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7 Frequently Asked Questions about Foot Levelers Chiropractic Orthoses
1. How long have Chiropractors been prescribing Foot Levelers to their patients?
Foot Levelers orthoses were first developed in 1952 by Dr Monte Greenawalt, a chiropractor in Iowa, USA. Dr Greenawalt noticed that many of his patients developed hip and spinal pelvic problems after wearing rigid sub-talar neutral orthoses commonly prescribed by podiatrists.
Dr Greenawalt developed his 3-arch plantar vault theory around the same time Root developed his subtalar neutral theory. These two main theories are still the predominant methods of prescribing orthoses today.¹
He went on to develop an orthoses that fitted the following criteria:
- – Custom-made to ensure proper support and comfort.
- – Flexible to allow the normal foot wave motion during the gait cycle.
Must support all three arches of the foot because he recognised that ‘lifting’ only the medial longitudinal arch created excessive strain on the lateral aspect of the foot.
– The corrections to be ‘set’ to allow the normal pronation motion of the foot but block excessive pronation. Restricting normal foot motion was found to cause hypermobility problems in other joints of the lower extremity.
– Casting should be done weight-bearing to fully assess the foot for excessive pronation due to the permanent plastic deformation of the plantar and bone to bone ligaments. Dr Greenawalt patented the foam casting system in 1967 and it is now used by many laboratories world wide.
– Made to create a symmetrical foundation for the spinal pelvic region so that it reduces spinal scoliosis.
2. Are Foot Levelers orthoses custom made?
16 measurements are taken from the foam cast or the digital scanner to custom fit the Foot Levelers orthoses. The cast or scan is sent to the laboratory in Virginia, USA where it is made on a weekly basis.
The laboratory process has been submitted and approved by the Australian Taxation Office for an exemption of GST as a custom made health device.
3. How are Foot Levelers orthoses different from the orthoses prescribed by Podiatrists and Orthotists?
Podiatric orthoses are made for foot problems whereas Chiropractic orthoses are made to balance a tilted or twisted pelvis due to the asymmetrical ‘dropping’ of the foot arches. The Foot Levelers orthoses are designed to minimise the number of visits a patient requires to achieve maximal medical improvement from chiropractic care.
Podiatric orthoses are made primarily for poor foot function whereas Foot Levelers orthoses are made primarily for the whole body alignment to balance the pelvic/spinal foundation so that the chiropractic manipulations of the spine and pelvis hold the alignment.
When a patient presents with a ‘laterally flexed’ (tilted) pelvis, as evident on A-P lumbo-pelvic weight-bearing x-ray, often the only solution is an orthoses.
Most patients acquire excessive pronation of the feet bilaterally but asymmetrically. This leads to what a chiropractor would term a laterally flexed pelvis. Due to the permanent plastic deformation of the plantar and bone to bone ligaments of the foot this pelvis misalignment will constantly reoccur unless stabilisation of the feet is performed.
Often traditional rigid orthoses are made with less regard to the overall biomechanics of the spinal pelvic region thus creating imbalances and affecting the outcomes of the chiropractic care.
This has been recognised by Donald E. Baxter MD, American Orthopaedic Foot and Ankle Society (Past President) and author ‘The Foot and Ankle in Sport’ when he described the perfect orthoses. In his expert opinion they should be:
- Semi-rigid or flexible.
- Give support and control to both the hindfoot, midfoot, & forefoot.
- Provide extra shock absorption.
- Be lightweight but maintain its shape.
- Have a high Health Professional/Patient satisfaction rating.
Foot Levelers orthoses have been made to these requirements since 1952.
4. Do Chiropractors undergo extra training to be proficient in prescribing Foot Levelers orthoses?
Undergraduate training for all chiropractic courses in Australian universities require substantial hours learning anatomy, physiology and biomechanics of the lower limb. Students also learn manipulative techniques of the soft tissues and joints of the ankles, knees and hips. A basic understanding of orthoses is taught along with objective tests such as the navicular drop test.
The post graduate certificate course, Advanced Spinal Stabilisation is a compulsory prerequisite provided by chiropractic specialists in the field of lower extremity conditions and prescribing chiropractic orthoses. A written and practical examination is undertaken by all chiropractors prescribing the Foot Levelers orthoses.
5. Have Foot Levelers performed peer reviewed research into the effectiveness of their orthoses?
Since 1992 Foot Levelers have developed the largest body of evidence by a orthoses laboratory. A combination of peer reviewed papers, platform and poster presentations at internationally recognised conferences and the anecdotal evidence from over 30,000 chiropractors world wide who regularly prescribe the Foot Levelers orthoses.
- Reduces knee injuries in footballers by 31%.
- Reduces fatigue in lower extremities.
- Improves balance and proprioceptive responses which could prevent slips and falls particularly serious in elderly people.
- Improves foot alignment.
- Reduces shock to foot and ankle thus may prevent need for ankle surgery.
- Improves body alignment, stabilises a laterally flexed pelvis which may reduce long term stress to the hip joints thus preventing recurring low back and hip degenerative conditions.
- Enhances athletic performance, professional golfers could hit the golf ball up to 15 metres further due to improved golf club head velocity.
- Improved Q angle of the knee to prevent patella tracking conditions and serious knee injuries.
- Reduce lower extremity discomfort in workers standing greater than 6 hours per day.
- A) – Patient responds better to Foot Levelers orthoses:
I’m writing to tell you about the impact that the foot levelers have made at our place.
We purchased a pair for each of us last year on the advice of our chiropractor Joe Krawec. Joe has looked after us for years and our girls (11 and 13) have had regular chiropractic care since they were babies. Despite regular treatments both girls struggled with leg and foot pain and on the recommendation of our GP we purchased custom made orthotics through a podiatrist.
Over the next few months Hannah’s pain persisted to the point where she was unable to walk after playing basketball without intense heel and foot pain. She was diagnosed with plantar fasciitis so we went back to the podiatrist and purchased a new set of rigid orthotics with a channel to accommodate the plantar ligament.
The obvious course of action would have been to stop the basketball but try stopping a kid that is determined to play! By this time Hannah was committed to playing at the highest level possible and was selected to play in Japan. Her metro side had qualified for the national championships and she was also heavily committed to the Country Victoria development program she was determined to keep playing and training.
Joe told us that he was introducing the Foot Leveler orthoses to his practice and we arranged for the kids to be fitted. We were so impressed by the process and samples, we ordered a set for each of us.
We have been wearing them for almost 12 months now and find them so comfortable we choose to wear them constantly. Hannah’s heel and foot pain disappeared completely within four weeks and has not returned. She trains and plays intensively up to 20 hours per week completely pain free. Her performance has improved dramatically, and her vertical leap is tremendous.
It’s not possible to overstate the difference the foot levelers have made. We will be lifelong customers.
Anne-Maree Kaser, Traralgon, VIC.
- B) – Health Professional responds better to Foot Levelers orthoses:
“Have you ever changed your mind? As a poor student I thought Foot Levelers too expensive relative to other orthotic products on the market that I thought would do pretty much the same thing. In 1987 we were able to provide off the shelf products for as little as $40.00 – $80.00. I helped a lot of people with low budget products – even my dad and I.
Almost 20 years later with a change of activities the standard off the shelf and heat mouldable orthotics, even with multiple adjustments to the orthotics and my feet, failed to provide relief. I had to stop Latin Dancing, which was very disappointing to me, my partner and our social network.
Initially I thought that the Foot Levelers orthotics would not do much for my right foot pain. Nevertheless the opportunity arose to order a pair at one of the Synaptic Design post graduate seminars. Without much hope I put the orthotics in my shoes and we went dancing that Friday night. Two hours later the transverse arch pain had not returned. I wondered if the relief was because I had given my feet a rest from dancing for a few weeks. So to test the hypothesis we went dancing on Saturday and Sunday night as well. No problem! Three years later with as many as 10 hours of dancing per week– still no problem!
I am left to conclude – all orthotics are not created equal!”
Dr Patrick Shwaluk, Chiropractor, Brisbane, QLD.
Foot Levelers are currently supplied to team members of:
- Australian Rugby Union team (Wallabies)
- Australian Netball Team
- Australian Athletics Track Team
- Australian Hockey Team (Hockeyroos)
- Australian Professional Golfers.
6. Do health funds currently recognise and rebate Foot Levelers orthoses?
Yes, a number of them do. Patients need to check with their respective health fund as to whether Foot Leveler orthoses are covered by them & if they are, whether the patients level of cover includes the purchase of these custom made orthotics.
Health funds such as Medibank Private and MBF for example rebate chiropractic patients for custom made orthoses. Health funds such as Australian Unity and Australian Health Management (AHM) only rebate patients who have been prescribed a Foot Levelers orthoses by a chiropractor accredited proficient by Synaptic Design.
7. How long do Foot Leveler Orthotics last?
The average lifespan of the Foot Levelers orthoses is 3-7 years with many patients able to continue wearing them long after this time frame, without side effects such as muscle and ligamentous atrophy and adhesive capsulitis.
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