Roy Siegel, DC, says good balance is the key to spinal health. Caring for his patients' feet is the foundation of his chiropractic care. "A slight imbalance in the foot can impact their ankles and their knees, as well as the spine," he says.

The New York City-based chiropractor notes that an uncorrected pronation of the foot can also impact his ability to help his patients, making his adjustments less effective. He puts much of the blame on the fact that we wear shoes most of the time. "We really weren't designed to put our feet in jail [shoes]," he says. "Look at an infant. You can see full function of the foot and independence of all toes. You don't see that in many adults, especially those walking around on concrete in New York City."

Though he does not advocate that his patients doff their shoes and walk barefoot, Siegel has built a large niche business prescribing orthotics to correct the damage that shoes can cause. This has made sense since his practice opened on W. 65th Street, across the street from the Lincoln Center, home of New York City Ballet and American Ballet Theater, as well as near New York's famed theatre district of Broadway. Many of Siegel's orthotic clients are professional dancers and performing artists, who, because of the slope of raked (sloping) stages and the many hours of performing and rehearsing, put their feet through a grueling punishment. But it is not just performers who need orthotics. In addition, Siegel helps patients with various needs, from every day use to athletics.

But the key to getting good orthotic correction is fitting the insert correctly. And to that end he uses The Orthotic Group (TOG)'s GaitScan.

Walking to the Perfect Fit

The GaitScan measures the patient's feet while he or she is moving in a normal walking or running pattern. And for Siegel, this is really the key to the device's effectiveness. "I've only had to do one redo of the 90 pairs of orthotics that I have made since receiving the GaitScan 4 months ago," he says. "When I was using a static mold to produce orthotics, the redo rate was 10%."

The device consists of a Dell laptop that is connected to a pressure plate. Before his or her gait is measured, the patient fills out a detailed questionnaire that includes information both about the feet (do they have specific foot pain, sweat or have bunions, for example) and the type of shoes he or she wears (such as street shoes, athletic shoes, or skates). Once that information is loaded into the computer, Siegel instructs the patient to first step on the plate for a static measurement.

Once the information from the static measurement is recorded by the computer, the patient walks or runs across the plate, which measures 1,650 cm2 and is 13 mm thick. The 4,096 sensors in the plate scans 300 times per second to create a two- and three-dimensional picture of the patient's foot. Siegel says that the patient does not have to hit a particular target while he or she is walking barefoot across the plate. "I tell them to walk with a normal, relaxed gait, looking straight ahead," says Siegel. Occasionally a patient will be worried that he or she did not walk across the plate correctly, so Siegel has them do it again. Since the report is electronic, there is no wasted materials. It does not matter if the patient hits a different part of the plate. Because of the plethora of sensors the results do not change.

The computer measures such variables as how the patient is walking and how the pressure on his or her foot is being loaded. "It's really easy to interpret the data," says Siegel. "It's so simple to see where there's too much pressure."

And the patients see it as well. The pictures are color-coded in an intuitive way. Areas that have too little pressure being put on them are blue, those just right are green, those that are a little heavy are yellow, and those with too much pressure are red. "The patients instantly see what's wrong," says Siegel. "The orthotics sell themselves because of the moving 2- and 3-dimensional imagery on the laptop."

Even though the data is easy to interpret, even by a lay person, choosing the perfect orthotic based on it is not. That's where experts at TOG come into play.

TOG Partnership

After evaluating the data with the patient, Siegel then sends it to TOG. He then consults with the company via telephone about the patient's results. "This is where the company takes it to the next level," he says. "They help out with every patient." Currently, Siegel only prescribes TOG orthotics.

The Toronto-based company offers orthotics for activities such as every day wear, running, hockey, and golfing. The company personalizes each orthotic with Siegel's name and phone number.

Choosing the GaitScan

The key to getting good orthotic correction is fitting the insert correctly.

When Siegel saw a demonstration of the GaitScan, he was immediately sold. The unit provides everything the practitioner needs to do a gait analysis. The unit consists of a Dell laptop, the scan plate, and a color printer. Of the latter piece of equipment, Siegel rarely uses the printer—he says that patients almost never need a printout. The screen image is powerful enough evidence that the patient needs an orthotic. Siegel leases the device, and expects that will give him more flexibility to upgrade as the technology improves. (The company recently had a software upgrade).

The GaitScan comes with a comprehensive manual and TOG sponsors regular seminars. Siegel says that the device is very easy to learn and simple to set up. He learned the fundamentals of the device during that initial demonstration. No special medical or technical knowledge is necessary to perform the test. In most cases, Siegel's office staff performs the test itself. Siegel always interprets the data for the patient.

In the few months since Siegel has been using the GaitScan, it has become an integral part of his practice.

For a Roundtable discussion on orthotics, check out our December 2006 article titled "Put Your Best Foot Forward."

Siegel does a gait analysis on every patient in his practice. "It's part of the first visit," he says. "I want to see how they ambulate." The only time he will not do a gait analysis is if the patient is in severe pain and is not walking with his or her regular gait. He will wait and do the analysis after the patient is better.

When not in use, the GaitScan is stored on a shelf in Siegel's 1,500-square-foot office. And when in use, the device takes up and requires little space—just four feet, two feet on either side of the plate—to perform the test.

In addition to the gait analysis, the first visit includes a health history, examination, bioimpedence analysis, and x-rays, if needed.

At the second visit, Siegel offers the patient an evaluation of his or her first examination, including their gait analysis. The results can indicate the need for an orthotic, but Siegel does not use the results to make a hard sell. Instead, he usually waits for the patient to ask how the problem can be fixed. If there is a need for orthotics and the patient is excited about optimizing his or her foundational balance, orthotics are ordered. And this approach has paid off. "The patient feedback has been wonderful," he says.

C.A. Wolski is a contributing writer for Chiropractic Products.

Gait Seminars

The Orthotic Group (TOG), Toronto, offers additional knowledge through its TOG Super Seminars.

Roy Siegel, DC, a New York City-based chiropractor, knows the value of the seminars firsthand. "They're very comprehensive and not only cover types of orthotics, their need and application, but educate the attendees on the biomechanics of gait, especially the action of the feet and ankles," he says.

The company is in the process of conducting seminars in celebration of its 20th anniversary. The first will take place in Calgary, Alberta, on Sept. 29 and the second will take place in Markham, Ontario, on Dec. 1. Registration information is available on the company Web site at www.theorthoticgroup.com.

The featured speakers will be Kim Ross, BSc, MSc, DC, PhD, and Alan Lustig, DPM, two experts in the field of biomechanics.

The company also offers individual seminars on foot biomechanics and custom orthotic therapy, gait analysis training (using TOG GaitScan), advanced foot biomechanics, and custom orthotic therapy, and plaster casting.

The foot biomechanics and custom orthotic therapy seminar is designed for all skill levels, and covers lower limb anatomy, biomechanics, muscle activity during gait, assessment techniques, and casting in sub-talar neutral.

The gait analysis training is facilitated using the GaitScan. The seminar covers why gait technology plays an important role in the analysis of the foot, how the GaitScan can help in the practitioner's clinical setting, the gait cycle, and how and why this is important in the patient's diagnosis.

The plaster casting seminar is also hosted by Lustig and is a half-day hands-on class designed to teach the practitioner how to take a sub-talar plaster-of-Paris cast of the foot.

Dates and locations for each seminar are available on the TOG Web site.