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Improving Your Musculoskeletal Health... Starting With Your Feet

The Basic Process

The Basic Processes

Initial Patient Evaluation

To determine if the patient should be evaluated for PCIs, check the patient’s shoes for uneven heel wear, and if confirmed, check for Morton’s Foot Structure (deep first web space).

Posture Dynamics has developed a form for evaluating, managing and tracking the patients.5


See Forms Section (in the back) to find full size copies of these and other patient management forms.

Record subjective musculoskeletal findings (symptoms). These symptoms may be presented by the patient in the form of specific complaints about pain. Other subjective findings may be recorded in conjunction with the treatment the patient is undergoing.

Record objective postural findings. The evaluation form prompts these objective findings which are organized in two categories, red and blue (see forms section).

Complete the Appraisal based on the objective findings.

Present the Plan of Action to the patient.

Record Objective Findings

The objective findings are recorded while observing the patient walk, stand and bend their knees.

With shoes off, have the patient walk (enough speed to be stable) a distance of 10-15 ft. in a straight line. The patient’s head should be looking forward, not down at the feet.

Check each item on the form:

  • How severely are the feet pointing in or out, or are they straight?
  • Is the patient drifting or walking straight? 
  •  Is the patient symmetrical or asymmetrical?

5 These forms are available printed in color from Posture Dynamics, or may be copied from the back of this manual, or from the CD (Process refers to Red & Blue Objective Findings).

  1. With the shoes removed, have the patient stand upright in a normal, natural, comfortable posture with the arms relaxed along the side. Have the patient nod the head forward and back a few times to reset the postural proprioceptors, stopping with the head level. Observe the patient’s posture.

Check each item on the form:

  • Is the head over the spine or shifted forward?
  • Are the shoulders straight or rounded and shifted forward?
  • Is the back straight or swayed (pelvis rotated forward)?
  • Are the thumbs pointing forward or inward?
  1. With the shoes removed, have the patient stand naturally, feet about 10-12 inches apart and parallel. If unsteady, the patient may face a wall close enough to touch the wall for support. Tell the patient to keep the upper body straight (up and down) and look straight forward while bending the knees just until the heels start to lift off the floor. (no squatting)

Explain to the patient that you are observing the ankles. Ask the patient to allow their body to move freely and naturally as they bend their knees.

Check each item on the form:

  • Are the ankles remaining straight, or are they collapsing inward when the patient’s knees are bent?
  • Are the patient’s knees tracking straight over the feet, or are they moving inside the feet toward each other when the patient’s knees are bent? (Knock-Kneed) Are they moving to the outside of the feet? (Bow Legged)
  • Is the heel bone everting (leaning in) or inverting (leaning out)?

When the patients are scheduled for the PCI evaluation, request the patients to wear the shoes they wear daily (to work). If these shoes are new or nearly new, request the patient to bring in a pair of shoes that have worn soles.

Is most of the wear on the forefoot of the shoe on the medial or lateral side? Shoe wear is not a reliable way of determining the amount of hyperpronation or supination, but it is a good way of recognizing the dynamic response to hyperpronation. It is helpful to take notes about the wear pattern for monitoring changes in the patient’s gait pattern over time.


Based on the Objective Postural Findings, appraise the patient’s Postural Condition:

  • Does the patient have Progressive Postural Arthritis6? (3 or more redfindings)
  • Does the patient have Non-Progressive Postural Arthritis? (0-2 red findings)

Plan of Action

Based on the patient’s Postural Condition, determine a Plan of Action.

If the patient has Non-Progressive Postural Arthritis, but your evaluation suggests that reducing hyperpronation would be an appropriate preventive care option, explain the benefits to the patient and recommend PCIs. .

If the patient has Progressive Postural Arthritis:

  • Explain to the patient what Postural Arthritis is and the benefits of addressing the condition now (or as necessary, the consequences of ignoring the condition).
  • Explain the Posture Control Insole™ concept or give the patient the PCI Recommendation Form.
  • Obtain the patient’s agreement and schedule a time for fitting.
  • Proceed with arch evaluation and FMD measurements.

6 Postural Arthritis is a term defined by Dr. Rothbart, defining a postural condition which generally increases the patient’s risk of developing arthritic conditions because of significant joint misalignment.

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