Current Pedorthics March-April 2016 | Vol.48, Issue 2 - Page 25

How an Epidemic of Equinus Created a Successful Retail Pedorthic Business "It makes sense, as there is an epidemic of Equinus in our society, and the causes are chairs, cars, shoes with heels, and toilets." with orthotics and many without. I wondered why. I started using the Silfverskiöld test², the classic evaluation technique for Equinus, as part of my regular evaluation. I discovered that a large majority of my patients had little, if any, range of motion in the ankle with the gastrocnemius engaged and not much more with the knee bent. Many people showed the classic signs of Equinus. I was beginning to understand why they had problems like plantar fasciitis, bunions, neuromas, Achilles tendonitis and more. Humans need at least 10 to 20 degrees of ankle dorsiflexion to ambulate normally³ and avoid injury; the patients in question didn’t have it. It makes sense, as there is an epidemic of Equinus in our society, and the causes are chairs, cars, shoes with heels, and toilets. When do we ever get the natural stretching of the posterior compartment that we need? The hamstrings, Achilles tendon, gastrocnemius and soleus are all allowed to shorten as we walk around in shoes with 10 – 12mm of heel elevation, sit on chairs at work, and lie in bed at night. I started using the zero drop shoes with my plantar fasciitis patients. I reasoned that, if the treatment for plantar fasciitis is arch support, rest and stretching, then bringing down the heel height of the shoes may actually start treating the cause instead of the symptoms. After all, when a patient is sent to physical therapy for treatment of plantar fasciitis, they are going to work on stretching the posterior compartment. The rest of the day is spent with the foot plantar flexed. So, I encourage my clients to wear zero drop shoes with arch support during the day and Birkenstock sandals (also zero drop) at home. The results have been dramatic. Here are two cases studie s to share showing the zero drop concept on people for whom zero drop footwear might be contraindicated. Patient #1 was a morbidly obese, diabetic patient with a cavus foot in Equinus and severe callousing Current Pedorthics March/April 2016 23