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The Biomechanics of Linear & Rotational Movement

Introduction

The biomechanics and ergonomics of movement is a difficult concept to understand.    We have a very complex set of neurological interactions between the Cerebellum, Inner Ear, Visual Cortex, Extraparamidal Element of the Spinal Cord, compounded by Mass Loading of Load bearing joints, Phasic Firing of Extrinsic and Intrinsic muscles, all which work in a synchronous interaction with each other to keep us from falling forward.     

 Overview Video (Click)



The critical element of this chain of events is the anatomy and Tri Motion function of the foot, which allows us to move forward along with froward momentum created by gravity.    The complexity of the foot gives it the unique ability to absorb impact loading (heel contact along with the knee), and within a precise millisecond, it changes into a Rigid Adapter through complex joint wedge interlocking between the rearfoot (Sub Talar Joint) and midfoot (Midtarsal Joints) to that of a stabilizer.    In addition the 1st Ray (Navicular, medial cuniform, 1st Metatarsal and Hallux (big toe) needs to properly resist abnormal foot collapse (pronation) by plantarflexing during the midstance phase of the gait cycle.    Wow... what a mouthful of activity.

If the foot can not properly absorb impact loading and properly transmit these forces properly, then these abnormal forces will transition up the leg effecting one or more load bearing joints which over time can create injury and disease such as degenerative osteoarthritis.

 

General Foot Types:   There are many foot types, however these are the three basic foot types most commonly seen.

 

 



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The Biomechanics of Linear Movement
 

As Biomechanical Specialists, we are concerned about the types of movements the athlete performs.   Linear movement is quite different than Rotational Movement.   Certain joints are affected by problems in linear movement, namely the rearfoot (Sub Talar), the midfoot (Midtarsal) and 1st Ray (medial forefoot column).   Upper joint areas are also vunerable, namely the knee which is severely affected from abnormal foot collapse, (pronation) which disrupts the normal hinge function of the knee.   The hip and spine are also affected by the same problem of pronation.   In controlling linbear movement, proper rearfoot to midfoot alignment (neutral joint positioning) is critical.  

 

Methods such as casting or foam boxes and even Laser imaging can cause a series of errors in making a corrective Bio Engineered Device.     3DO (3D Orthodynamics) is more accurate because it does not rely on the "Art Form" associated with casting and foam box impressions.   This would also include Laser as well.   If the technician or physician does not compute the proper deformity and replicate this in the casts, we are waisting our time in manufacturing,   In addition, there are lab errors in the manufacturing process as well that add to the identified 27 error points associated with this Art Form.   

 

3DO Imaging starts with a stable and reproducible stance position and then software is used to reposition the foot geometry through dynamic analysis of Mass Displacement, Motion Analysis, Pressure Analysis, Body Balance, Symmetry, Gait Analysis and 3D Geometry.  

 

Operation Overview (Click)

 

The data is then fed to manufacturing methods for custom manufacturing;

• CNC Milling

 

 



• Thermo-pressed Shell Manufacturing (best) which pre-stresses the plastic to take repetitive cyclic load conditions and not break down and loose correction.

 

 

 Linear Movement Types

• Walking



"Its time to go for a walk"

• Hiking (Walking on variable terrain)

• Running (Movement with linear velocity)

 

 

 

 





The Biomechanics of Rotational Movement
 

Rotational Movement requires the foot to supinate and pronate as the body repositions in different movements.   Goals of intervention are to allow the foot to have increased range of motion.   We use more flexible stressed induced plastics that can take repetitive stress and not loose their geometric positioning.   

 

 

Examples of Rotational Movement Types



• Tennis, Racket ball and Basketball

• Cleted Sports (Football, Soccor, Baseball)

 

 

 

 



Foam Box Impressions

Direct Orthotics

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Foam Box Impression Process
 

In situations where 3DO Imagers are not available, we advise the utilization of a Foam Box Impression Kit to manufacture Medical Grade Orthotics.

 

Important Considerations

 

Break In and Wear Instructions

Thank you for your order!
We hope you enjoy your new custom orthotics.

Wearing Instructions

1.      Initially, you should be wearing your new orthotics for approximately one hour the first day, two hours the second day, and three hours the third day, etc. If you do not experience discomfort, continue to wear your orthotics throughout the day. If any painful feelings arise, immediately remove the orthotics from your shoes and try again the next day.

2.      Always wear socks or stockings to avoid and minimize skin irritation.

3.      Certain shoes may not accommodate your new orthotics, however, they should fit the style you ordered. Different styles of orthotics are available for different shoe types and can be purchased at 20% off which makes them $149.00 per pair plus shipping.  

 

>>> Simply visit www.directorthotics.com/reorder for discounted pricing.

4.      On rare occasions your orthotics may make unusual noises such as “squeaks”. This is the result of the orthotic materials rubbing against your shoe material. We suggest that you try sprinkling baby powder into your shoes to reduce friction between the materials.

5.      Should your new orthotics start to wear or appear to be breaking down over time, DO NOT try to correct the problem yourself. This could potentially cause improper function and void any guarantee. Give us a call to discuss any issues.

 Trimming Instructions

Full length orthotics may need to be trimmed to fit your existing shoes. They are made slightly longer on purpose because (a) we do not have your shoe in our lab in order to make a perfect fit and (b) we do not want the orthotic to be too short and allow it to move forward and backward in your shoes.

If your orthotics need to be trimmed you may simply trim off excess material with sharp scissors. Your shoes original insoles make a perfect guide. Trim off a small amount of material at a time and test shoe fit often so that you do not take off too much material.

 

 

Information Form Label

 

Name:
Order#:
Address 1:
Address 2:
City:
State:
Zip:

             

Please check any boxes where you are experiencing pain:   Heel:                            o Left                   o Right            o Both Arch:                           o Left                   o Right            o Both Ball of Foot:                o Left                   o Right            o Both   Please fill out info in section below
Please choose	Athletic
our orthotic	Dress
style ordered:	Diabetic
Shoe Size:
Age:
Gender:	o Male     o Female
Weight:

 

Optional Comments:

                                                                                                                                                                       

Prescription Forms for Physicians

 

 

Downloads

 

Orthotic Rx Form

https://www.dropbox.com/s/r6ttpt8h6wj99iq/Prescription%20Form.pdf?dl=0

 

Sandal Rx Form 

https://www.dropbox.com/s/mk5u4yqf7wm2iqx/Manual%20Simple%20Sandal%20Form.pdf?dl=0

 

Repair Rx Form

https://www.dropbox.com/s/vwzo869nqjqg2k1/REPAIR%20FORM.pdf?dl=0

Insurance Billing Codes

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Comments:

As we all know, benefit payments are reliant on a number of issues including correct billing, proof of medical necessity, the qualifications of the consultant or claims examiner.   The outcome measurement report is a valuable outcome measurement document to demonstrate medical necessity.   X Ray reports and other supporting documentations should also be attached.

Some carriers pay and some do not.   What I have outlines above is an example of scenario's which could be played out.   Key elements are proper alignment of diagnosis (ICDA-9) to procedures (CPT).    Patients with serious orthopedic issues need your attention and intervention.  I recommend you fight claims which are arbitrarily denied.   Many times the consultant reviewing the claim is not qualified, (example RN or LVN).  

Especially in patients who have had complications from injury or surgery (example joint implant surgery), may need to have a letter explaining the value that static and dynamic 3D kinematic imaging and analysis provides in preventing more costly surgery.  Many surgical procedures fail because the pathomechanical etiology is not or has not been addressed. 



Orthotic Manufacturing

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Optical Laser Imaging

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G3 - Re-Invented

High Resolution Stereoscopic Laser for Physicians and Orthopedic Technicians

 

 

 

G3

• Ultra High 3D Static Resolution Imaging
• True 3D Laser Imaging with precision accuracy
• Portable and reliable
• Works with Digital Imager Live Software
• Connects to Tripod for easy positioning
• No limitation on surfacing.   G3 Scans Barefoot, Socks, Nylons, Positive Casts or amputations.

 

Benefits

• No plaster and no mess. . .
• Works with Digital Imager Live Cloud Software
• Quick and easy to use
• Images transmit over Internet for quick and efficient manufacturing
• 3D Images direct to CNC, Thermopressed Custom Manufacturing or Custom On Demand Solutions

Imaging

 

 

 

 

 

Pricing

• Call us at (714) 669-9600 for a pricing quote & availability

www.digitalorthotics.com



True 3D Laser Imaging versus 2D Interpolated Guessing. . .

• 2D Optical Systems (Tomcat, Pedalign, Foot Levelers. . .) are not 3D and can not provide legitimate solutions.   It is all about guess work with these systems.   They are fine for less controllable devices such as Prefabricated Insoles, and Accommodative devices.   But when precise control of Subtalar, Midtarsal Joint and 1st Ray function is needed, they fail to adequately perform. 
• Laser Imaging is the ONLY TRUE 3D Optical Solution that is legitimate. . . 
• 2D Optical Systems ARE NOT 3D and CAN NOT provide XYZ Geometry. . .
• Do what is right and build your reputation on technology which is accepted by the EXPERTS. . .

 

Hypermobility Syndromes, Pronation, Supination

 

Functional Biomechanical Disease Module 1

 You Tube

Basic Foot Types

 

Key Points to Remember. . . Treat the symptom and the cause = Maximize patient care and results.

 

Anatomy

Functional Biomechanical Specialists tend to break the foot into 4 unique quadrants.   Each has a special function.

  

 

3D = Transverse - Sagittal (Frontal) - Lateral Body Planes

You must think 3D when you understand or work in the field of Biomechanics.   Every plane is affecting the injury or diseased part of the body.

 

Shock Absorption V Stability

The Foot is a Tri-Plane Motion marvel. 

• It works in all three body planes simultaneously.
• Its function is affected by all body planes
• It functions as a Shock Absorber along with the Knee at Heel Contact and when the forefoot approximates the floor, it instantly changes into a Rigid Stabilizer for the absorption and effective transmission of mass into the propulsive phase of the gait cycle.
• Understanding Foot Biomechanics is Key to the proper foundational analysis of Cyclic Load Mechanics of the body.  If you treat leg, knee, hip, pelvic, or spinal structures, you must include foot biomechanics because body mass, motion, balance, pressure, gait, and symmetry all stem from the body interacting with the floor through the foot.   3DO Imaging simplifies this task through software analysis.

Environmental Factors that can accelerate Disease

 

Man Made Terrain

The body is not made to interact with Man Made Surfaces, (cement - tile - asphalt).   It is a variable terrain adapter designed for uneven surfaces.   When the foot is subject to consistent flat hard terrain, abnormal kinetic loads are created leading to structural and or functional diseases.

 

Extrinsic Musculo-Skeletal Forces

Sedentary lifestyles can influence conditions such as Equinus.  Equinus is a very unstable and deforming sets of forces affected by congenital or acquired muscle group shortages.   

 

 

Lateral Plane (x) = Abnormal Forward Mass Migration from Equinus

 

 

Normal Foot Position (Frontal Plane) and Lateral Mass Migration of Body 

 

Footwear

Man made footwear is a another additional set of conditions that adversely affect abnormal static and dynamic cyclic load conditions.   From fashion footwear to ill fitting shoes, all contribute to additional forces which can affect all load bearing structures.

 

Pediatrics - Children

Early detection is the key to successful treatment.   Evaluating children starting at the age of 5 to age 22 is critical in providing adequate structural and functional correction.  As bones grow, we can affect structural change for the better. 

 

Wolff's Law - Our goal is to minimize these effects

 

Wolff's law is a theory developed by the German anatomist and surgeon Julius Wolff (1836–1902) in the 19th century that states that bone in a healthy person or animal will adapt to the loads under which it is placed. If loading on a particular bone increases, the bone will remodel itself over time to become stronger to resist that sort of loading. The internal architecture of the trabeculae undergoes adaptive changes, followed by secondary changes to the external cortical portion of the bone, perhaps becoming thicker as a result. The inverse is true as well: if the loading on a bone decreases, the bone will become weaker due to turnover, it is less metabolically costly to maintain and there is no stimulus for continued remodeling that is required to maintain bone mass.

 

Mechanotransduction 

The remodeling of bone in response to loading is achieved via mechanotransduction, a process through which forces or other mechanical signals are converted to biochemical signals in cellular signaling. Mechanotransduction leading to bone remodeling involve the steps of mechanocoupling, biochemical coupling, signal transmission, and cell response. The specific effects on bone structure depends on the duration, magnitude and rate of loading, and it has been found that only cyclic loading can induce bone formation. When loaded, fluid flows away from areas of high compressive loading in the bone matrix. Osteocytes are the most abundant cells in bone and are also the most sensitive to such fluid flow caused by mechanical loading. Upon sensing a load, osteocytes regulate bone remodeling by signaling to other cells with signaling molecules or direct contact. Additionally, osteoprogenitor cells, which may differentiate into osteoblasts or osteoclasts, are also mechanosensors and may differentiate one way or another depending on the loading condition.

 

Hypermobility Syndromes

 

Foot Types Involved (2)

1. Hypermobile Pes Planus (Common Flatfoot)
2. Hypermobile Pes Cavus (Rare Disorder)

Both of these conditions cause extremely unstable cyclic load conditions affecting the leg, pelvis, and spine.

 

Pes Planus - Transverse & Frontal Planes

This is a very common orthopedic condition which creates a wide array of pain syndromes in the foot, leg, pelvis and spine.   All three body planes are affected with this disorder.

The foot fails to wedge-lock rearfoot (subtalar) joints against midtarsal joints, and leaves the 1st Ray (navicular - medial cuniform - 1st metatarsal - hallux) unstable and hypermobile.   This creates a functional forefoot varus condition.   As a result, the medial forefoot collapses taking the leg into excessive transverse plane rotation.   This offsets patella glide in the knee, it also creates excessive pelvic rotation and resultant lumbar pressure. 

 

 

Normal Frontal Plane Alignment of Rearfoot to Forefoot

 

 

 Left = Non Weight Bearing (Forefoot Varus)  Right = Forefoot collapse with Rearfoot Valgus

Pes Planus - Lateral Plane
Equinus conditions (discussed above), increases mass displacement and pronatory motion substantially.  This accelerated force, increases the kinetic load trauma to the foot and load bearing skeleton structures.

Treatment

1. 3D Weight Bearing Kinematic Imaging
2. Gait analysis
3. Range of Motion Analysis
4. Digital 3D Imaging & fabrication of Bio Engineered Orthotics
5. Stretching exercises to reduce any identified equinus disease.
6. Dispensing of Custom Devices and Follow-Up in 3 weeks - 3 months - 12 months.
7. Re-calibration and adjustment of devices every 2 years