Treating FHL: Why It's Essential For Orthotic Success

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Q: What success have you found which surprised you the most and what outcomes most surprise your patients?
A: “It is the broader postural benefits which have impressed me and my patients the most,” offers Curryer.
He continues to have success with the usual foot-related symptoms but has also seen an increasing number of referrals for patients with chronic postural pain.
Curryer treats them with the SPF model, in conjunction with physiotherapy and massage therapy, and usually resolves between 50 percent and 100 percent of these issues.
Curryer says most of his patients have been getting physiotherapy and massage therapy and/or chiropractic care with no long-term resolution. He adds that most of them have been wearing conventionally-prescribed foot orthoses for many years. Simple application of SPF principles and slight changes to physiotherapy treatments to adjust asymmetries and other problems have proven themselves clinically time and time again, according to Curryer.
Dr. Williams says both he and the basketball player were pleasantly surprised by what happened in his case.
“He’s really pleased with his outcome and he has ordered two extra pair of orthotics,” notes Dr. Williams. “But I also am amazed at how much difference the first ray cutouts for Fhl make in working with patients who have chronic low back pain and other postural conditions.”
Once the first MPJ can dorsiflex as necessary, all patients experience increases in their hip extensions, allowing them to propulse more efficiently and more powerfully, according to Dr. Williams.
When he does video analysis, Dr. Williams uses an overhead camera to watch for arm swing difference and body rotational compensations. Every time he does the “after” video, after modifying a temporary orthotic for a patient with a first ray cutout, et. al., the patients always move backwards on the treadmill. The “before” video usually shows them right up on the front of the treadmill by the controls.
Dr. Williams says after patients have the first ray cutout for their Fhls, they get much more extension immediately and they have to back away from the control panel so they won’t walk into it. “It is really amazing,” he says.

Final Notes
“This is a complex area to debate,” adds Curryer. “I have found that it was only through extensive personal research and practice that the principles and benefits of this mode of treatment became clear. Unfortunately, it appears there is still a poor comprehension of newer biomechanical models and their clinical application in the schools and the broader podiatry population. This seems to be improving slowly but still appears to be generally misunderstood, if known about at all.”
Dr. Dananberg (pictured) practices in Bedford, NH. Mr. Curryer is in private practice and is an orthotics consultant for Health Canada. Dr. Ocker has a private practice in Upland, Calif. Dr. Williams practices in Merrilville, Ind.

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