It is also hypothesized that the utilization of the 3DO System for testing and electronic casting will result in superior orthotics than those produced from conventional casting methods. The ability of the 3DO System to gather comprehensive data on static load bearing pressure points, weight distribution, and gait testing provides the tester and orthotics lab with important additional information in creating more advanced orthotics. Further, the portability of the system and the speed of which testing can be completed lends itself to mass customization in industrial applications.


History
For 60 years, Ergonomic Orthotics have proven to be effective modality in minimizing or eliminating symptoms in patients with neck, shoulder, spine, hip, knee, foot and ankle problems by focusing on maximizing closed kinetic chain mass displacement, (weight) effecting the body by controlling complex tri-motion function of the foot as it impacts the ground.

A health questionnaire was designed and circulated to determine the scope and nature of the problems. Upon written interviews with the linemen and groundsmen, 65% responded with the complaint of various chronic musculoskeletal pains including the lower back, neck and shoulders.  

Method
Edison employees at two service centers were offered the opportunity to volunteer for a pilot study to evaluate the effectiveness of Orthotics. They were given a free scanning of static and dynamic weight-bearing on a dual functioning 3-D static and dynamic Imager. Those who demonstrated abnormal scans were then recommended to purchase Orthotics at a significantly reduced rate understanding that they came with a 100% satisfaction guarantee for a full refund. Of the 112 employees available, 70 entered the study with the understanding that were would be a 1 month, 3 month, and 6 month follow-up.   

Six Month Follow-up Survey Summary:* Only 41 employees where available the day of survey collection.
* 4 had either never worn or stopped wearing them for various reasons
* 2 employees had complaints that were related to the shoe/boot and are being resolved.
* Does the Orthotic help you with your job? 62% Yes, 20% sometimes
* Do you have less pain now (prior to health questionnaire) from using the Orthotics?
o 20% said a little
o 40% said moderate improvement
o 25.7% said significant improvement 
* Help improve chronic problems? 57% Yes, 20% sometimes, 14% No
* Do you wear them daily? 86% Yes, 11% sometimes, 3% No
* Rate the value? 37% very valuable, 49% somewhat valuable
* Would you recommend Orthotics to your family and friends?
* 86% said Yes
* 10% said No 



Data Results Discussion
The subjective data reflects a positive response from the T & D linemen and groundsmen.

The purpose of the pilot study is to determine the effectiveness of the Orthotics at addressing the following concerns:



Does it help with the job?
The survey shows that 62% of the employee available on the day of data collection felt that the Orthotics helped them with their jobs.

Is it reducing physical symptoms and complaints?
Almost 86% responded with either a little, moderate, or significant improvement with the use of the Orthotics.

Is it helping in reducing or preventing injuries?
Both service Centers report that there has not been an injury or accident since the beginning of the study.

Additional Notes
At one month and three months, phone surveys were conducted at random. Results were favorable and most complaints were resolvable with Orthotic adjustment.  The six-month survey (see attached) has places for written feedback. Most of the employees had both written and verbal positive feedback. It is my recommendation that we continue to locate the other members in the study and collect their comments.

Conclusion
The preliminary results which represents a four month ( Huntington Beach) and six month (Saddleback) evaluation demonstrates and confirms in part the effectiveness we were attempting to prove. It must be noted that further symptom reductions will occur over the next six to eight months as the workers continue to wear and comply to the utilization of Ergonomic Orthotics. The goal is to stress the importance of wearing Orthotics as much as possible (work, home, sports and play). Generally compliance should be good because of the benefits (relief of pain, fatigue etc…), however we may want to consider some educational material and follow-up to ensure compliance which will justify greater benefits to employee and employer.

There were also considerable problems noted in the boot wear being worn by employees. With the mechanically demanding positions and environments the T&D workers are faced with many of them wore improper foot wear (oxford shoes, cowboy boots, and severely broken down foot wear). We attempted to educate them on proper fitting boots, but it is apparent we could have had even greater results if we had a compliance program which met recommendations established by OSHA, NIOSH. The Orthotic is only as good as the boot in which it fits. Especially in cases with broken down foot wear which distorts the quality of biomechanical control of the Orthotic since the Orthotic is meant to work in a bottom sole which is parallel to the floor surface.

The development of new, lighter, stronger, materials has increased the variety of devices and computerization has improved the overall quality of these products. When the foot is subjected to persistent abnormal patterns of gait, a particular set of symptoms will follow. The principles of biomechanics in the lower extremity must be understood before attempting to prescribe these devices. Human gait has been described by Steindler as " a series of movements where the body moves forward and the legs are placed in front of the trunk to prevent us from falling on our faces1." This point is clearly demonstrated by watching babies take their first steps with arms flailing, body swaying from side to side, and finally falling into mommy or daddy's outstretched arms. This explanation is misleading as to the simplicity of the process. There are 26 bones in the foot alone with 17 functional joints and many more articulations. There are numerous intrinsic and extrinsic muscles of the foot innervated by 6 nerves acting on those joints. In addition, there are precise applications of all the lower extremity and postural muscles. Therefore, each has a specific function and firing order in the sequence of movements that make up gait. Therefore the act of walking must be a well coordinated psychoneural and musculoskeletal process that is both repeatable step after step and accommodates to changes in conditions1. There are many variations of this pathway that may be considered ambulation but not necessarily normal gait. Variants to normal gait can be due to congenital anomaly, anatomic variation and loss of function due to traumatic event. It is when these variants of normal gait are multiplied by years of walking that most foot pathology occurs. Each year of walking consists of over 2.5 million steps and each walking step translates to a force of 2.5 times our body weight.

Treatment for Tarsal Tunnel Syndrome. Pain from tarsal tunnel syndrome may be relieved by treatment with orthotics, specially designed shoe inserts, to help redistribute weight and take pressure off the nerve. Corticosteroid injections may also help. Surgery is sometimes performed, particularly if symptoms persist for more than a year, although its benefits are under some debate. Tarsal tunnel syndrome caused by known conditions, such as tumors or cysts, may respond better to surgery than when the cause is not known. Recovery from this surgery can take months before a person can resume normal activity. It should only be performed by experienced surgeons. 

Flat Foot
Flat foot, or pes planus, is a defect of the foot that eliminates the arch. The condition is most often inherited. Arches, however, can also fall in adulthood, in which case the condition is sometimes referred to as posterior tibial tendon dysfunction (PTTD). This occurs most often in women over 50 but it can occur in anyone. The following are risk factors for PTTD: 

Wearing high heels for long periods of time is a particular risk for flat feet. In such cases, over the years, the Achilles tendon in the back of the calf shortens and tightens, so the ankle does not bend properly. The tendons and ligaments running through the arch then try to compensate. Sometimes they break down and the arch falls. Some studies have indicated that the earlier one starts wearing shoes, particularly for long periods of the day, the higher the risk for flat feet later on. Other conditions that can lead to PTTD include obesity, diabetes, surgery, injury, rheumatoid arthritis, or use of corticosteroids. Some research suggests that flat feet in adults can, over time, actually exert abnormal pressure on the ankle joint that can cause damage. One indirect complication of flat arches may be urinary incontinence or leakage during exercise. The less flexible the arch, the more force reaches the pelvic floor, jarring the muscles that affect urinary continence. Nevertheless, whether flat feet pose any significant problems in adults is unknown. For example, a 2002 study on athletes with flat feet indicated that they had no higher risk for leg or foot injuries than athletes with normal arches.       

Treatment for Flat Feet in Children. Children with flat feet often outgrow them, particularly tall, slender children with flexible joints. One expert suggests that if an arch forms when the child stands on tip-toes, then the child will probably outgrow the condition. Treatment for Flat Feet in Adults. In general, conservative treatment for flat feet acquired in adulthood (posterior tibial tendon dysfunction) involves pain relief and insoles or custom-made orthotics to support the foot and prevent progression. In severe cases, surgery may be required to correct the foot posture, usually with procedures called osteotomies or arthrodesis, which typically lengthen the Achilles tendon and adjusting tendons in the foot. One procedure uses an implant to support the arch. These procedures have potential complications and conservative methods should be tried first. 

Abnormally High Arches
An overly-high arch (hollow foot) can cause problems. Army studies have found that recruits with the highest arches have the most lower-limb injuries and that flat-footed recruits have the least. Contrary to the general impression, the hollow foot is much more common than the flat foot. Clawfoot, or pes cavus, is a deformity of the foot marked by very high arches and very long toes. Clawfoot is a hereditary condition, but can also occur when muscles in the foot contract or become unbalanced due to nerve or muscle disorders.  Claw toe is a deformity of the foot in which the toes are pointed down and the arch is high, making the foot appear claw-like. Claw toe can be a condition from birth or develop as a consequence from other disorders.  


Original Document: http://adam.about.com/reports/000061_10.htm

How does it occur?
This inflamed heel growth plate is caused by overusing the foot with repetitive heel strikes. It may also occur from wearing shoes with poor heel padding or poor arch supports.  

What are the symptoms?
A child will complain of heel pain. Running and jumping usually increase the symptoms.  

How is it diagnosed?
The health care provider will find tenderness over the bottom part of your child's heel. In severe cases of calcaneal apophysitis, he or she may order an x-ray to be sure there is no damage to the growth plate.  

How is it treated?
Your child may need to rest or do activities that do not cause heel pain. It is very important that your child wear shoes with padded heel surfaces and good arch supports. Extra heel pads may be placed in your child's shoe. Your health care provider may recommend shoe inserts, called orthotics. You can buy orthotics at a pharmacy or athletic shoe store or they can be custom-made. Your provider may also prescribe an anti-inflammatory medicine for your child.  

When can my child return to his or her sport or activity?
The goal of treatment is to return your child to his or her sport or activity as soon as is safely possible. If your child returns too soon the injury may be made worse, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to his or her activity will be determined by how soon your child's heel recovers, not by how many days or weeks it has been since the injury occurred. In general, the longer your child has symptoms before starting treatment, the longer it will take to get better. If the heel hurts, your child needs to rest from his or her sport or activity. Your child should rest for several days at a time and then go back gradually. Before returning, he or she should be able to jog painlessly, then sprint painlessly, and be able to hop on the injured foot painlessly. If at any time during this process your child develops further heel pain, he or she should rest for 3 to 4 more days until the pain is gone before trying to return again.  

How calcaneal apophysitis be prevented?
Calcaneal apophysitis is best prevented by having your child wear shoes that fit properly. The heel portion of the shoe should not be too tight, and there should be good padding in the heel. You may want to put extra heel pads in your child's shoes. 


Original Document: http://www.med.umich.edu/1libr/sma/sma_calcapop_sma.htm