It's already November and I am wondering where the year went!  Soon it will be Christmas and then 2008!  The older I get the faster the years go by and the more there seems to be to get done. It's hardly fair, is it?

One of our major undertakings this year was changing the medical branding from Classic and Select to Formthotics System. Why did we do this? Mainly because there are so many products on the market that all claim to be the equivalent of Formthotics®, when in reality most of them are just another form of insoles (albeit with a slightly higher arch region) made by the same process, (heat-compression moulding or injection moulding) as the standard insoles that come in shoes. Any of these products can help to reduce a particular patient's symptoms but do they improve foot and leg function and are they really "foot orthoses" or "orthotics"?

I guess that it is a question of defining what we mean by the term orthotic. If we mean an insole product that comes out of a packet and maybe has a wedge somewhere on it then any shoe insert can be called a foot orthotic and there is no need for the terms orthotic, insole or arch support because they are all interchangeable.

The term orthotic ought to mean a custom prescribed medical device to straighten or align parts of the body and improve their function. A foot orthotic should therefore reliably alter skeletal alignment and also improve the function of the foot and leg. Root described a model and method for doing this by way of precisely prescribed devices made on "casts" of the foot in the neutral subtalar position. He called such devices Functional Foot Orthoses. When I designed Formthotics, I followed Roots principles, that the device should be capable of being custom formed to the arch of the neutral foot ad then posted with wedges. This is why the product is milled to variable thicknesses throughout instead of being compressed from a sheet of material of a single thickness or injection moulded.

The name Formthotics® was chosen to signify that this was an orthotic that was customized by FORMing it to the contours of the individual foot and also the shoe to make a neutral shell that was subsequently posted. I still maintain that the only alternative to making the device on a neutral subtalar cast (by the Root method) is to start with a product that has been MILLED as opposed to being compressed because the temperatures and pressures required to make a compressed product cannot be duplicated in custom fitting the product to the patient's foot and shoe.

To further complicate matters scientific research has now established that even expensive hard custom devices do not reliably improve foot and leg function or significantly alter biomechanics as they are intended to. Lower extremity function is too complex to be understood by a mechanical model. The effects of the muscles and nervous system must also be considered and better understood. It is likely that there is a wide variability of individual response/adaptation to a given orthotic device. The Formthotics System is our attempt to address some of the other factors (such as joint restrictions, proprioception, balance, supination resistance, the windlass mechanism and loading on particular muscles) involved in improving foot and leg function. The Formthotics System includes the biomechanical principles developed by Root but adds clinical tests of function, which can be easily performed and appreciated by both the therapist and the patient. Using Formthotics® to make a custom shell and then adjusting it with posts and assessing the patient's functional response provides safety and reassurance for both the patient and the therapist.

We believe that this method or system of making custom foot orthoses has many advantages over taking an insole out of a packet and sticking a wedge on it because the foot appears to have a certain resting posture.

Hence the name Formthotics System as a new brand to signify to the patient that they have been provided with therapy to improve the function of their lower extremity and relieve their pain.

I hope that you will have a very Merry Christmas and a Healthy and Happy New Year.

Charlie Baycroft