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
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