I wondered, do I really need a heel cup and arch when these elements were always the ones I was having to adjust for best comfort and control.  For as simple as a Graceyfeet insole is to look at, the science behind it is quite extensive. Graceyfeet works because pronation and bony alignment in and of themselves do not cause pain unless there is existing physical trauma or excessive mechanical stress to the tissues. Poor alignment does produce high plantar pressures that transmit excessive vertical forces through the joints of the foot and ankle and up the chain; that is what causes the pain and prolongs healing times. This is why, for example, we place a valgus wedge (or 1st ray cut-out) under the forefoot in the presence of a plantarflexed, hypo-mobile first ray. But what if there was a material that blocked the ground reaction force (GRF), allowed the 1st ray to drop, and molded to the heel and met-heads so well that it dispersed the pressures over a larger surface-area without the need for a heelcup or special pads? This is exactly what Graceyfeet does in a 3/16" thin, flat insole. Graceyfeet drops the pressure that causes pain, maintains a preferred joint movement path, and can be used in the presence of gross deformity and existing pathology. The full-length Kevlar turns vertical forces into horizontal forces while the PPT/SRP stores and returns energy under load. If the GRF is blocked and not allowed to reach the foot, where does it go? It stays in the cleat/ground interface. This results in improved grip on dirt, turf, and court surfaces. Faster acceleration times, quicker jumps, sharper cuts, powerful push-offs, etc....This stuff digs hard and releases perfectly. This in-turn, instills confidence in a player's base of support. But they should practice in it first! Immediately he will experience what the advantages feel like, and soon they will become second nature; freeing your player's mind to focus on his assignments of play, not his feet.

Now don't get me wrong, I do believe orthotics (Heel cup, posts, wedges, MLA pads, custom molded shells, etc.) work to reduce pain, improve balance and alter the kinetics and kinematics of gait!


 Graceyfeet is a tool for the toolbox to control pain and improve function. It can be complimentary to existing orthotic devices or for athletes who have soured on the use of orthotics altogether. It can go next to the skin and be cut for cast shoes, wrist pads, crown pads for helmets, slide pads, glove/mitt pads, chest pads, shoulder pads, and anywhere reduced pressures are desired. It's anti-microbial and anti-bacterial! It can be washed and dried in a machine! I can silkscreen a logo or player's name on it! It's very cool stuff. 

So, you've read this far.  Congratulations!  You've earned the right to know more...
1. Baitch SP, Blake RL, Fineagan PL, Senatore J: Biomechanical analysis of running with 25 degree inverted orthotic devices. JAPMA, 81:647-652, 1991.
2. Bates BT, Osternig LR, Mason B, James LS: Foot orthotic devices to modify selected aspects of lower extremity mechanics. Am J Sp Med, 7:328-31, 1979.
3. Blake RL, Denton JA: Functional foot orthoses for athletic injuries: A retrospective study. JAPMA, 75:359-362, 1985.
4. Blake RL: Inverted functional orthoses. JAPMA, 76:275-276, 1986.
5. Blake RL, Ferguson H: Foot orthoses for the severe flatfoot in sports. JAPMA, 81:549, 1991.
6. Blake RL, Ferguson H: The inverted orthotic technique: Its role in clinical biomechanics., pp. 465-497, in Valmassy, R.L.(ed.), Clinical Biomechanics of the Lower Extremities, Mosby-Year Book, St. Louis, 1996.
7. Butler RJ, McClay-Davis IS, Laughton CM, Hughes M. Dual-function foot orthosis: Effect on shock and control of rearfoot motion. Foot Ankle Intl, 24:410-414, 2003.
8. Chalmers AC, Busby C, Goyert J, Porter B, Schulzer M: Metatarsalgia and rheumatoid arthritis-a randomized, single blind, sequential trial comparing two types of foot orthoses and supportive shoes. J Rheum, 27:1643-1647, 2000.
9. Cheung JT, Zhang M: A 3-dimensional finite element model of the human foot and ankle for insole design. Arch Phys Med Rehabil, 86:353-358, 2005.
10. Dananberg HJ, Guiliano M: Chronic low-back pain and its response to custom-made foot orthoses. 89:109-117, 1999.
11. D’Ambrosia RD: Orthotic devices in running injuries. Clin. Sports Med., 4:611-618, 1985.
12. Donnatelli R, Hurlbert C, et al: Biomechanical foot orthotics: A retrospective study. J Ortho Sp Phys Ther, 10:205-212, 1988.
13. Dorland’s Illustrated Medical Dictionary, 25th ed., W.B. Saunders, Philadelphia, 1974. 
14. Duffin AC, Kidd R, Chan A, Donaghue KC: High plantar pressure and callus in diabetic adolescents. Incidence and treatment. JAPMA, 93:214-220, 2003.
15. Dugan RC, D’Ambrosia RD: The effect of orthotics on the treatment of selected running injuries. Foot Ankle, 6:313, 1986.
16. Eggold JF: Orthotics in the prevention of runner’s overuse injuries. Phys. Sports Med., 9:181-185, 1981. 
17. Fuller EA: Center of pressure and its theoretical relationship to foot pathology. JAPMA, 89 (6):278-291, 1999.
18. Fuller EA: Reinventing biomechanics. Podiatry Today, 13:(3), December 2000.
19. Gross ML, Davlin LB, Evanski PM: Effectiveness of orthotic shoe inserts in the long distance runner. Am. J. Sports Med., 19:409-412, 1991.
20. Gross MT, Byers JM, Krafft JL, Lackey EJ, Melton KM: The impact of custom semirigid foot orthotics on pain and disability for individuals with plantar fasciitis. J Ortho Sp Phys Ther, 32:149-157, 2002.
21. Guskiewicz KM, Perrin DH: Effects of orthotics on postural sway following inversion ankle sprain. J Orthop Sp Phys Ther, 23:326-331, 1996.
22. Hertel J, Denegar CR, Buckley WE, Sharkey NA, Stokes WL: Effect of rearfoot orthotics on postural control in healthy subjects. J Sport Rehabil, 10:36-47, 2001.
23. Kilmartin TE, Wallace WA: The scientific basis for the use of biomechanical foot orthoses in the treatment of lower limb sports injuries-a review of the literature. Br. J. Sports Med., 28:180-184, 1994.

There is no doubt that a bad case of Shin Splints can be incredibly difficult to rehab from.  Shin splints are a painful condition in the lower leg involving inflammation that occurs in the anteromedial compartment (the inside, front of your shins). Shin splints are considered an over-use syndrome and can result from intense ballistic activity such as boxing, running, or plyometric exercises such as platform jumping. The symptoms for shin splints include painful tightness and/or tenderness around the tibia, especially after running or walking for long distances over hard surfaces. Shin splints are generally caused by excessive strain and stress of muscles and tendons along the shin bones (tibia and fibula) and subsequent fluid retention in the interstitial spaces of the anterior leg.  There are no contractile fibers over the bone in this area to assist in pumping fluid away, only a broad fascia of connective tissue.  When micro-swelling persists in this area, it causes pressure over the bone and a painful ache.   Overuse of the surrounding muscles and high ground reaction forces are the most common mechanisms of injury.
Excessive motion of the subtalar joint of the feet serves to increase vertical pressures through the lower legs. Over-pronation leads to internal tibial rotation and increases the tractional forces upon the muscles and ligaments while excessive supination reduces the contact surface area of the foot and drives increased pressures up the limbs..

Rest, Ice, Elevation, Compression, and positive-flow massage are required to help alleviate shin pain; running and other strenuous activities should be avoided until the condition is minimized. Shin Splints can frequently be prevented by warming up with an appropriate stretch routine before participating in intense physical activity.

Footwear with hind-foot support and midfoot control in combination with a pressure-reducing insole is a good way to prevent and reduce the effect of shin splints, especially for boxers, football players, runners, or anyone who strikes heavily with the heels or are constantly on their toes.  Orthotic insoles are useful in that they help control the foot and reduce excessive plantar pressures and unwanted vibrations. Stability in the frontal plane combined with heel cushioning has been shown to reduce impact ground reaction forces (GRF) while repositioning the force vectors and reducing their magnitude.  These changes result in more comfortable weight-bearing during high impact, or long duration activity.

A blurry-eyed arrival to the conference from weeks of inspired creativity in the "Rehabilitation Arts" was met with friendly faces, kind hand-shakes and hugs.  I had a wonderful time meeting and re-meeting everyone and I am told my talk went over quite well.  It was titled "Pedorthic Solutions for Persons With Proteus: Phun With Pheet!" and I demonstrated the fabrication techniques I employ to make Brian Richards' custom orthotics.  I took out the algebraic math and used some simple geometry to demonstrate the concept of fore-foot varus or valgus wedging for dispersing plantar pressures while simultaneously relieving large bony masses at each stage of the gait cycle. I had limited evaluation findings except for my powers of recall (I've seen this population since 1999), photos, conversations with Brian and the casts of his feet.  A great many assumptions were made regarding joint position from the STJ and above but nothing beats good communication to gain a thorough understanding of a person's pathology.  I employed a tissue stress approach to identify key areas of need and selected the materials that could do the job. I issued Brian his new orthotics in front of the audience and other than two small areas of fit and feel, Brian said,"It feels like I'm walking on air!"  A priceless moment.
My friend Daniel was awesome in delivering a method of adjusting Crocs with a heatgun.  I and the audience were raptured by his passion and creative enthusiasm.  I also introduced my "Conceptual Pedorthics" approach whose philosophy states that assisting the human body in self-locomotion will improve life experience and strives to view the foot as an existential tool.  This school of thought allows for open-minded, evidence-based, pedorthic foot care within the confines of the patient's functional life.  Thank you, Dr. Leslie Biesecker, Kim Hoag, Julie Sapp, Barbara King, Mary Timmerman, Pam Goddard and all the great people involved in the Proteus Syndrome Foundation in one way or another.  Thank you to Uneaqual Technologies, Fastcut CNC, Pel Supply, and the good folks at Podiatry-arena.com .  Best of all, A cause has been found.  And that was the best news all day long! 
http://www.proteus-syndrome.org/proteus-syndrome/medical-research/

Proteus Syndrome.  If you don't know, Now you do.  I've worked with persons with Proteus for 14 years and I'll be speaking at the conference in October.  Please read a become aware of this rare disease.  Thank You!

http://www.proteus-syndrome.org/html/reference/fulltext.pdf

"Dear Chris, I am in Greece and wearing my jogging shoes with the pad you made for (me) as well as the orthotic as I write this email. In fact the only reason that I am thinking about the pain I used to have is that I am writing you!  Thank you, G.A." 

The above is a pleasant and informative email sent to me that introduces my next topic quite nicely.  How and Why the body is able to conform and tolerate an orthotic device to the point they are "forgotten" are questions clients often ask but receive few specific answers on from healthcare professionals.  What my patients are mostly looking for is useful information, based in science, that explains why we recommend they slowly get used to their orthotics.  
Well, it's not for functional ability of the orthotic device to 'break-in', but for the body's comfort to increase compliance in using the device.  I tell them, "The foot can get used to just about anything, but we want it to get used to the RIGHT environment."
Here's HOW that happens:
Nerves of sensation are found in abundance in the Dermis layer of the skin.  Meissner Corpuscles are responsible for signaling light, fast touch.  Pascinian corpuscles sense deep pressure and vibration.  Free nerve endings are responsible for pain and temperature changes.  Proprioceptive nerves sense positional and rotational changes at the joints.  These nerves work independently and in groups to let the brain know what the physical changes of the skin are and where the limb is in space.  Placing an orthotic under the foot and inside a shoe has been shown to alter joint position, plantar pressure distribution, and pressure magnitude.  Changes in these variables are detected by the nerves in the foot and if an abrupt or large change is experienced for too long a time, a pain threshold may be reached.  This means that a device may place the foot in a desired corrective position but may also induce a pain response if the brace is not anatomically correct and is not introduced slooooowly.

So I do not say a word of the above to my client unless they ask in a way that leads me to believe they would understand those complex concepts.  Instead a reply such as,  ">>>To be continued<<< - CG

Let's start off by giving a few references:

Milani, TL, & Hennig, EM (1993). Pressure distribution under the foot at the take off in volleyball jumps and high jumps Fosbury Flop. In Biomechanics XIV, (pp. 874-875). Paris: International Society of Biomechanics.

Energy absorption of different court surfaces:  http://www.asbweb.org/conferences/1990s/1998/86/index.html

Volleybal Biomech Differences btw Sand and Rigid surfaces in Squat Jump:  http://www.ncbi.nlm.nih.gov/pubmed/15079993



Orthotics do have an effect on the angular alignment of the bones of the foot in stance and it is widely accepted that these changes translate to a change in plantar pressures and center of progression during gait.  The degree or magnitude of effect on pain and function is not well known and published results are largely subjective or speculative.  Too bad.  But what we do know is that by altering the plantar pressures during gait, we can elicit the effect of breaking a player's cycle of loading the foot in a painful area and relieving an overused area of compensation.  But what about the playing surface and how can we reduce the risk of injury occurring in the first place??

In Jumping, the softer and more compliant a surface is, the greater amount of force is transferred to the jumping surface.  Additionally, the body will make angular compensations at the LE joints and hips to improve stability, increase extension moments, and launch during a jump.  It would appear that the softer surface (Sand) reduces the likely hood of impact injuries but at the expense of increased loading of the support structures of the foot and ankle at angles that do not occur on a more rigid surface.  Compensations such as these are highly individualized and each player will have their own method of positioning themselves for proper launch and landing.  This would be enhanced in barefoot conditions v. shod.

The lesson to take away here is that an orthotic can have very little effect on the alignment of the LE on a typical sand volleyball court.  Depth of sand and a billion other assumptions are being made of course, but if a team is training on sand, they should schedule their matches for sand surfaces as the body will have learned to perform on that surface.  A player may actually jump higher on rigid surfaces having trained on sand, but foot placement and impact forces will be dramatically different on the rigid court and an increase in the likelihood of injury may occur.  Multi-surface training and an understanding of each individual's compensations to varying court surfaces are keys to injury reduction.  An orthotic with good energy return, flex, support, and a shock-absorbing sockliner should help a player adjust to the changes in plantar pressures and bony alignments that are found going from sand to more rigid court surfaces.

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