Mid and Rear foot Control
Because Dr. Root basically described the foot in terms of fallen arches and hypermobility of the heel, it was logical to focus on the mid- and rearfoot when trying to stabilize the foot. Arch supports help prevent the arch from collapsing when standing. Heel cups contribute to stabilize the heel and heel posts can bring the subtalar joint into its neutral position.
Mid- and rearfoot support is predominantly effective when standing (static support). The support quickly diminishes as the weight transfers across the midfoot to the forefoot. As the heel lifts off the ground during normal gait, mid- and rearfoot orthotics become ineffective. Mid- and rearfoot control provides only a partial correction for hyperpronation.
Dr. Rothbart has demonstrated that in people with flexible feet, the motion of the entire foot, including the heel, can be controlled by proprioceptively ‘supporting” the forefoot . Supporting is placed in quotes because this is a dynamic system rather than a passive support system. (see 30-70 Rule).
The advantage of forefoot control is twofold:
- Hyperpronation is controlled throughout the entire gait cycle (dynamic support).
- Forefoot control dimensions are small which creates a less bulky insole.
Controlling hyperpronation through the entire gait cycle produces significant postural changes in the body, and a less bulky insole offers high patient compliance. Even a significant hyperpronator is able to place a Posture Control Insole™ (PCI) offering the desired correction inside a “normal” pair of shoes.
The kinesthetic feedback loop established by ground forces positioned under the medial column of the foot reduces hyperpronation without the need for bulky arch supports and heel cups. For patients with flat or near flat feet, a modest amount of arch support enhances the PCI function.