tendons that act as guy ropes or slings for the arches.

When these components are perfectly balanced, the foot can handle almost any amount of work. However, even a minute deviation from normal can cause adjustments that will eventually produce injury either in the foot, or in its supporting muscles and tendons, or even in the structures above.”

“The human body is a marvelous instrument. When in perfect alignment and balance, there is almost no feat of endurance the body cannot handle even on a regular basis. However, structural imbalance of even minor degrees can result in incapacitating injuries and persistent disabilities.

Prevention and treatment of musculo-skeletal injuries in the athlete, therefore, rests in the establishment of the structural balance and architectural integrity of the body-and its re-establishment should injury occur.”

 “I cannot emphasize too strongly that most athletic injuries are structural, almost architectural, not medical. You would almost be better off in the hands of an engineer than a medical doctor when this type of injury occurs.

At least you would not have your problem complicated by medication that in the long run will do no good. What the runner needs is to be restored to structural balance.”

If George were here today, I’d assure him his vision is alive and well.

Custom Orthotics Why, How and When

By Dr. Tim Maggs
© 2002

Many runners currently have one or more pairs of orthotics. Custom made orthotics are typically an investment made during some desperate phase of life that usually involves a chronic injury. This desperation is oftentimes met with less than successful results. In spite of this fact, most runners would benefit from orthotics, but the success comes when they are purchased before being injured. And here’s why.

First of all, custom orthotics are not just for runners with foot problems. The feet are the foundation of our entire structural system and are the sole or contributing cause of many structural problems. So, if you’re suffering with low back, hip, hamstring, calf, sciatic or other problems, even upper body, your feet will usually be involved. If we don’t balance and stabilize the feet as our primary goal, we limit the potential benefits when attempting to correct and balance our structures.

Generic orthotics that can be purchased “off the shelf” have limited benefits. Just as you would never think of wearing some generic running shoe from “off the shelf”, don’t be cheap when it comes to one of the more important decisions you’ll make involving your running life. Your foot is made up of 26 bones, 33 joints plus 126 ligaments, muscles and tendons. Your running longevity will be greatly impacted by keeping your feet happy.

So many patients of mine resort to buying orthotics only after injured. With a pro-active, instead of reactive, management of the structure, many of their debilitating injuries could have been prevented. Keep in mind, my goal is to help runners stay running, and if injured, to get back to running. Again, paying now is always less than paying later.

Foot Exam

The examination of the foot is a great place to start when concerned about the structure. With the athlete in the standing position, a simple “fingers under the mid-arch” test can be done. Both feet should have a similarly high arch, so that a good chunk of fingers can make it under the arch. If the feet are flat, different in arch height or have excessively high arches, custom orthotics are imperative.

A study of shoe wear should be done next. Keeping life simple, just look for different wear patterns on the base of the two shoes. If they exist, orthotics will help. Third, look at the runner from behind with no shoes on. If the achilles tendons bow or bend due to pronation of either foot, this adds to the urgency for orthotics. If either toe points in or out when standing, think orthotics. Finally, upon standing, note the center point of the knee cap, and then the bump on the bone (tibia) just below the knee cap. They should be almost in line with each other. If the alignment between the two points is more than a ¼” off, make sure you note this.

When deciding what type of orthotics to buy, here are a few guidelines. Some doctors recommend rigid orthotics instead of softer orthotics. A rigid orthotic has limited value, as it is designed to treat the foot as an independent part of the body. With running, this type of orthotic has no give, which is necessary for normal foot motion. There’s also no shock absorption in the orthotic, so the foot, leg and low back must absorb all shock. (Bad idea!) The foot is unable to move in a complete and normal manner due to the restriction of the orthotic, altering the normal motion relationship between the foot and the rest of the body.

A softer orthotic will allow the foot to move in it’s full range of motion while providing shock absorption in the heel with each foot strike. Some orthotics have better shock absorption than others, and this is an important feature to look at when deciding on which orthotics to buy.

The method used to get fitted for your orthotic is important too. Many doctors use the neutral casting method, which casts the foot in a non-weight-bearing position. The preferred method is to have the foot evaluated and casted in a weight-bearing position so the influence of gravity can be considered.

Conclusion

Custom orthotics are the very beginning of learning more about your biomechanical system. The foot is the foundation of your entire structure, and imbalances in the low back, neck, hips and entire muscle system can certainly originate from the feet. If attempts are made at correcting any structural condition without first considering the feet, the benefits will be limited.

So ask you doctors for a complete structural foot exam in the standing position with an evaluation of the wear patterns of your shoes. This should be done at least once a year on all athletes. Finally, if we could ever get all sports docs to include standing x-rays of the low back and neck and make specific structural recommendations, we'd be well on our way to a national network of help for all injured athletes. Ah, to dream.