Ability to Predict Orthotic Outcomes

The absolute best part about being able to accurately assess your patient’s mechanics is that it allows you to predict orthotic outcomes. 

How this works is quite simple. When you know where the faulty mechanics are and you can trace those faulty mechanics back to the patient’s chief complaint, the only thing left is to be able to manipulate the patient’s mechanics or gait to make the imbalance “less imbalanced”.

One of the basic tenets of our biomechanical philosophy is this. We do not try to make everyone perfectly straight, we simply try to make them less crooked. There are many reasons for this. We most definitely strive for symmetry, The fact is, many people cannot tolerate being perfectly symmetrical, mainly due to compensations and acquired functional deficits that are not immediately correctable. 

How does this relate to predicting orthotic results?  Both the static and dynamic exams assess the patient’s relative symmetry.

The static exam additionally assesses the patient’s relative flexibility. After you assess a patient’s mechanics, you also need to get an idea of how flexible or rigid the area in question is.

The more rigid or inflexible the area that you are trying to manipulate, the more difficult it will be for you to affect a change in that particular area. Hence the patient will either take a much longer time to respond to your orthotics or the orthotics may in fact not be able to handle a particular patient’s imbalances.

The static exam helps you to place your patients into a refined gradation system that allows you literally predict how they will do with orthotics before you even offer orthotics as a treatment modality. 

The Static Exam

My partner and I came up with a patient classification system based on a static exam that we developed and incorporated into our patient exam and paperwork. How we developed this classification system is an interesting story but for now let me simply state that we classify our patients clinically into three classes based on their relative symmetry and flexibility. 

Clinically there are specific things you look for such as angle and base of gait, arch height on and off weight bearing, various X ray criteria, ankle position etc…,

But in brief, Class one patients are relatively symmetrical and flexible, Class three patients are asymmetrical and relatively inflexible, and Class two patients are somewhere in between.

This is not a subjective class system. It is a rather precise classification system that is gone over in great detail in the course. This tool alone allows you to predict how someone will do with orthotics before you even offer them as a treatment modality. 

It is no small point to state that it is just as important to know who not to put into orthotics as it is who to offer them to.  With this data you can really educate and communicate very clearly what the road ahead will be like for any given patient.

You’ll know if they will have an easy break in period or will they potentially have some soreness and difficulty getting “adjusted” to the position that you are placing them in. 

Patients don’t worry about a little knee discomfort if you tell them about it first but if you don’t… well, that is how frustration and upsets occur. So the point is that this is not only a method of “screening” your patients to see how they will do with the correction that you are ultimately going to apply to their skeletal system, but it also tells you which patients you have to spend a bit more time with and which patient you really don’t. 

The Dynamic Exam or Gait analysis

There are only two purposes for doing gait analysis on your patient. The first is to be able to assess your patient’s mechanics so as to spot the areas of imbalance or faulty mechanics that they exhibit during gait. The second is to gauge the efficacy of orthotics and or any other conservative modalities such as strappings or taping that you use in your practice including shoe gear. 

With the exception of the patient’s verbal feedback, the static and dynamic exams are the only way to truly determine how effective your conservative treatment modalities are.

But ultimately, it is the correlation and subsequent interpretation of what you see on the static and dynamic exams to the patient’s chief complaint that makes gait analysis such an essential diagnostic and evaluative tool.

This particular topic is a rather large section of our course as it is an essential skill that you need to master as it allows you to become completely expert with orthotics. In fact, the things you spot or notice on the static or dynamic exams has everything to do with your ability to effectively address your patient’s chief complaint, the designing or adjustment of their orthotics.

It is quite amazing to us how complicated this all got – how complicated gait analysis has become and therefore how impractical it has become to use in everyday practice

It apparently did not directly correlate to specific actions when various things were seen and noticed upon exam. When you saw whatever you saw during gait analysis, what exactly do you do about it?  What exactly do you do to the orthotic or how exactly do you design the orthotic to effectively address what you saw during the exam?  Again, this is covered extensively in our course. 

We have done is to take gait analysis and break it down to the point where you need only look for a few simple things within literally two segments or areas of your patient’s body when observing their gait.  The gait analysis we teach is very simple, practical and effective.    

Our goal is not to make people perfectly symmetrical. It is to make people comfortable by making them less crooked and stable in a less crooked position. When you give someone back their stability, you immediately place them on the path to recovery and a pain free existence. Being able to assess your patient’s mechanics is essential to determine when they are in fact stable. Factually speaking, that is how simple our system is.

Confidence►