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Making Biomechanics Great Again

Podiatrists and other professionals are manning a wounded ship when it comes to biomechanics and orthotics.

The current peer reviewed science argues against the legitimacy of Root theory(1-6), the 40 year old gold standard. Jarvis, Nestor et al published in 2017 concluding that “We believe that the assessment protocol advocated by the Root model is no longer a suitable basis for professional practice. We recommend that clinicians stop using sub-talar neutral position during clinical assessments”(7).

In this age of evidence based medicine, little positive peer reviewed evidence exists when it comes to custom foot orthotics.

Simultaneously, changes in insurance coverage, technology, our lifestyles and economic demands have created a better informed foot suffering public with a demand for better, more certified products, better presentations, better marketing and better promises that can actually be fulfilled, right now.

Marketing unproven paradigms theorizing how the human foot functions and how custom foot orthotics are based on science and fact is obsolete and in need of a state of the art replacement. The results of presenting unconfirmed assurances when it comes to custom orthotics have authorities questioning their value and necessity since 2011(8).

In fact, there is a countertrend to the value of subtalar joint neutral custom cast orthotics advanced by kinesiologists that movement training and physical therapy provide better solutions to the problems for which foot orthotics are prescribed especially when it comes to injury prevention, performance enhancement, movement complaints and quality of life upgrading.

“The Birthday Cake” metaphor of economist Pine and Gilmore introduced in 1998 (9) has created a model in economics known as The Experience Economy (10) . that may explain why the custom orthotic is cemented and declining.

No one argues that the original birthday cake baked at home from scratch and STJ Neutral cast foot orthotics both continue to deliver their promises as iconic products. However, to avoid sharing the fate of the dinosaur, they both needed to acculturate to the changing economics and demands of their ultimate consumers in order to survive and thrive. As it stands today, the birthday cake has adapted successfully and the custom foot orthotic has trailed behind the changing needs and stresses of the foot and posture suffering public.

The agrarian history of the birthday cake had mothers baking birthday cakes from scratch (ingredients). Then mothers began paying Betty Crocker for premixed ingredients (commodities). Later, busy parents ordered cakes from the bakery or grocery store (products + services). Today, in the time-starved present, parents outsource the entire event to a business that plans an event that includes a cake (product + service + the experience) and the birthday cake lives on.

A similar sequence of events holds true for foot beds. Footbeds started with well placed materials such as arch pads, strappings and gadgets onto feet and in shoes (ingredients). Later the arch support was developed (product). Next, the arch support advanced to foot orthotics that were attached to a professional practice (product + service). Sadly, the foot bed has never evolved to the forth level by adding the value and positive economics of “the experience”.

There are diverse theories of contemporary biomechanics attempting to create an experience for custom foot orthotics that have fallen short after years of trying (11). Custom Foot Orthotics have languished as a $22 piece of plastic product that promises the world and fails to produce it too often.

The Facts and Myths:

  1. Custom foot orthotics promise to reduce pain for some foot and postural problems and at least short term, they do
  2. Custom foot orthotics promise to improve muscle engine function and to some extent, they do but possibly the wrong muscle engines
  3. Custom foot orthotics promise to reduce moments about the knee that are theoretically helpful --- and although they do, there is only peer reviewed evidence that this biomedical engineering reduces foot and postural problems in rare cases
  4. Custom foot orthotics promise to align the foot and ankle into the most anatomically efficient position (subtalar joint neutral) and they cannot
  5. Custom foot orthotics promise that they are custom made to correct specific foot imbalance --- and they do not
  6. Custom foot orthotics promise to reduce stress and strain on your body by bringing your feet back into proper or even perfect alignment --- and they do not
  7. Custom foot orthotics promise to redirect and reduce damaging movements (hyperpronation) that take place in closed chain --- and they do not
  8. Custom foot orthotics promise they are fabricated from “precise imprints of your feet” --- and they are not
  9. Custom foot orthotics promise that they are tailored to the individual when most of them are not (12)

The modern theory with the most traction and support of this group is The Tissue Stress Theory promoted by Kirby and Fuller (12-13) and being practiced internationally.

Dr. Kirby publishes that the first step in practicing Tissue Stress is to “specifically identify the anatomical structure that is the source of the patient’s complaints”.(14) This suggests that Tissue Stress Theory is complaint oriented and not a practical paradigm for an experiential presentation.


Now, think of examples where company’s stage meaningful experiences in addition to their products in a memorable and personal way such as NetFlix which took the movie rental and made it an exciting experience worth billions. Think of the coffee bean and Starbucks. Then Expedia and Sleep Number Matress.

The Foot Centering Theory of Structure and Function

This brings us to The Foot Centering Theory of Structure and Function: A Biomechanical Paradigm Shift For Diagnosing and Treating Feet built for experience economics first published in 2007(15).

The Foot Centering Theory incorporates “restorative foot orthotics”, a new generation of footbeds that purposefully act as props that posture the feet more optimally. This results in their ability to make feet more trainable (think ballet) and more capable of repairing, restoring and being better balanced with better movement over time. Restorative foot orthotics (RFO’s) come with an experiential promise of prevention, performance enhancement, upgraded quality of life, endurance and durability. In some cases, the orthotic props can be weaned away because the body can manage life’s tasks on its own (compare to props like blocks and belts in yoga). Restorative foot orthotics add an experience to the use and services performed by a foot bed. RestorThotics, the trademarked name of these devices can and will Make Biomechanics Great Again.

The Importance of Foot Typing

Root proved that biomechanically responsible care of the foot and posture must include a foot typing system that subgroups feet (and cohorts of feet) into subgroups in order to customize their treatment and research. Historically arch height, the wet test and Roots varus-valgus foot types have not provided enough data to classify and subgroup all feet to clinically relevant and evidence based. Paul Scherer DPM, in1996 presented a foot typing system that was clinically relevant but could not classify all feet(16). In 2006, Roberta Nole PT, C.ped patented a foot typing system with relevance and an ability to subgroup all feet but that led to over-the-counter foot beds that lacked the ability to be further customized(17). Finally, in 2007, Dennis Shavelson DPM (the author of this article) U.S Patented a foot typing system which subgrouped all feet and led to custom foot orthotics that were foot type specific and capable of being further customized individually. The system was named Functional Foot Typing(18).


The benefits of using foot typing as the starting platform for biomedically engineering the lower extremity is that foot typing exposes the primary locations of pedal pathology before, during or after complaints allowing biomechanists, surgeons, physicians, therapists, athletes and the foot and postural suffering public to address the foundational biomechanical components of their problems, primarily and restoratively(19). This expands the current scope of biomechanics towards wellness and away from “Band-aid Cures”. Foot Typing provides the foundation for economic experiences for foot beds such as prevention, performance enhancement, quality of life upgrading, fall prevention and improved mobility to name a few.

Foot Centering Theory, using Functional Foot Typing, The 3-D Vault of The Foot, The Centroid of The Vault of The Foot, Functional Foot Typing, The Rearfoot and Forefoot SERM-PERM Interval and the primary protocols that are in place to correct overvaulted and undervaulted feet. This leads to orthotic props that generate “orthotic reactive forces” that counteract the crippling forces of gravity, hard ground and shoes reducing the need for ones bones, muscles, tendons, ligaments and neural strategy to mandate energy in that direction. This allows for all these structures to enjoy an integrated focus on supporting, balancing, moving and living life. That is the experience that restorative foot orthotics offer to orthotic users for the future.

Think of the experience of foot binding where intentionally, props were applied that that left feet deformed and non functional as a sign of status in ancient Chinese culture(20) and then envision the experience of offering the foot and postural suffering public restorative foot orthotics that can remodel, rejuvenate and make feet more functional (21).

One may agree or disagree with the tenets, terminology and practice of Foot Centering but one thing is clear. The shortfall of high level additions to the literature in the last decades has proven orthodox biomechanics to be in need of a new timelier paradigm for biomechanics – enter RestorThotics.

Biomechanics image

Unless professionals want their orthotics to remain commoditized, they will eventually be compelled to upgrade their offerings to the next stage of economic value by making them experiential.

The RestorThotic Experience

The RestorThotic experience lives in the context of wellness, holistic care, performance enhancement, prevention, quality of life upgrading, restorative care and skilled maintenance.

RestorThotics are more like training wheels than eyeglasses or most custom orthotics(22). They are props that, in the hands of dedicated and skilled professionals, restore feet and postures towards health and longevity by offsetting the degenerative and deforming forces of gravity, hard ground and shoes in a civilized society. This allows clients and patients to be trained, monitored and maintained pragmatically.

Functional Foot Typing and RestorThotics were U.S. Patented in 2011 and can be imitated but not duplicated. They have been alpha and beta tested now for ten years successfully by Podiatrists and other professionals.

Biomechanics diagram

RestorThotics are a collaboration between a podiatrist turned biomedical engineer of the lower extremity and an acknowledged foot orthotic fabrication expert. Over the past 20+ years, together, they re-invented and perfected diagnostic tests, casting techniques and covert fabrication, presentation and marketing programs that generate foot orthotics guaranteed to deliver prevention, performance enhancement and quality of life upgrading for the first time.

RestorThotics are useful in most practices that include orthopedics, physical therapy, podiatry, chiropractic, licensed massage therapy and movement therapy especially when there is no insurance coverage for orthotics in network, for your out of network coverage patients or for cash pay patients looking for more than pain relief. They are dispensed at $600-$1000 a pair.

RestorThotics: Orthotics you can be proud to present and dispense

Foot Centering Technology
  • U.S. Patented
  • Guaranteed to improve the movement and comfort aspects of life (19)
  • Classified correction of casts and fabrication of orthotics using Foot Centering Technology
  • The 1st Foot Type Specific Foot Orthotics
  • Exclusive biomechanics education, coaching and training that ensures success from Dr. Shavelson with a one year contract

Are you ready to Make Biomechanics Great Again?

drsha@foothelpers.com www.foothelpers.com 212 288 1723


  1. McPoil TG, Cornwall MW. The relationship between subtalar joint neutral position and rearfoot motion during walking. Foot Ankle Int. 1994;15:141–45. doi: 10.1177/107110079401500309. [PubMed] [Cross Ref]
  2. Payne CB. The past, present, and future of podiatric biomechanics. JAPMA. 1998;88(2):53–63. [PubMed]
  3. Lee WE. Podiatric biomechanics. An historical appraisal and discussion of the Root model as a clinical system of approach in the present context of theoretical uncertainty. Clin Podiatr Med Surg. 2001;18(4):555–684. [PubMed]
  4. Nigg BM, Nurse MA, Stefanyshyn DJ. Shoe inserts and orthotics for sport and physical activities. Medicine and Science in Sports and Exercise. 1999;31:S421–8. doi: 10.1097/00005768-199907001-00003. [PubMed] [Cross Ref]
  5. Stacoff A, Reinschmidt C, Nigg BM, van den Bogert AJ, Lundberg A, Denoth J, Stussi E. Effects of foot orthoses on skeletal motion during running. Clinical Biomechanics. 2000;15:54–64. doi: 10.1016/S0268-0033(99)00028-5. [PubMed] [Cross Ref]
  6. Heiderscheit B, Hamill J, Tiberio D. A biomechanical perspective: do foot orthoses work? British Journal of Sports Medicine. 2001;35:4–5. doi: 10.1136/bjsm.35.1.4. [PMC free article] [PubMed] [Cross Ref]
  7. Jarvis, Nestor, Bowden & Jone: Challenging the foundations of the clinical model of foot function: further evidence that the root model assessments fail to appropriately classify foot function; Jour of Foot & Ankle Res; 2-3-2017
  8. https://well.blogs.nytimes.com/2011/01/17/do-orthotics-really-help
  9. Pine J, Gilmore J: Welcome to The Experience Economy; Harvard Business Review; July-August 1998
  10. Pine J, Gilmore J: The Experience Economy: Updated Edition, July 2011, #: 10254-PBK-ENG; Harvard Bus School Publishing
  11. http://orthopedia.wikia.com/wiki/Foot_Posture_Theories
  12. Telfer S, Gibson KS, Hennessy K, Steultjens MP, Woodburn J. Computer-aided design of customized foot orthoses: reproducibility and effect of method used to obtain foot shape. Arch Phys Med Rehabil. 2012 May;93(5):863–70
  13. Kirby KA. Subtalar joint axis location and rotational equilibrium theory of foot function. J Am Podiatr Med Assoc. 2001; 91(9):465-488.
  14. Fuller EA, Kirby KA. Subtalar joint equilibrium and tissue stress approach to biomechanical therapy of the foot and lower extremity. In Albert SF, Curran SA (eds): Biomechanics of the Lower Extremity: Theory and Practice, Volume 1. Bipedmed, LLC, Denver, 2013, pp. 205-264.
  15. Shavelson D: A Closer Look at Neoteric Biomechanics; Podiatry Today; vol 20, Issue 9, Sept 2007, pp 60-66
  16. Scherer P, Morris J: The classification of human foot types, abnormal foot function, and pathology ; 1996; Clinical Biomechanics of the Lower Extremities; chapter 3, Mosby Publishing
  17. Attaining Successful Outcomes through Functional Foot Typing: Nolaro press; April 2015 http://nolaro24.com/wordpress/?p=126
  18. Schupak A, Shavelson D: What’s Your Foot Type; youbeauty.com; July 25, 2012
  19. Shavelson D: The Biomechanics of the Diabetic Foot; Dec 2011, Global Perspective on Diabetic Foot Ulcerations, Chapter 7
  20. Mao J: Foot Binding: Beauty and Torture; Int Jour of Biological Anthropology;2007, vol 1, pp 111-117
  21. Peacock D: The Peacock Press Test; Podiatry Management; August 2015, pp 138-144
  22. https://podiatry.com/ezine/iframe/730

Additional References:

  1. Burkhard-Kriesel C: Growing the Experience Economy; Cornhusker Economics, 2011
  2. https://yogainternational.com/article/view/why-use-props
  3. Attaining Successful Outcomes through Functional Foot Typing: Nolaro press; April 2015 http://nolaro24.com/wordpress/?p=126