Evaluate the Internal Longitudinal Arch
The purpose for evaluating the arch is to establish if the PCIs should include arch supports.
If the patient has flat feet, arch supports make the PCIs work better. If the patient has functional arches, even if they are low, arch supports are generally not recommended.
In all likelihood, you will already have noticed if the patient has flat feet when you have observed the patient walk and when you measured the FMD.
An easy way to evaluate the arch is to observe the patientís arch while sitting followed by standing. If when standing:
Do not use PCIs on patients who evaluate with rigid (flat or cavus) feet or stable arches. They will be ineffective, and the patient will in all likelihood reject them as uncomfortable or awkward. See Contraindications.
If you are not sure if you are observing a very low flexible arch or a flat foot, place a pair of 9.0mm insoles on a hard surface floor and have the patient stand on them. Have the patient repeat the knee bend. If the arch collapses to the ground as before (no improvement) the patient has flat feet and needs arch supports. Otherwise the patient has functional arches and it is recommended to start the patient without arch supports.
Watching the Patient Walk
A patientís gait can reflect several issues. What we want to ascertain is if the patientís gait is purely a reflection of the patientís foot mechanics, or if it is influenced by restricted motion, compensation for pain or structural deformities, from birth, injury or surgery. Look for symmetry, knee and ankle motion. Always ask: What could be the cause of this motion pattern? Does it originate with the foot or elsewhere?