Two methods of orthotics production

TWO METHODS OR WHY ORTHOTICS ARE NOT HELPING

In the modern world orthopaedics the understanding of the fact that position of all above-located structures of skeleton-muscular body carcass depends on feet correction – this understanding is not developed. Note that these structures sustain the processes of cellular metabolism. Despite that individual orthotics are customary called “orthopaedic”, they could not be attributed to medical articles and could not be considered as affecting the functionality of human organism. Theories that deal with feet correction, as well as methods of making orthotics, are not based on biomechanics’ knowledge. In essence, there are no methods for feet diagnostics and feet correction. There is no connection between the results of diagnostics and the ideas and patterns of orthotics manufacturing process. For example, when technical articles are manufactured, the draft is used. It is the base for production and for articles’ quality control.

Nowadays negative and indifferent attitude to orthotics is observed among population. Also the doctors themselves are saying that orthotics do not eliminate the feet deformations. All this signifies the resulting conclusion – there are no means to assist in elimination of joints’ wearing out, in dealing with spinal cord deformations. Besides, there are apparently no means for regulating the internal organs’ functioning and for eliminating inflammations and pain sensations. These sad facts correlate with data on feet deformations’ increasing for population of developed countries. This number soared from 4-7% to 85-97% within last 50-60 years.

Physiology views the pump function of skeleton muscles as the foundation for sustaining cellular metabolism of the entire human organism. This pump function is distorted because of deformities in structures of skeleton-muscular body carcass. In addition, possible malfunctions in lymph pumps and venous-muscular pumps must be taken into account.

To investigate mistakes and misunderstandings – the reasons for impossibility to use modern orthotics as feet correctors, – it is important to clearly understand what exactly the deformation is. Not going very deep into the theory of biomechanics, we introduce as axioms the fundamental definitions of deformation.

1. The disturbances in contractile pump function of skeleton muscles.

They have to be considered as fundamental disturbances, while reflecting the physiological essence of organism’s vital functions. And exactly on restoration of muscles’ pump function all the efforts of orthopaedics must be directed, particularly the activities on feet and spinal cord correction.

2. Displacement of GCG of human body with respect to CG for feet support triangle.

In this case it is necessary to view interconnection of deformations of feet’s support arches with spinal cord deformations. It is also important to consider the presence of distortions in kinematics of joints’ bones conjugation.


3. 
Displacement of skeleton from middle-balanced (neutral) position.

This effect may take place as the result of disbalance in forces – forces of load and muscles forces that hold and sustain the skeleton position. In this case it is necessary to take into account the external load, namely the body’s GCG position and muscles tone.

All three definitions are interconnected and, at the first glance, independent. But it is not possible to restore the muscles’ pump function without bringing the skeleton into neutral position. Yet neutrality of position can only be gained by bringing body’s GCG to coincide with CG of feet support triangle. In other words, correction is the implementation of all three interconnected issues. Their essence constitutes: main component of deformation appears to be the external load, the point of its application (i.e. the position of body’s GCG), that muscles accept and compensate. These are just the parameters that are considered in designing and calculations of details for artificial limbs and prosthetic appliances (orthotics are attributed to this group). Naturally, doctors do not possess knowledge of these categories and they couldn’t impart to orthotics those properties that assist in feet functionality restoration.

At present, professional orthotic makers deal with the feet skeleton and up as far as knees. The fundamental parameters – load and direction of its action couldn’t be taken into account in this case. Neither conditions are created for bringing skeleton-muscular feet carcass into neutral position under the load (this affects muscles development and their pump function). Another extremely important parameter – difference in legs’ lengths – is not considered either. Not only feet and joint deformations are connected to this difference, but also position of the hips (their inclination would be the reason for scoliosis posture). Doctor does not know the kinematics of skeleton elements’ movement, how skeleton is rebuilding and how its functionality is changing within each of five distinct phases of stepping cycle. For these reasons, rigid support is routinely placed under internal foot arch (this deprives the foot of possibility to amortize, to extinguish velocity of stepping foot). Furthermore, the support feet arches are not the objects for correction, the skeleton is placed not on the support points. Everything abovementioned leads to development of even more complicated deformations than initial ones. Substantial disturbances in the entire support apparatus inevitably follow as well.

The very process of taking feet imprints is full of errors – being performed in sitting position or in recumbent position, not taking into account any load or position of body’s GCG with respect to feet support points. To manufacture the orthotics itself using imprints (negatives), the entire sequence of technical operations is still routinely needed. At the end of the day, one can only wonder about the original feet problems, and sometimes even doubt which orthotics is for the right foot and which is for the left. Thus, there is no end to mistakes and misgaps. It would be sufficient just to state that no correction can take place if the load and its direction are not taken into account, if load is not compensated by the muscles, and if skeleton is not brought to neutral position. But regrettably, it is how orthopaedic specialists all over the world are working these days.

There is another technology available which differs in principle from currently existing technologies. We speak about so called “method of hydrostatic correction” for skeleton-muscular elements of the entire loco-motor system. While standing on the pillows of communicating vessels, the human body takes the stable vertical position (under this condition the difference in lower limbs’ lengths is compensated). Furthermore, body’s weight (load) is assumed by feet’s skeleton-muscular carcass; the load is evenly and uniformly distributed over support surface of feet soles and compensated by Pascal forces (these forces of hydrostatic pressure always act in the direction from bottom up). Force of weight (load) and Pascal hydrostatic force are equal in magnitude, which fact prompts the skeleton to take and keep neutral position. In this case the foot imprint represents the anatomical copy of corrected foot, supplemented by elements of stabilization and amortization of foot support arches. Exactly this imprint is reliable information source for feet diagnostics, for revealing the character of deformation – heel bones location, difference in legs’ lengths, proper heel-piece height that secures neutral position of feet arches (arches are supported by their own three basic points).

Everything that was described permits to manage such complicated deformations as hyperpronation of subtalar joint, deformities in transversal arches and toes, pain sensations in heel-bones and joints, scoliosis, varicoses, diabetic angiopathy and many other disturbances routinely considered unavoidable.

It is worth to underline that one and the same professional – orthopaedic technician – must be responsible for diagnostics, for feet and spinal cord correction and for orthotics manufacturing.

This specialist must be confident in reasons for discrepancies in skeleton symmetry, must know how to define anatomical and functional difference in legs’ lengths. Moreover, this orthopaedic technician must be able to balance the skeleton on the pelvic level, to correct the spinal cord. The great asset would be the knowledge of how body’s GCG might be brought to CG of feet support triangle, and how load on feet arches could be compensated. Only using such pattern of approaching the patient’s problems, it is possible to state that orthotics are doing no harm to patient, that they are solving correction problems for body’s skeleton-muscular carcass and contributing to restoration of cellular metabolism. But for time being doctor determines the diagnoses, then laboratory technician who had never seen the patient, makes orthotics. Orthotics are not adjusted and their influence on human organism is never tested in any way.