A Closer Look At Neoteric Biomechanics
- Volume 20 - Issue 9 - September 2007
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For years, it seems like the $5,000 bunion and pressures from HMOs diverted DPMs’ attention from biomechanics. The emphasis of our education and practices strayed from Root toward Ilizarov and coding. “Gold standard” orthotics cast from foam or “posted to cast” do not generate the pride and acceptance that a Root device once did for podiatry and our orthotic fees are less justified when compared to high-tech, over-the-counter footbeds and custom devices casted by other providers or over the Internet.
The solution is neoteric biomechanics, a school of functional lower extremity biomechanics based on the functional dynamic arches and the vault of the foot. Practicing Functional Foot Typing™ (FFT) allows clinicians to profile feet, before or after developing pathology, into one of 16 functional foot types. After classifying patients, DPMs can educate patients and treat their feet and posture.
After diagnosing patients, one can educate them and treat their specific foot types. Concepts like the inherited nature of foot problems, performance enhancement, pathology and deformity prevention, and improving quality of life become understandable and marketable to physicians and patients. One can prescribe, cast and fabricate functional foot type-specific orthotics, improving results while reducing failures and complications.
Understanding Anatomical Considerations With Neoteric Biomechanics
The foot can be divided into three sections: a rearfoot pillar, a forefoot pillar and the digits. The 33 joints in the foot can either stabilize the bones or move them within ranges of motion. Muscles insert into the bones as tendons and provide leverage, mobility or stability as they contract and expand. The rearfoot and forefoot pillars can function as separate units or they can unite at their apex (or keystone) as an arch to be supportive. In different feet, one or both pillars can be rigid and supportive, flexible and adaptive or any combination of the two. This is why foot typing is so critical before rendering care to any group of patients.
In his pioneering work, Root observed the foot in gait.1,2 His biomechanical theory focuses on subtalar joint (rearfoot) pathology and control. Since Root’s work, advances in functional lower extremity biomechanics have focused on rearfoot control in order to diagnose and treat feet, and the success and failure of their orthotics and biomechanical care is monitored by gait evaluation.3-7
Neoteric biomechanics goes beyond Root because it takes into account that there are so many daily functions that do not involve rearfoot first loading. Consider static stance, backward movement, side to side movement and up and down movement using Root theory, and you will begin to see where it needs upgrading. Neoteric biomechanics allows one to diagnose and treat patients for living, not only as they move forward from point A to point B.
Root’s followers take a subtalar neutral non-weightbearing cast and then post the rearfoot in varus, rarely adding any modifications or postings to the forefoot of their orthotics. This technique often fails clinically due to the inherent variations of feet and their myriad demands. Neoteric biomechanics expands the diagnostic and treatment capabilities of practitioners of biomechanics by using language and concepts that are teachable and easily understood by the public and the medical community.
What Are The Key Tenets Of Neoteric Biomechanics?
Historically, there have been attempts at profiling and classifying feet for foot type-specific diagnosis and treatment. The low, medium and high arch types, the Greek foot, the French foot and the Morton’s foot as well as Hiss’s classification system for feet have failed to achieve mainstream recognition and application.8 In Valmassy’s 1996 text on biomechanics, Scherer wrote a chapter introducing a classification system for typing feet into one of nine foot types.9 This system served as the seedling for neoteric biomechanics. The Scherer classification system has been modified and upgraded into a system known as Functional Foot Typing, which has been accepted for U.S. patent consideration.