I took the orthotics that I had been wearing for almost four months and added a combination of forefoot, and rearfoot posts (wedges), to increase the tilt of the surface. I went out into the long hallway of my building, to test every change. With each increase in the wedge, I would first observe additional pressure in the arch area of the foot. But with each increase in the wedge, chronic foot and knee pain would decrease. I wore each increase for about 2-3 months before considering the addition of more wedge. Generally, I would adjust to the increased Theta (wedge) in about 4-5 weeks, arch discomfort would dissipate, and a more natural feeling returned.
During that time, I determined that softer plastics, built at the same Theta angle, did not maintain the angular correction during weight bearing. And although they felt more comfortable at first, it became obvious that the more rigid plastic resolved symptoms better long term. It was clear that the angle theta had to be maintained during weight-bearing activity to be effective, and that a gradual but consistent increase in Theta was usually preferred clinically.
It also became clear that with each five degrees increase in angular correction, a noticeable improvement was documented clinically. A decrease in symptoms was observed, even though the patient had increased their weight-bearing activity. Initially, I started with a traditional hard plastic orthotic, heat-formed to cast impressions of my feet. I increased the angle of he wedge at five degree increments. Each time I went up a correction, I was surprised that I adjusted to the changes, and with time, wanted even more. The joke in the office was: How high do we really need to go? Every increase seemed more radical and excessive. But each correction up to what looked like way too much Theta, appeared to be beneficial.
Here’s what I learned:
- The angle Theta had to be maintained during weight-bearing activity to be effective.
- A gradual but consistent increase in Theta was usually preferred clinically.
- Rigid orthotics with up to 20 degrees more wedge (Theta), produced clinical improvement of chronic pain, in both my feet and my knees. Similar changes in patient symptoms were documented in about 15-20 clinical patients over the course of about 2 years.
At this time:
- I did not know why or how much wedge was necessary to achieve optimal function.
- Similarly, I did not know why the addition of so much more varus tilt was helpful.
- Most importantly, I did not know how to measure the varus wedge in an orthotic device.
Not being able to measure or quantify the amount of wedge, I could not duplicate or fabricate orthotics at any specific angle of correction. Even though I had Identified the angular wedge as the functional part of any foot control devise, I could not measure it, and therefore like so many other orthotic researchers before me, I could not test or study my theories as a science.
I knew that the wedge was positioned in the frontal plane, and that the right three points in that same plane defined the angle Theta. Determining the correct three points to use took another four years, and help from a supernatural source. As fate would have it, I accidently figured out the right three points, before realizing the answer was in the calculus all along. My four-year search for a way to accurately measure Theta, is perhaps the most important part of this 40 yearlong adventure. To be told in the next episode.