A Multidisciplinary Approach to Foot Posture

Benefits of a multidisciplinary approach to health care are vast for the betterment of patients and clinicians alike. 

This approach recognises the function of all processes and systems within the body, rather than focusing on a single site of pathology or dysfunction.

When looking at many of the chronic conditions, it is important to consider that each joint or body part is a link of a chain; the areas above and below are influenced by the activity occurring around it. 

Areas that are seemingly unrelated and located distal or proximal to a symptomatic area may actually be the true cause of dysfunction.

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A multifaceted view is particularly useful with regards to the biomechanics of the foot.

Despite age, gender or culture, proper arthrokinematics of the foot joints is fundamental to its optimal function. Optimal foot function and position ensures conservation of energy and an efficiency of function essential to the biomechanical workings of the lower limb. 

Functional rehabilitation goals have a much greater chance of success, when optimal foot arthrokinematics and biomechanics are introduced either through exercise or external support in the form of a custom foot orthotic.

Traditional postural theories for foot biomechanics were often unilateral in their development resulting in assessments based on one's professional view point.

Newer theories have now emerged that are more multidisciplinary in their development that better serve us and our patient community. To use custom foot orthotics as an example, we can illustrate the benefits of the multidisciplinary approach clearly.

Traditional manufactured orthotics were too limited in their assessment and casting scope and therefore failed to provide visible postural changes on the foot, the ankle and the knee. 

Using the subtalar joint alone as the guide for foot health ignores the other 32 joints and their kinematic needs. 

These orthotics inherently require additional areas of modification to help compensate for the poor postural changes, that include multiple array of force redistribution fixes (metatarsal pads, cutouts, skives and wedges).

The emphasis in these circumstances becomes less about correcting foot position and more about shifting tissue stresses and forces.

Outcomes are based more on the ingenuity of the technician than on science. 

Newer biomechanical theories, such as the integrated multi-axial theory offer a broader perspective and respect the arthrokinetics of the whole foot and its impact on the kinetic chain above. 

All disciplines can come together in agreement on this theory and contribute within their own specialty towards this common goal. 

The integrated multi-axial position simply means the foot is placed in the best possible posture for function for each individual clinical presentation.

The integrated multi-axial™ position is detailed as the maximal amount of closed-chain supination any particular foot can achieve at midstance, with the heel, first, and fifth metatarsals in contact with the ground. 

The goals of this postural change and improvement are simple; this optimal supinated stance allows for ideal foot arthrokinematics during gait and provides a stable foundation for the skeleton above to stand on. 

The secondary effects include reduced torsion of tibia & femur, decreased joint stress throughout the lower limb and spine, and improved function of musculotendinous junctions. 

Rehabilitation programmes progress faster, surgeries can be avoided and the future biomechanical health of the patient is improved for years to come. 

Care programmes and supportive devices made from this science couple for the most effective and successful treatment of patients with faulty foot posture.

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