Development of Integrated Multi-Axial Posture Theory™


Biomechanical integration involves the consideration of the human body, in its entire complexity, wherein each individual articulation is a part of a well-connected chain with spheres of influence ranging between distal to proximal.

The functional integration of the foot and ankle becomes an area of prime interest in this regard, especially when examining the chain reaction it sets forth during the gait cycle.

Advancements in technology and instrumentation have contributed largely towards the better understanding and analysis of the foot and ankle motion.

The dynamic link of the foot and ankle becomes more evident as we study the different phases of gait starting from heel strike to toe-off.

One of the main joints in the foot, the talocrural or ankle joint is formed by the tibia, the fibula and the talus, which when affected by the anterior and posterior muscles, creates movement in the lower limbs in dorsi- and plantar-flexion. 

The ankle complex also contributes to propulsion and balance which are essential in ambulation.

However, the MASS4D® Integrated Multi-Axial Postural™ approach demands analysis beyond this one critical joint to encompass the holistic movement patterns of all 33 joints working in unison.

This integration leads to constant postural adjustments and readjustments the body undertakes on variable terrains and at variable speeds.

This is at the core of optimal foot biomechanics, necessitating the need to recognise the function of all the articulations in the foot and ankle rather than focusing on a single site of pathology or dysfunction or standard of care.

Another important aspect of foot functionality is its multi-axial capabilities which are required for adaptability to uneven terrain while walking.

It is the ankle which permits movement of the foot in multiple planes; a fact which, along with the optimal arch of the foot, should remain central to the manufacturing of orthotics.

This approach is needed to reflect the correct posture and alignment of the foot while providing for transient changes occurring in the lower limbs during motion.

Postural stability is crucial to boost optimal articulation alignment which, in turn, facilitates optimal arthrokinematics of the foot and ankle.

A high-calibre orthotic must enhance balance and posture of the body by facilitating proprioception through the plantar surface of the foot proximally to the central nervous system, throughout all types of daily activities.

The MASS4D® Integrated Multi-Axial Postural Theory™ looks at establishing a foot posture which results in optimum neuromuscular efficiency, reducing the stress placed on the entire kinetic chain so that tasks can be performed with the least amount of energy.

For this purpose, it is necessary to ensure that all articulations work well within their natural ranges of motion (ROM) to produce the greatest productive force while maintaining full functionality in the foot.

Reference List:

  1. Root, M.L., Orien, W.P., Weed J.H.: Normal and Abnormal Function of the Foot, Clinical Biomechanics Corp, Los Angeles, 1977.
  2. Payne, C.B.: The Past, Present, and Future of Podiatric Biomechanics. J. Am. Podiatr. Med. Assoc., 88(2): 53-63, 1998.
  3. Cornwall M.W., McPoil, T.G.: Three-Dimensional Movement of the foot during the stance phase of walking. J. Am. Podiatr. Med. Assoc., 89(2).: 56 – 66, 1999
  4. Huson, A.H.: Biomechanics of the tarsal mechanism: a key to the function of the normal human foot. J. Am. Podiatr. Med. Assoc. 90(1).:12-17, 2000.
  5. Landorf, K., Keenan, A.M.: Efficacy of foot orthoses. What does the literature tell us? J. Am. Podiatr. Med. Assoc., 90(3).:149-158, 2000.
  6. Pfeffer, G., et al: Comparison of Custom and Prefabricated Orthoses in the Initial Treatment of Proximal Plantar Fasciitis. Foot & Ankle Int. 20(4):214-221, 1999.
  7. Hodgson, B., Tis, L., et al. The Effect of 2 Different Custom-Molded Corrective Orthotics on Plantar Pressure. J. Sport Rehabil. 15: 33-44, 2006.
  8. Cobb, S., Tis, L., and Johnson J.: The Effect of 6 Weeks of Custom-molded Foot Orthosis Intervention on Postural Stability in Participants with >7
  9. Degrees of Forefoot Varus. Clin. J. Sport. Med. 16:316–322, 2006.
  10. Glaser, E., Bursch D., and Currie S.: Theory, Practice Combine for Custom Orthoses. BioMechanics. 8(9):33-39, 2006.
  11. Botte RR. An interpretation of the pronation syndrome and foot types of patients with low back pain. J Am Podiatry Assoc 1981 May;71(5):243-53.Friberg O. Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. Spine 1983 September;8(6):643-5
  12. Hoppenfeld S. Physical Examination of the Spine and Extremities. Norwalk, CT: Appleton Century Crofts; 1976.
  13. Michaud TC. Foot Orthoses and Other Forms of Conservative Foot Care. Baltimore: Williams & Wilkins; 1993.
  14. Rothbart BA, Estabrook L. Excessive pronation: a major biomechanical determinant in the development of chondromalacia and pelvic lists. J Manipulative Physiol Ther 1988 October;11(5):373-9.
  15. Subotnick S. Case History of unilateral short leg with athletic overuse injury. J Am Podiatry Assoc 1980;5:255-6
  16. Valmassy RL. Clinical Biomechanics of the Lower Extremity. St. Louis: Mosby; 1996.
  17. Ahroni JH, Boyko EJ, Forsberg R. Reliability of F-scan in-shoe measurements of plantar pressure. Foot Ankle Int. 1998 Oct;19(10):668-73
  18. Barnett s, Cunningham JL, West S. A comparison of vertical force and temporal parameters produced by an in-shoe pressure measuring system and a force platform. Clinical Biomechanics. 2001 (16 ):353-357
  19. Hsiao H, Guan J, Weatherly M. Accuracy and precision of two in-shoe pressure measurement systems. Ergonomics. 2002 Jun 20:45(8):537-55.
  20. Hurkmans HL, Bussmann JB, Benda E, et al. Accuracy and repeatability of the Pedar Mobile system in long-term vertical force measurements. Gait Posture. 2006 Jan;23(1):118-25
  21. Kernozek TW, LaMott EE, Dancisak MJ. Reliability of an in-shoe pressure measurement system during treadmill walking. Foot Ankle Int. 1996 Apr;17(4):20409.
  22. Mueller MJ, Strube MJ. Generalizability of in-shoe peak pressure measures using the F-scan system. Clinical Biomechanics. 1996 11 (3) :159-164
  23. Quesada P, Rash G, Jaroe N. Assessment of pedar and F-Scan revisited. Clin Biomech . 1997 Apr;12(3):S15.
  24. Randolph AL, Nelson M, Akkapeddi S et al, Reliability of measurements of pressures applied on the foot during walking by a computerised insole sensor system. Arch Phys Med Rehanil. 2000 May;81(5):573
  25. Keith Rome, Douglas Richie Jr., Anna Lucy Hatton (2010) Can Orthoses And Insoles Have An Impact On Postural Stability? PodiatryToday: October 2010, Vol. 23, Issue 10.

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