Our feet are the foundations that not only support our physical frame, but also maintain our stability and balance throughout all different kinds of movements and demands. Before they can gain full competency to do their job, they need to be conditioned. This conditioning happens in the first five years of life, when it is essential for children to be bare footed as much as possible so the tactile contact with the ground trains their feet. Not only the the muscles and the joints are challenged and strengthen with bare foot walking, the brain and the nervous system have a chance to establish muscle and joint memory for a powerful gait and balance in space.
Unfortunately, we are put into shoes too early in life and the arches of our feet do not become fully conditioned. Inadequate mechanical and neurological stimulation of the feet leads to some degree of over-pronation (flattening) of the arches. Since, most of the time, the foot on one side over-pronates more than the other side, our structural base becomes tilted. The foot on the side with more of a fallen arch will experience bending of the ankle and inward rotation at the knee.
The pelvis commonly drops down on the same side of greater fallen arch and this will begin changes in the vertical alignment of the spine, inducing a chain of asymmetrical muscular tension and imbalance. The patterns that each person adopts introduce weak spots in the main frame of the body and will predispose that person to predictable physical wear and tear, injury and expedited degeneration at those areas. Of course, when we are young we don't feel the effects grossly, but the cumulative stress catches up with us when we are older.
For example, when arches of the feet are developed and maintained adequately, the normal pattern of ambulation is such that, after the heel strikes the ground, the foot rolls on its outer aspect before our toes, specially the big toe, engage in pushing us off the ground and forward. But, when the arches have lost adequate shape and strength, after the heel strike, our foot roll inwards and the toe push off happens at the inner side of the base of the big toe.
This overtime leads to developing bunions, which are calcium build up at the inner base of the big toe in order to provide mechanical support for the stress that being place on them.
Other issues that can arise from asymmetrical fallen arches is the bending of the ankle and torsional strain in the knee on the same side. When the foot over pronates and ankle bends in, the knee turns inwards. This internal rotation causes the forces that are transmitted from the ground upwards and weight bearing downwards to place greater stress on the inner knee joint structures, often leading to medial meniscal tears.
Further up in the body, at the pelvis, a downward tilt is induced most commonly on the same side as the greater fallen arch. Such unleveling of the pelvis impacts the spine and the upper body. The lumbar vertebrae will have a tendency to bend towards the low side and may lead to functional scoliosis. Of course the body will attempt to compensate, however, these compensations cost us stress at various part of the body and produce a pattern of muscular imbalance that eventually lead to greater wear and tear, degeneration and faster aging.
Ultimately, the long term care and correction requires wearing custom orthotics that are specifically casted for the functional arch of the feet. There are three ways to cast for the arches:
1. Non weight bearing- casting is done with plaster tapes wrapped around the feet and the hardened mold sent to lab for fabrication. This method takes an impression of the anatomical arch, the arch we have without any pressure placed on it by our weight. Patients often find orthotics made in this fashion to be feel rigid and uncomfortable. This is due to the fact that these orthotics do not allow for normal, small, pronation of the arches which act as a shock absorber. Orthotics made in this fashion also do not correct the tilt in the pelvis.
2. Full weight bearing- casting is done with the patient standing up and stepping into a foam cast, one foot at a time. From a biomechanical perspective, this method works better than the first one in providing a better and more comfortable arch support, however, the pelvic corrections are not complete. This is due to the impression being taken at full stress on arches that have lost their full integrity.
3. Semi weight bearing- casting is done with the patient seated and the Doctor guiding and applying pressure into a foam cast with the patient extending the big toe in order to lock the functional arch in place. Orthotics made in this fashion not only provide the best fit and contour for a comfortable and well supported ambulation, but also have the maximum effect in reducing torsion at the ankle, knees and leveling the pelvis.
Dr. Bina adheres to the third method above when he casts his patients for custom orthotics. For more information please call our office at (610) 642-4400.