How do we define "Work so well"? What can you expect on behalf of your patients?
- Among patients who dynamically hyperpronate: Reduced dynamic hyperpronation - less internal rotation of the lower extremity, reduced knee and hip pain as well as low back pain.
- Among patients who dynamically supinate: Relaxation of the supination pattern - softer heel strike and a reduction in muscle tension in the calf muscles.
- Among hyperpronators you should detect a posterior pelvic rotation and a more level pelvis - more upright upper body and a posterior shift of body center of gravity - less postural stress on the lower back.
- Over time as the body responds fully to the postural shift, head and shoulders will come back for a healthier more upright posture - improved posture of upper back and neck.
- Reduction in common foot discomfort and pain.
As with all change, some patients respond more profoundly while others require more time to adjust. One thing is certain, better than 95% of your patients will describe a positive change, and you should expect your patients to report noticeable reduction in foot, knee, hip back and neck pain. Over time, 2-3 weeks, in combination with therapy, pain reduction should be significant.
This technology works so well because it is based on a model describing the dynamic foot, but first a static observation.
When you place the foot in its weight bearing subtalar neutral position, you will notice that the first metatarsal rotates and elevates. This is often mistaken for forefoot varum, a rare structural variation of the foot that may result from a birth defect, injury or surgical procedure. Inspection will demonstrate that the 2nd through the 5th metatarsals are on the floor while only the first metatarsal is elevated.
Hyperpronation occurs as a result of the first metatarsal having to travel downward in order to become weight bearing, and when doing so, the medial longitudinal arch collapses, the ankle rolls in and the lower extremity rotates internally. This does not deny that some hyperpronation can come from laxity of the bones in the midfoot, but since so many young people also pronate significantly, it is reasonable to believe that the elevated first metatarsal is the primary reason for hyperpronation, and that laxity of the ligaments in the midfoot may be a secondary cause.
Being a podiatrist, Dr. Rothbart who discovered the concept of the elevated first metatarsal, initially based his evaluations and tests on static observations, and as a result decided to build the ground up underneath the first metatarsal as positioned when the foot was held in weight bearing subtalar neutral. He quickly discovered that this was unworkable because it threw the patients off balance by shifting center of body mass too far posterior when walking. As a result, he started to experiment with lesser compensation and in the process of doing so, discovered that the body seemed to provide a higher amount of correction than expected based on the lesser dimensions of the wedge.
Based on his observations, Dr. Rothbart theorized that the neuromuscular system amplified the effect of the wedge. Working with a large number of subjects he concluded that an optimal dimension of the wedge was roughly one third the amount of elevation of the first metatarsal when the foot was held in a subtalar neutral posture.
He concluded that the Kinetic Technology® (wedge) does not act as a passive foot support like traditional arch supports. By all appearances, the muscles controlling the foot are activated to reduce hyperpronation. This may be due to a change in gait cycle timing when the first metatarsal and big toe senses ground contact.
From a practical perspective, it is clear that hyperpronation is reduced significantly. By visual observation it appears to be reduced by on average 70%. Based on a sample of over 5,000 patients, over 95% respond very favorably to ProKinetics® Insoles. Patients find ProKinetics® Insoles comfortable to wear, report significant reduction in discomfort and pain, and a sense of greater stability and overall comfort.
A factor not to be forgotten is patient compliance. Because this is a proprioceptive system rather than a support system, corrective dimensions are very small so 1] ProKinetics® Insoles fit comfortably in almost any pair of shoes, and 2] become completely transparent so as to not leave any feeling of having a foreign object in ones shoes.