First 15 years of Orthotics Research

Theta Orthotics Research.

Dr. Brent JarrettI had been practicing podiatry for about 4-5 years when I developed an acute retro-calcaneal bursitis on my left foot. I had a history of moderate transient foot pain right and left, a ruptured Achilles tendon right 1-2 years earlier, chronically painful knees with multiple history of trauma right greater than left, intermittent intense low back pain, occasional neck pain, and chronic low-grade finger and wrist-joint pain.

As the heel pain intensified to sharp disabling pain, minimized but not controlled by high levels of anti-inflammatory, I had my assistant apply a “low dye strap” as she had observed me do for my patients.  I noticed an immediate improvement of the symptoms with a rapid return of symptoms following disuse of the tape.  As the tape dressing stabilized arch and foot function, I desired a device that would do the same.

I had been making my own orthotics for about 5 years when I took neutral position slipper casts of my feet, made a positive plaster mold, heat contoured (both rhoadure hard plastic and polypropylene plastic) to the plantar surface, and created neutral position orthotics with the rear foot posted in neutral position.  As I began to wear both soft (polypropylene) orthotics and hard (rhoadure) orthotics with identical design, I observed a more rapid acclimation to the soft device but a more significant reduction in symptoms with the hard device.  I saw immediate moderate reduction in symptoms and began to wear the hard orthotic during most all weight-bearing periods for the next six months.

Although an increased level of ambulation was observed from the pretreatment period, significant pain, especially noticeable in the morning, was still present, motivating me to think the orthotics were not doing anything and, in fact, causing some of the pain. After one eight-hour period without the orthotics I had worn consistently for six months, I had to put them back in. I knew they were helping me, but I still had so much pain.  I could relate to the many patients who admitted they walked better with their orthotics yet still had much unresolved pain.

I went to the lab, ground off 5 degrees of angulation from the heel post (because they felt too high), and heated the front of the plastic, which left the orthotic plate position 5 degrees less angular tilt than it was on the cast impression.  I put the orthotics in my shoes, walked 50 yards, and knew that I had taken away a part of what was working to reduce the pain.  I went back to the lab and this time added 5 degrees of angular tilt to the heat-contoured plastic plate with rear foot and intrinsic forefoot posts and put the orthotic back in my shoes. I felt immediate pain from the high part of the device. Within 24 hours there was a much greater tolerance to the device with a noticeable decrease in heal symptoms.

Although I was not measuring the design of the contoured plate, I knew, when I stabilized the plate with additional tilt, that improvement was observed. When I took some of the tilt away, benefit was diminished.  I wore this device for three months with a significant reduction in foot symptoms, but far less than complete resolution. The original discomfort associated with the high part of the arch was mostly gone.

I went back to the lab and this time added 10 degrees of additional tilt in the same fashion as before and put the finished orthotic into the same shoes I had worn with all previous orthotics.  Immediately, I felt the sharp pain of the elevated arch but kept the orthotics in.  They felt excessively high, but I noticed a decrease in heal pain almost immediately.  Some inside arch pain was present for several weeks, but it was gradually becoming less obvious; and my heal pain was 90 percent gone. I wore these orthotics with 10 degrees additional tilt for about 9 months, during which time even brief periods of ambulation without my orthotics resulted in a return of the sharp pain. An attempt to resume a 2-mile every-other-day jogging routine resulted in an increase in the pain although still significantly reduced from original pain.  Pain during basic walking activities was mostly gone with full-time orthotic use.

I began adding additional tilt to the orthotics of patients with similar reduction in symptoms.  Although no effort during this time was made to measure the angular tilt of the neutral plate formed to the patient’s foot, angular tilt added was measured up to 10 degrees.

At this time, I went back to the lab and added, with extrinsic and intrinsic posts, 15 degrees additional tilt to my neutral plate.  The inside arch was noticeably uncomfortable immediately. I considered taking some of the tilt out as it might be “too much correction.” Acclimation to the device with diminished arch pain was observed for several weeks. A decrease in symptoms of 95 % plus, even with jogging routine, was observed.  It was further observed that brief periods without the orthotics felt strange but were not so quick to generate original heel pain.

I wore this device for the next six months with what I considered complete resolution of my heel pain. Unexpectedly, I observed noticeable improvement in pain and range of motion in my knees which had been chronically symptomatic over an 18-year period. Although my pain was mostly gone, it felt like I required more correction, mostly as it related to my knees.  I really couldn’t believe that I did, but in the interest of research I went back to the lab and added 20 degrees of angular tilt to the same neutral plate impression.

Upon placing the orthotics in my shoes, I observed the elevated inside arch somewhat painful; but even though I felt excessively supinated, my knees felt immediate benefit. Over the next 2-3 years, attempts to measure the angular tilt of a neutral plate, along with the added angular correction added, were made. Significant difficulty in measuring the angular embodiment was encountered.  The hyperbolic configuration of the neutral plate confused my efforts for almost 2-3 years.  I was finally successful in defining the angular measurement of the angular embodiment of a neutral plate and subsequently the finished orthotic itself. Many of my own patients were observed and the newly quantified angular design inherent in functional plate orthotics was related directly to foot function and related symptoms.  Over that time, understandings related to optimal design resulted in production of orthotics having THETA measurements up to 39 degrees.

Orthotics research with Theta quantified between 20 and 40 degrees have since been used on over 4,000 patients from eight different podiatrists and six different chiropractic physicians. Foot and leg function with associated postural changes have been directly related to Theta.

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