"A Step In The Right Direction"
Step Forward of Oregon

Technical Discussions

1.  What is "Metatarsal Arch Support" and what does "Balanced Corrective Orthotic" mean?
2.  What's the deal with the feet and how they can cause pain elsewhere in the body, while often the feet don't even hurt?
3.  Casted Orthotics vs. Pre-Formed Orthotics
4.  Pronation, Supination, and Plastic Deformation
5.  Basics, "Break-In," and Sports
6.  Shoe Last, how is the shoe shaped, and is it right for you?

7.  What about High Heels or Western Boots?
8.  a)  How does the Soft Step Orthotic work on the muscles of the foot? 
      b)  Do the muscle fibers increase in mass/strength? 
    * The adaptation process; what is "environment?" 
     ** Homeostasis:  Life Force?

     *** Biodynamic flexibility

1.  What is "Metatarsal Arch Support" and what does "Balanced Corrective Orthotic" mean?
     The foot's structure is basically a Tripod with a Universal Joint in the center.  The heel is the point at the rear, and the ball of the foot comprises the pad at the front behind the toes (foreward balance is controlled mainly by the first and fifth toes).  To balance the bone structure we need to give the foot a "Reverse Tripod" of support that is flexible in the middle (Mid-Tarsal Joint area). 

     The Metatarsal Arch is the void centered under the long metatarsal bones of the foot.  This void is behind the ball of the foot, and ahead of the Mid-Tarsal Joint (the Mid-Tarsal Joint is the group of 5 small bones in the middle of the foot, see above photo).  The Metatarsal Arch must be fully supported for proper foot function.  It gives the front half of the foot something on which to balance when the knee moves forward of the heel.  "Metatarsal Arch Support" is corrective support placed in the Metatarsal Arch area.

     A "Balanced Corrective Orthotic" is one in which the support system properly supports all three arches of the foot (1.  MEDIAL Longitudinal, aka Longitudinal, 2.  LATERAL Longitudinal, aka Transverse, and 3.  METATARSAL).  You cannot properly stabilize and support the whole foot without all three arches properly supported in proper proportion.

    Mechanics:  The main purpose of MEDIAL and LATERAL arch supports is to collectively stabilize and support the Cancaneous (heel bone), on which the Talus and ankle rest.  The main purpose of the METATARSAL arch support is the support and stabilize the Metatarsal bones and Plantar muscles along the bottom of the foot, and give the front half of the foot something to balance on, stabilizing the knee as it moves foreward with each step.

2.  What's the deal with the feet and how they can cause pain elsewhere in the body, while often the feet don't even hurt?

     HOMEOSTASIS: Let's start with Homeostasis. Homeostasis simply means that the subconscious mind and nervous system want to self-align and self-correct our physical bodies, but other forces are interfering. The obvious main forces are GRAVITY, SHOES, and LIFESTYLE. 

     SHOES AND LIFESTYLE: Shoes are not correct, and are not the natural environment for the feet. The natural environment of the feet is barefoot on soft ground. This provides somewhat even pressure throughout the bottoms of the feet, and no pressure anywhere on the tops or sides. Shoes interfere with the balance function of the foot and impede the body's ability to heal itself. Lifestyle is just as important. If you are in pain and your diet is out of balance, and you constantly do whatever it is that makes the pain worse, your body will not be able to heal properly from the injuries of life.

     This conversation is mostly about GRAVITY and being on your feet: Gravity is the largest influence for most people, since gravity never stops. You can eat different, you can think different, you can go with good shoes, bad shoes or no shoes, but for this discussion the only way for feet to escape the effect of gravity is to sit or lie down. The foot is like a tri-pod, with a universal joint in the center, tuned to hold the whole body against the force of gravity. The standing body consists of bones (like the beams in a steel building), and muscles and connective tissues (like the tension cables that position those beams).

     HOW STRUCTURES WORK: The cables of a steel building are engineered to be a certain length at a certain tension when the structure is plumb and square, just like our bodies. If the ground shifts under the structure the foundation will move, and beams will move out of their intended position.  The misalignment of the beams will create uneven tension in the cable system, resulting in fatigue at various places in the system. Some cables will slack, and some will be overstretched. Over time, even small unevenly distributed loads can become big problems.  Beams may even begin to deform. The symptoms would be things like the interior and exterior finishes of the building cracking and needing extra maintenance. The source of the problem isn't the crack in the drywall on the fourth floor, it's the unstable foundation. If all we do is patch and paint the damage, the building will keep shifting and we will have to apply repairs again, and again. One thing that needs to be addressed in this case is correction of the supporting foundation. Now it is possible that the problem may be from a faulty cable, rather than a shifted foundation, but as with buildings, the human body's foundation is almost always involved at some level since our shoes are not shaped like feet and our feet do not live in a natural environment.  A government study showed that at least 87% of people have a physical problem in their body that is caused by misaligned feet.

     OUR BODIES: Just like the building, with our bodies, if we re-align and stabilize the foot bone structure (the supporting foundation), then what is above can balance and straighten, restoring normal length and tension to the cables. As any engineer knows, you don't plumb and square a multi-level structure from the top down, you start at the bottom and work up. This process is forced by GRAVITY.

     How we end up hurting somewhere other that the feet: The feet are the foundation of the entire body structure and any misalignment in either foot will cause a corresponding shift somewhere else in the body to compensate. To some degree this is fine, but many people suffer from too much compensation at one ore more points, and have painful symptoms as a result. There are 37 muscle divisions that control the 26 bones of each foot. That means 37 different cables controlling 26 beams. This is a very complex system, that can handle a variety of tasks over varied terrain. It is also a very sensitive system, and when not functioning correctly can manifest pain in many different places, from the toes to the neck. If the foot is slightly out of whack, the shin will move a little this way, the thigh will move a little that way, then the hip is in a strain, which leaves the pelvis slightly off, which is affecting the spine becuase it is BALANCING on the pelvis, etc.....and a 7 pound bowling ball is sitting on top of the whole chain, with GRAVITY constantly pulling down on it.

     THE PRESSURE SENSITIVE FOOTPRINT: We use the pressure sensitive footprint in the fitting process for our orthotics.  The pressure sensitive footprint is a map of the misalignments of the bones of the feet, and it gives us direct feedback as to where the stress is, which is often an area somewhere else in the body that is actively compensating for those misalignments. There are two main levels of information that can be gleaned from the footprint, Mechanical and Biological.

      IN A MECHANICAL WAY: As an example, if we see excess pressure at the base end of 5th metatarsal bone, we can pretty much guarantee there will be hip pain on that side. This hip pain is mainly a mechanical effect of the foot misalignment (in this case forefoot varus), and is easily corrected with the proper shoe insert providing proper metatarsal arch correction. The foot is crooked, a little, and it causes the leg bones to be slightly out of alignment in a certain way, which puts abnormal torque on the hip muscles. There are many mechanical effects of misaligned feet, with some of the most common being pain in the feet (of course), and then we can work our way up: Ankles, knees, hips, low back, mid-back, and neck and shoulder areas. "Wow, doesn't that cover just about the whole body?" "Yes, because it is possible for misaligned feet to be negatively affecting many other areas of the body."

     NON-MECHANICAL: Half of the diagnosis of a footprint is mechanical, the second half is biological.  Reflexology is the study of the nervous systems interconnections, and while there is variation from person to person, the basic premise applies to almost everyone at some level. When you walk barefoot on soft ground (an ideal situation), the bony parts of the feet settle into the soil and the soil pushes up into the soft areas of the bottoms of the feet supporting the arches and stabilizing the whole structure. Ideally, in this situation the pressure of bodyweight is fairly evenly distributed across the bottoms of the feet. This stimulation (like light massage) to the nerves in the bottoms of the feet provides corresponding stimulation, and usually increased circulation, throughout the body. These associations are mainly with the organ systems, so for example when you walk in the sand barefoot, the sand is stimulating all the organ systems, and encouraging health throughout the body. That is one reason we feel good after going barefoot on the beach. Now if we only do it once a year, and we do too much, we will experience muscle soreness because we are using muscles that are out of shape from wearing shoes. Nonetheless, the good stimulation still happens to the organ systems. Another reason to spend more time on the beach...

     With the footprint of the misaligned foot, we can see what organ systems are possibly being overstimulated by the excess pressure that is ever-present in one particular spot, and oppositely, where there is not enough pressure to provide stimulation. A good example is that a person with noticeably dark center to the metatarsal pad at the ball of the foot (where the toes connect) will often have restricted breathing or bronchial issues that are aggravated by the excessive pressure on that spot. Just relieving this pressure will often relieve the restriction. The effects can actually go both ways, meaning that particularly high pressure print on the spot that correlates to the heart may be a foot misalignment that is over stimulating the heart, or, a heart problem that is showing itself through it's effect on the foot's alignment.

     BALANCED CORRECTIVE ORTHOTICS: There are two main goals of balanced corrective orthotics. ..

1. To place bones of the feet in proper alignment restoring beam and cable alignment, easing stress in compensating areas.

2. To provide more even pressure throughout the bottoms of the feet for a more healthy natural environment for the feet, which contributes to proper overall nervous system stimulation. Ultimately, relief of pain, and better overall health.

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3.  Casted Orthotics vs. Pre-Formed Orthotics

     Casted orthotics begin with a mold of the improper muscle balance that the feet and legs currently have. They are usually made in a non-weight bearing position, and the foot is usually supported with some pressure from under the 5th metatarsal head and with the other hand at the inside of the ankle joint to establish neutral alignment for the ankle. The theory is to mold to the neutral foot, and the orthotic will hold the foot and ankle neutral when standing.
     For some people, a modicum of support and stability will meet their needs, and a casted shape can give relief for many foot and back problems. But since we are not restoring collapsed metatarsal arches with this technique, it can help only partially, and many problems cannot be adequately addressed.
     The casted is a mold of the muscles as they are balanced at the time of the mold, with the ankle placed into neutral. It can be a "neutral" orthotic, meaning essentially no adjustments and ground flat and level on the bottom, or it may have correction built-in in the form of heel varus or valgus wedging (common), and/or arch pad additions (rare) such as metatarsal or longitudinal.
     Often heel varus or valgus wedging in a casted orthotic is over-correction and must be re-evaluated every 2-5 years. The patient will eventually train to neutral (usually within 2-5 years) and must then be refitted to a neutral orthotic or they will eventually end up over-corrected. This correction is mostly ankle oriented and will not correct a fallen metatarsal arch unless it is manually added to the orthotic. Important:  Without metatarsal arch support the body will balance toward the heels (almost always locking the knees in hyperextension for stability which tilts the pelvis forward) and the person will usually not get complete relief from low-back tension. In addition, without metatarsal arch support the plantar muscle group in the bottom of the foot will not relax fully, and the person will usually not get complete relief from Plantar Fasciitis (sore heels).

     A pre-formed orthotic PROPERLY SHAPED, such as the Soft Step or Plastosan (not the only options), and PROPERLY FITTED, will place the bone structure of the foot close to optimum position, allowing the skeleton to balance as it naturally does when barefoot on soft ground (with the knee balanced over the Mid-Tarsal Joint of the foot which is proper posture). In this case, all three of the arches of the foot are supported, the mid-tarsal joint is allowed to flex naturally, and the whole foot is stabilized laterally (side-to-side). Lateral stability is a function of the reverse triangle that the orthotic provides to interlock the triangle design of the foot.
     When the foot is properly supported, the results are noticible for most people. The proprioceptors in the brain will unlock and center the knees over the Mid-Tarsal Joints of the feet, and most of the muscles used for standing and walking relax. In this posture, muscles are at a state of rest and only experience tension when needed for movement. The pelvis balances on the hips, and the spine balances on the pelvis.

4.  Pronation, Supination, and Plastic Deformation

     Over Pronation is the ankle collapsing inward beyond the proper position.  Pronation pulls inward, with effects generally starting at the ankle or knee, and working up with time to hip and spine. The spine can be in tension right away, especially the lumbar region (low back).
     Over Supination pulls outward, and usually shows symptoms early at the neck and shoulder areas, and later works down to the knee and hip.
     Plastic Deformation means tendons and connective tissues have been stretched beyond the point where they will rebound to the normal length and resilience.  This means that some feet cannot be retrained.  There is no way to know for sure who will train to the correction, or who will be dependent on the supports (most people experience some or much training to the correction).  If they are plastically deformed, they may not retrain, but they will still benefit from the balance, support, and alignment of the arches, as long as they use them.

     PS:  When evaluating whether a person over pronates or over supinates, remember that the foot can be twisted (forefoot varus) and show signs of both, which can be confusing.  The important thing is to align both the forefoot and rearfoot independently, to provide normal amounts of pronation and supination throughout the gait cycle.

5.  Basics, "Break-In," and Sports

     Basic functions of the Soft Step Foot Correctors 
     (applies to most but not all feet)

1.  To support the bone structure of the foot in the position of a normal arch.
2.  To support the soft tissues in the foot in the position of a normal arch (similar to barefoot in sand or soft ground).
     This allows the skeleton to balance over the middle of the foot, and the muscles and tendons to relax that hold the body up, except to be used for movement.  The body's Center of Gravity (COG) will be centered over the mid-tarsal joint.
        Balance provides a relaxed muscle state.
        Balance provides 3 dimensional ready state for movement in any direction.
        Balance provides strength to skeletal structure through alignment.
3.  To stabilize the rearfoot with cupping at heel and up to mid-tarsal joint.
4.  To stabilize the forefoot with metatarsal lift.
5.  To allow mid-tarsal joint full flexion in all directions within proper normal range.
6.  To work the muscles and tendons that control the arches by encouraging flexion at the midtarsal-joint when walking or running.
7.  To provide a stable environment from day-to-day so the foot is not adapting to particular shoes.
8.  To encourage total body realignment with long term usage.  

     Soft Steps are a training tool, and need not be used every day, or in all shoes.  The longer the usage in years, the more independent the body becomes as it is retrained.  After several years of regular usage, it will usually take another several years to lose the training if usage is stopped completely.  This is average, and does not apply to all people in the same way.

     Results may vary, and may require additional help from other sources such as Chiropractic, Rolfing, Massage, Acupuncture, Reflexology, Physical Therapy, Nuitritionist, etc. 

     The Soft Step or Plastosan will address some of the Structural aspects of the body, but there are also Chemical factors (such as diet or lymphatic or neurological problems, etc. [Dehydration alone can severly impact soft tissue compliance.]), and Mental factors (such as attitude or emotional state, etc.) as well.  If any one or more of these basic factors are significantly out of balance it may hinder the results of the orthotics, or make it difficult for the wearer to adapt.

     Break in schedule

Walking comfort    2-3 weeks
Running comfort    2-3 months
Posture retrained   2-3 years
Total Balance        5-10 years, or more

  1.  First day, 15 minutes to 30 minutes, (take arches out for at least 3 hours) repeat later in the day.
  2.  Second day, 45 minutes to 1 hour, (take arches out for 3 hours) repeat later in the day.
  3.  Third day, 1 hour to 2 hours, (take arches out for 3 hours) repeat later in the day.
  4.  Fourth day, 2 to 3 hours, (take arches out for 3 hours) repeat later in the day.
  5.  Fifth day, begin increasing time as comfort allows until you are wearing them all day long.  Some days will be more comfortable that other days, that is normal.

     Shoe last (see next section on this page) is a critical factor for most people.  This is the amount of lateral curve built into the sole.  Most people will have a certain amount of curve that they prefer, and choosing a different last will usually result in trouble with gait and foot function.

     Sports are helped once the person is comfortable (2-3 months).  For golf, it helps unlock the knees and straighten the back, which is key to a proper stance and consistent swing.  With running, and any sport that includes running, like basketball or tennis, participants usually experience increased performance, less fatigue, and are less apt to acquire injuries.

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6.  Shoe Last, how is the shoe shaped, and is it right for you?

    Shoe Last is the overall shape of the shoe, including curvature, width, height, taper, and other miscellaneous details of the fit.
    For this discussion, the focus is on curvature.  As you can see from the photos on the right, the amount of curvature can vary from shoe to shoe. 

Top:  Straight Last:  Straight line through center of heel, arch and toe.  Most often preferred by flatter feet and over-pronators.

Middle:  Semi-Curve Last:  Some curvature of the forefoot toward the center line of the body.  This is the most common last available, and is suitable for average feet.

Bottom:  Full Curve Last:  Forefoot curves noticibly toward body midline.  Ususally preferred by people with very high arches, who tend to walk on the outsides of their feet (supinate).

   You can site down the sole lengthwise and evaluate the shoes in your closet, most of the time your favorites will all have about the same last.  That is probably the best last for you. 
    If you wear our corrective orthotics and you have a preference for Straight or Full Curve lasted shoes, you may find yourself buying Semi-Curve lasted shoes after a few years of using the orthotics, as they are designed to retrain the shape of the foot to proper alignment, which normally matches to a Semi-Curve last.  Be aware that this is only a guideline, and that every person is unique.  Always buy shoes that feel "natural" and "comfortable" regardless of the details of lasting or sizing.

7.  What about High Heels or Western Boots?

High Heels     
     High heeled shoes are OK!  You don't have to give up your lifestyle choices if you make good decisions along the way.  Just like Western Boots, if your High Heels are fitted large enough, they are not totally detrimental to your foot health.

a.  Don't wear raised heel shoes of the same height everyday, or your body posture muscles will adapt to that position.
b.  Make sure the shoes are large enough.  Fight the urge to be concerned about the visual impact of a larger size, no one will notice but you. Make room for your toes, they are supposed to be the widest part of your feet.
c.  If the shoes hurt, and adding orthotics doesn't give you relief, get rid of the shoes, no matter how much you paid for them!  You can drastically alter your body by wearing improperly fitting shoes.
d.  With Soft Step Foot Correctors, you can put them inside your stockings to help secure your heel in the shoe.
d.  Always take shoes with slick plastic soles to your cobbler and have them convert them to thin rubber soles.  $10 for rubber soles, or $10,000 for an injured knee repair?

Western Boots
     Western Boots, and other Slip-On Boots are fitted differently than other shoes.  They are compatible with the Soft Step Foot Correctors if they are not excessively tight fitting on the top of the instep (over the middle of the foot). 
     If they were closely fitted without any added arch support, then the Plastosan Orthotic is usually the best choice.  It is low profile enough to slip right in under the feet, and is stabilized by the "heel counter" construction of the boots.  The Soft Step or Plastosan will provide much needed metatarsal arch support.
     Remember that many feet get larger with age, and some boots will not stretch with you (for example, Kangaroo skin, which rebounds to its original size after being stretched).  Just like High Heels, if your Western Boots are fitted large enough, they are not totally detrimental to your health.

8.  a)  How does the Soft Step Orthotic work on the muscles of the foot?
     The foot is a tripod with a universal joint in the middle. It is medially biased (to the inside) for shock absorption, and has 26 bones with 37 muscle divisions that position and control the bones. Ligaments and fascia help hold the bones together, but the muscles are the main factor in determining foot arch shape and performance.
     Each moment of your life your nervous system is constantly moving forward replacing your cells and adapting to the circumstances of your thinking and environment.* With strength training and stretching we can change the physiology of the agonist (flexing) muscles being used because they are adapting to the circumstances.
     When you walk, you are training the muscles that control the foot bones. If you don't walk, the muscles that form the arch will not develop functional strength. With a natural environment (bare foot with soft earth), the action of our foot design ensures the muscles that control the foot are sufficiently exercised, stretched, and held in position (supported).
     Our current method of living involves walking or standing on mostly hard surfaces, and putting shoes on our feet that restrict the toes and do not naturally support the arch muscles. The result is that the body acquires improper posture and muscles adapt to this environment, attempting to reduce stress in key areas, generally causing increasing misalignment over time. The feet are not designed for this situation and slowly lose the battle of homeostasis** vs. gravity (entropy). Since the whole body is balanced on the feet, the misalignment will radiate up the body all the way to where the head sits on the spine (cervico-cranial junction).
     To compensate for the hard surface/unnatural shoe situation we need to simulate a "bare feet on soft ground" situation as much as possible. This is the function of the Soft Step Foot Corrector. When properly fitted it is shaped like the soft earth footprint of the healthy arch position. This shape also includes flexibility*** that matches the soft tissues of the foot, resulting in action that works and stretches muscles for appropriate strength and flexibility.
     Tip: It is important to make sure shoes are not restricting toe movement, as the tiniest amount of restricted toe movement is detrimental to the health of the feet, and the rest of the body that is balanced on the feet.

8.  b)  Do the muscle fibers increase in mass/strength?
Over time, the mass/strength of the muscle fibers will redistribute toward normal size/strength ratios. This is illustrated by the series of pressure sensitive footprints we can use to track progress. Large changes in muscle mass or strength require large changes in the amount of work being done by the muscles on a continuing basis.

* The adaptation process; what is "environment?"
The environmental factors that influence our adaptation are vast in scope.
Our thoughts, thoughts of others, things we eat and drink, what we breathe, what we see, what we hear, lifestyle, climate, geography, genetics, gravity, entropy, chosen clothing, hours of light exposure, cosmic ray exposure, electromagnetic forces, and possibly many other factors.

** Homeostasis:  Life Force?  Homeostasis is your self-righting mechanism.  It is the property to regulate the internal environment of the body so as to maintain a stable, constant condition.  It is the antagonist to entropy.

*** Biodynamic flexibility is critical to the function of the foot.  If an Orthotic is not flexible, it cannot simulate the natural environment of the foot, and will often be a crutch at best.  Orthotic flexibility needs to match the natural flexibility of the body, and materials must be inert or problems may result.  The Soft Step Foot Correctors are made of a proprietary material that is the proper flexibility for human comapability and are FDA approved for diabetic use.

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