When I evaluate feet and ankles and note very different function side to side, and see 2 identical orthotics, I am puzzled. When I see the same but 2 very different orthotics; I am pleased. Before getting for for orthotics it is ideal to have all of the joints of the foot and ankle evaluated and treated. There are several movement restrictions that are treatable and can distinctly improve the function of these joints. Long ago I learned that the orthotics do not make much change in the transverse plane, (where rotation occurs) they do affect frontal (front and back view of foot) and sagittal planes (lateral view). These joints are very strong, so they can take some abuse, and in fact do. They may or may not have local pain, but the body reflexively compensates elsewhere and this distal area over time may become symptomatic. It is not unusual to find muscle imbalances in the presence of joint restrictions, and these reflexively restore when the joint, ligament, tendons and muscle are balanced. Treat all. Per above, rotation in the transverse plane must be treated, especially at the subtalar joint. It can be very rewarding, one treatment, and the clinet should then know self management. Terms like pronation can be misued, most clients I see have been told they pronate (too much) and I find they do so only at the forefoot. Why? Because the rear foot and mid foot supinates excessively, in fact remain in supination. So the joint mobilization addressthe supination and restores functional pronation of the rear foot and mid foot, and then the forefoot pronates, less, now normally. If foot and ankle joint dysfunbction persists it can alter forces and movements at the knee, the hip, the pelvis and reflexively; as far as the neck. If "whole-body" is important, incorporating foot care in the paradigm provides a good foundation, literally and figuratively. Happy Friday! Jerry
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