When fitting and reviewing Kinetic Orthotics^®, the following checks need to be made:

Length Adjustment

The anterior edge of the Orthotic needs to sit just behind the metatarsal heads. This should be checked in a static non-weight bearing position. The reason for this is that this position is closest to the position the foot will adopt just prior to toe-off. Should the Orthotic be too long in this position the anterior edge of the Orthotic will limit plantar flexion of the first metatarsal head and cause interference with the windlass effect resulting in a functional Hallux Limitus.

The length should be checked again at every subsequent review in case the length of the foot changes due to Wolf’s and Davis Law.

Orthotic Flexibility

The flexibility of the Orthotic should also be noted. Orthotics that are too flexible should be avoided as they may not recover in time from elongation and distortion that occurs as the body weight passes over the device. An Orthotic must resume its original position before the windlass takes place; otherwise it can cause interference and delay the timing of foot resupination. This may cause a functional Hallux limitus.

Prominence of Fascial Chord

The prominence of the fascial chord should also be noted on fitting and review. This is checked by dorsiflexing the first toe to imitate the position of the chord just prior to toe off. Observe how prominent the chord appears on the plantar surface of the foot.

The patient may complain of increased uneven pressure in the arch area of the plantar surface of the foot. In order to accommodate the plantar fascial chord all you need to do is grind a “V” groove into the top surface of the Orthotic taking care to blend the medial edge of the “V” with the surface contour of the Orthotic itself.

Sometimes the groove needs to be deepened on review as the chord can tighten due to Wolf’s and Davis Law.

Ankle Joint Restriction

Any sign of functional ankle joint restriction should also be noted. If the patient has marked genu recuvatum or an abducted gait pattern it is highly likely that the function at the ankle joint will be compromised and the patient may complain that the orthotic is pushing up heavily in the arch of the foot.

When walking the patient’s foot is likely to be rocking over and pronating on the Orthotic and even causing the foot to slip out of the back of the shoe. This can be generally overcome by adding a heel-raise to the device to facilitate ankle joint function.

In most cases a minimum of 3mm will suffice. On review this modification should be re-evaluated. If the biomechanical balance has changed, a patient who initially had the heel raised may complain of not enough support or a feeling of instability. Removing the raise at this stage will help the patient feel better supported and more stable.

Lateral Column Adjustment

If, on review, the patient complains of lateral foot pain or metatarsal pain and you have ensured that the device passes the previous four checks, a simple adjustment could be necessary to the lateral column. This consists of a shaft pad of 3mm EVA along the lateral column starting at the calcaneo-cuboid joint and finishing about halfway along the shaft of the fifth metatarsal.

This pad serves to stabilise the calcaneo-cuboid joint and facilitate the close packing needed just prior to initiating the windlass effect. Increased support of the calcaneo-cuboid joint helps to also stabilise the midtarsal joint. It is important not to overdo the support as it will limit plantar movement of the cuboid as the foot goes through midstance.

The cuboid must be able to move in order to maintain the foot’s ability to pronate and resupinate during the gait cycle.

Width Adjustment

Width adjustment of Kinetic Orthotics^® must always be done from the medial side. Narrowing the device from the medial side and lowering the medial heel cup then blending it with the lateral heel cup, is fine as long as the depth of the lateral heel cup is not reduced below 12-15mm.

The medial heel cup height can be lowered as much as you deem necessary for shoe fit but the lateral heel cup has to be maintained above 12-15mm to avoid pinching.

It is important for shoe fit that the device is narrow enough to sit right back in the shoe and not be squeezed forward by the shoe upper. If this happens there will be similar symptoms to those described above for a device that is too long. It is also important that the anterior edge sits flat on the forefoot sole of the shoe and is not sitting on the outside edges of the sole, which could cause the anterior edge to be elevated. Again, this can cause similar symptoms to patients with an Orthotic that is too long.

The Governing rule of Kinetic Codependence

When prescribing, fitting and reviewing Kinetic Orthotics^®, please remember that the objective is to provide stability in Frontal Plane and at the same time ensure that the device facilitates the smooth transfer of force through each key sagittal plane pivot site

It is essential to ensure that the orthotic both stabilizes the foot in the frontal plane and protects and facilitates pivotal function at each key pivot site through the windlass mechanism. This is the foundation for reliable and predictable results from Kinetic Orthotic Therapy.