Common Indications for the Inverted Orthotic Technique
What are it’s present common indications for use:
1. Really Any Pronation Problem (part of this is to get the practitioner and maybe laboratory used to it then having the first one being 35 degrees)
2. Almost all running orthotics benefit from this inversion (except the 5% of runners that are supinators)
3. Moderate to Severe Pronation (this is for most practitioners)
4. Pronation from sagittal plane deformities (along with stretching equinus if appropriate)
5. Pronation from transverse plane deformities (along with strengthening external rotators if appropriate)
6. Posterior Tibial Tendon Dysfunction
7. Tarsal Tunnel Syndrome
8. Lateral Meniscal Syndromes
9. Increasing of Genu Valgum while trying to avoid knee replacement
10. Medial Shin Splints (caused by athletics)
11. Patellofemoral Syndromes (caused by athletics)
12. Juvenile or Adult Acquired Flat Feet
13. Juvenile Bunion Deformities
Let us look at this list above briefly here to get an idea of its place in the biomechanical world. The basic premise of the Inverted Technique is that it works at the control of rearfoot pronation in contact and midstance phases. The practitioner has taken an impression cast capturing the forefoot to rearfoot relationship. If this relationship is the most important aspect of the pronation syndrome (say forefoot varus or metatarsus primus elevatus), and then a Root or Modified Root device is crucial if it can support the deformity captured. This is seen commonly when 5 degrees of forefoot varus can cause a 5 degree everted resting heel position. But, if the pronation is from other sources causing contact or midstance phase pronation, then the Inverted Technique is indicated. I have also always used the Inverted Technique with high degrees of forefoot varus or supinatus since supporting those deformities with Root devices can block first ray plantarflexion at times. Try accurately supporting 12 degrees of forefoot varus and not blocking first ray plantarflexion.
#1 Really Any Pronation Problem—this is cavalier, but even mild cases of pronation can be helped with 2-3 degrees of inversion force. This would be prescribing 10-15 degrees Inverted Orthotic Devices. Of course, you can accomplish the same with Kirby Skives, or Root Devices setting the correction 2-3 inverted, but if you are new to the technique it is good to learn on smaller amounts of inversion.
#2 Almost all Running Orthoses—95% of runners land inverted and pronate 8-10 degrees before resupination. Putting a 5 degree inversion force with a 25 degree inverted orthotic device is my standard running device. It is good to see if it helps the patient’s symptoms and tolerated for comfort. Of course, a 25 degree Inverted Orthotic Device functions differently in a neutral shoe, a stability shoe, and a motion control shoe. Even power lacing of an athletic shoe can make a big difference in stability.
#3 Moderate to Severe Pronation--typically any foot practitioner should be able to divide their patients who pronate into mild, moderate, and severe categories. The moderate and severe categories are the patients that this technique was designed for. If you are skilled in Root Biomecha