Questions & Answers

Questions:

Answers:

What did you do to reduce hyperpronation for your patients in the past and how well did it work?

Dr. Jelstrup: We used custom-made orthotics. It was a good product that served its purpose, but there were many problems we were not able to solve.

Dr. Cozzocrea: I didnít have a process for helping my patients with hyperpronation problems. Occasionally I would refer them out to get orthotics. Some were happy with them some werenít. Iíve tried a lot of different ones and even went to a seminar to try to learn how to make them but could never find one that I wasnít happy to get out of my shoes by the end of the day.

Dr. Moroff: In the past we based everything on the podiatric model or the medical model where the patientís rear foot was stabilized, the arch was fully supported. Using orthotics of this type worked all right for approximately 25% of our patients here in Florida, but many of our patients, especially those that were active, continued to present with the same myofacial postural deformations that we saw in earlier treatments. They would present with the same problems and plateau out.

Many of our patients liked them because they added comfort, but for somebody like me that treats postural problems, it wasnít acceptable because those patients would still continue to come in with the same symptoms.

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How did you go about integrating Posture Control Insoles™ into your practice?

Dr. Russell: All new patients are evaluated for Posture Control Insoles. So far we have introduced the PCIs to established patients by complaint or concern or if we see an obvious connection. I have set up a way so the front desk puts a reminder on the patientís clipboard. I have always been focused on adjustments so I like the idea that I can delegate the process of fitting the PCIs. I have trained my staff to do as many elements of the procedure as possible. The whole process is simple and straightforward. The indicators are clear. It didnít take very long to learn. See it; understand it; do it.

Dr. Hammons: Before I started using PCIs, I was already pretty active in terms of evaluating posture and referring patients to podiatrists or just using quality cut to fit insoles, so for me it was not very hard to implement the Posture Control Insoles™ program; it was just getting used to doing it all in-house.

I do the posture analysis, measuring of the first metatarsal deficit and the documentation. My assistant, who is also staffing the front desk, sizes the insoles to fit in the patientsí shoes. When she hands them their patient diary, she explains to the patients that they have to write down any changes whether positive or negative because we are changing the dynamics and the mechanics of their feet, and that impacts the whole body.

Dr. Jelstrup: My chiropractic assistant takes care of the whole process. When she has determined the appropriate insole for the patient, I come in for the final check. I do the initial explanation to the patients. Many times when the patient has an obvious problem but they have no pain, they are usually oblivious to the problem, and thereby also oblivious to the consequences. We see this with foot problems as well as with bite problems. Of course, at times we see patients with serious problems where we have to contact a podiatrist, but overall we can handle over 90 % of the cases ourselves.

She explains the principals of the standard insoles and hyperpronation and she explains the new concept of the technology developed by Dr. Rothbart, and she explains the importance of the correction to the patient.

Dr. Cozzocrea: We just started! It wasnít a big deal to implement the use of PCIs into the practice. Itís so quick. Lynn fits the patient on the spot or else schedules them to come back when weíre not seeing patients, as a matter of fact she does it right at the front desk.

PCIs are just easy to do. When I go to a seminar to learn something new, I always ask: ďHow long is this going to take.Ē Because if it takes too long Iím just not going to do it; it slows me down too much. I can refer Posture Control Insoles off to my staff and they can do it. Itís easy to do.

Dr. Moroff: Weíve always used this methodology in determining whether a patient needed some sort of orthotic. We evaluate the patient, and if certain risk factors show up, fitting PCIs is quickly incorporated into the next visit. An intern examines the patient on the first visit but does not go into the actual measurements. She looks at the foot for Mortonís foot structure and evaluates for hyperpronation and other foot abnormalities and classifies them as risk factors. On the second visit I personally go over those risk factors and do the measurements. It only adds about five minutes to my time with the patient.

The person that fits the PCIs in the patientís shoes is my back office chiropractic assistant, Kathy. She also takes patient histories on the first visit, and she takes the x-rays.

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What reasons do you give your patients for purchasing Posture Control Insoles™?

Mr. Tyler: I tell patients that Posture Control Insolesô give the first ray floor contact sooner and keep it in positive contact.  It improves the control of your foot so you have a more rigid and balanced foot for a more powerful push off.  I also tell them that they can expect to alleviate stress elsewhere in their body.

Dr. Jelstrup: I point out their faulty gait pattern and I point out the effects of a faulty gait pattern on the rest of the skeleton. I explain that in detail; how the resulting stress patterns manifest themselves through the knees, through their sacro-iliac joint, lower lumbars, lower dorsals, mid dorsal through the mid dorsal cervical junction and finally all the way up to the temporal mandibular joint.

I recommend Posture Control Insoles™ as an effective solution for my patients that hyperpronate. It is simple and I demonstrate the concept. They get it and they usually purchase several pair.

Dr. Russell: Whatever we recommend is designed to save the patient time, money, get them well faster. However nice we are here, theyíd like to spend less time here.

Dr. Cozzocrea: I start by asking patients if they have ever worn orthotics in their shoes. Some have experience some donít. Some were told they needed them but they were too expensive so they didnít get them. Some have inserts they bought from a store, but theyíre not sure what they need, so I give them a brochure.

I tell them that I have tried a lot of different orthotics and have never liked them as much as these. My chiropractor had actually recommended these for me. I was skeptical at first when I tried them but when I wore them for a day or two I was thoroughly impressed with what they did for me.

Theyíll change your posture; theyíll change your gait. Most orthotics donít work like these do when youíre moving, they just support you when youíre standing in place. I demonstrate to them how it changes posture. Usually the most powerful thing is when they go through the fitting process and they can actually see and feel how their knees move straighter with the wedges. I explain to them that when theyíre walking in just a regular pair of shoes their knees are rotating inward and that translates all the way up the body. With these insoles, your knees and hips will move more straight ahead.

Dr. Moroff: First off I tell them that their symptoms are arising from an overall whole body postural deformation rather than the old school ďa blown out of place pinched nerve theory.Ē Many of the patients have had chronic ailments and pain for long periods of time. Once they understand our holistic approach and how their feet can change their posture, itís easy to show them how, due to hyperpronation, a dropped foot leads to a twisting and alteration of posture all the way up to the neck.

I show them how and why I measured their foot and why it took a certain wedge height to bring the floor back up underneath their 1st metatarsal head to stabilize their foot. Then I show them how that in turn realigns their ankles, their knees and hips and how that also aligns the pelvis and how that in turn creates a better spinal symmetry all the way up to the neck and head.

Ms. Janssen: I describe the benefits of wearing the PCI as complimentary to the care we give. Lots of times I say ďweíre working on you from the top end because weíre correcting your atlas, your spine, all the way down, and then we come at you from your foundation to help your body hold your correction longer and for your symptoms to dissipate quicker and possibly go away forever.

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What has been your staffís reaction to fitting Posture Control Insoles™?

Dr. Russell: They enjoy being more involved in the patient care. All the staff wears PCIs, and they like to talk about how they work and their own experience with them.

Dr. Hammons: My assistant is very positive about fitting insoles. She wears them herself, so she knows what they feel like, so she is excited about providing them for our patients.

Dr. Jelstrup: Extremely positive reaction. It is easy work, and the patients have been extremely happy.

Dr. Cozzocrea: Lynn has felt the benefit from wearing PCIs and is very happy with them. She will encourage the patients to try them because of her experience wearing them. She also encourages them to buy additional sets; we offer a better price if itís a second or third pair. No complaints about extra work.

Dr. Moroff: The office staff really looks at the PCI program as a way for us to differentiate ourselves from other chiropractic offices by the fact that we take a holistic approach to the patient, starting at the feet. I see them being excited about telling our patients that the doctor will even be looking at your feet to determine why you still hurt. The PCI program has been a positive force in my office.

Ms. Janssen: My responsibilities are quite varied; I work the front desk, order nutritional supplies, take X-rays and fit and educate patients on PCIs. In our case itís a fluid situation, I deal with it as it happens. Lots of times theyíll come out and say can you fit this patient now? All I have to do is say yes or no. If I have time I do it, if not I go to the book and say letís schedule a time thatís going to work for both of us.

The experience of integrating PCIs into our routine has been a really good experience for me personally. Iíve enjoyed learning the technology and becoming a stronger part of the care of the patients we see.

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Are there advantages to require patients to wear Posture Control Insoles™ for certain treatments?

Dr. Russell: We are trying to make changes, changes that the patient can sustain. If it becomes obvious that they arenít going to be able to sustain without stabilizing a foot problem, then we get firmer about requiring a foot foundation. With some patients if they donít want to follow your recommendations, then the likelihood of being successful with the patient goes way down.

Dr. Jelstrup: I donít make PCIs mandatory for all patients, but if I see a faulty gait pattern, I deal with that gait pattern first.

Dr. Moroff: One of the main reasons is that it actually allows the body to be in a more neutral position so that any sort of treatment whether it be chiropractic, exercise, or other medical strategies will have optimal results.

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Do you feel like you have to sell your patients on Posture Control Insoles™?

Dr. Russell: We are not selling anything. I have learned that if there is a need, you tell them. Our patients learn through the evaluation. They get to feel and see the difference. It becomes obvious to them. I have never had to tell anybody that they have to get PCIs. The patients see and feel it on their own, and the conclusion hits them.

Dr. Hammons: I explain the need for PCIs in terms of the patientís symptoms. If the patient has low back pain, I show them how the posture of the back will change by supporting the feet properly. In order for us to see the full potential as far as our patients getting out of the symptoms theyíre having, getting them out of pain or chronic situations, addressing the feet is vital. Most people have a good understanding that if you align the feet properly, youíre going to have a lot of correction that just takes place by itself.

Dr. Jelstrup: I have never had a concept that I have to sell anything to my patients. I have always had the focus that I need to find out what the patients need, and consequently, I have never felt that I have to sell anything.

Nobody would have to be timid about recommending PCIs if they learn a process whereby they could test the results on the feet. There are many concepts within AK which would apply to this problem. So if you test the patient, and through the testing provide information to the patient that there is indeed a weakness happening throughout the skeleton and I may say such a testing shouldnít take over 5 minutes at the most, with communication.

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What is your personal experience wearing Posture Control Insoles™?

Dr. Russell: I like that they are thinner. Other orthotics crowds the shoe and pushes you out of it. I had a tendency to brace on the outside of my foot. With PCIs I donít brace like that.

Dr. Hammons: Got them in my shoes right now. I was not surprised because of what I do, bending forward all day, that I had occasional low back pain. I havenít had many issues for the last two months, and thatís the time Iíve been using PCIs. I have been using them in my running shoes and Iíve been very happy with them.

Dr. Cozzocrea: In wearing other orthotics I was always aware there was something in my shoe. I wasnít always consciously aware but if I stood and thought about it I could tell there was something in there. And now Iím never aware - Iím aware when I donít have them. I feel it in my ankles; theyíre kind of painful when I walk without them.

Dr. Moroff: I feel structurally secure. I feel balanced.

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What is your patientsí first reaction when they see the Posture Control Insoles™?

Mr. Tyler: Is this thin little thing is going to do anything for me? I explain to them how the PCIs stabilize the foot by engaging the muscles that control the feet and how that positively impacts the rest of the body. And because you guarantee the insoles, I give them a money back guarantee. ďIf they donít help us achieve our treatment goals, we can send them back and get your money back.Ē

Dr. Russell: ďIs that it?Ē A lot of the patients are surprised about the simplicity. It is a question of educating them and explaining why it can be so simple. The patients like that it isnít bulky.

Dr. Hammons: ďHow can these do anything for me?Ē Most people are thinking of traditional rigid orthotics, that donít look that comfortable and take up a lot of space. Once you educate them, get them to read the brochure so they understand where the correction is occurring, they get a pretty good idea how it works.

Dr. Jelstrup: My patients are not skeptical. I think this is because we are a family clinic, and we have served our patients for nearly 30 years.

Dr. Moroff: ďIs that all.Ē So I tell then that the simplest things often hold the most promising results.

Ms Janssen: Patients are initially surprised at how flat the insole looks and that itís going to be easy to get used to in their shoes, and easy to move from shoe to shoe. They seem pretty happy about that. And theyíre happy we can provide them with the correction ďon siteĒ and donít have to do a measurement and then send it off, wait, and have it made somewhere else.

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How have your patients responded to Posture Control Insoles™?

Dr. Hammons: I had a 15-year-old patient who was very active and involved with sports, but who had recurring low back pain. Initially, I had him using another insole; between that and my treatments we saw some results, but nothing lasting. I put him in a pair of PCIs and after about two months, I have not seen him as often and the old problems he used to have with leg length discrepancy, low back and hip pain are gone. Because heís so pleased about the results, his dad has been fitted in a pair and his mom is coming in for a pair. Now he only sees me every 4-8 weeks for a check-up.

Mr. Tyler: Very well.  One of my therapists here actually experienced significant patella-femoral pain.  She has severely pronated feet.  I fit her with Posture Control Insolesô and gave her a home therapy program strengthening her hip flexors and stretching out her ITB (Iliotibial band).  The combination of those two interventions really decreased her pain significantly.

Dr. Cozzocrea: They worked really well on my oldest son who is 9. When he was playing soccer it was painful to watch him run. His knees would turn in and his feet would swing out. And now, with the PCIs in his shoes, he runs almost normal. He noticed a dramatic difference so he wants them in his shoes all the time.

Iíve recommended PCIs to some patients that Iíve had a lot of difficulty with in the past, and that have been patients for a while. They have seen better improvement in holding their adjustments and are doing better overall since theyíve started using the PCIs.

I fit my mother in law. She had never shared with me about her foot problems, but when she heard about the PCIs she told me that she had seen her podiatrist and had purchased a pair of orthotics. They didnít work so well, and they charged her every time she went in to have them adjusted. I fit her in PCIs, and that was that. She loves them.

Dr. Moroff: They first feel as if they are not falling forward, or not being pulled forward by gravity. Pelvic and hip pain is going away just from the postural shift, and they are surprised they donít feel the insole under their big toe.

Weíre in golf Mecca here, and I treat a lot of professional golfers. They tell me that their coaches have noticed that their spine angles have changed for the better and that has allowed them better balance throughout the golf swing. The majority, better than 80% of my patients are athletic and I get very positive reactions from active people.

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Do many of your patients wear orthotics?

Dr. Russell: A large percentage have worn or looked into it before. There are a lot of people wearing orthotics that are not doing them any good or even harming them. A lot of people have been surprised when I have tossed their orthotics in the garbage can. They tell me that they have paid $400 for them, and I say: ĒDo you want to stay miserable because you paid $400, or do you want something thatís going to work for you?Ē

Dr. Moroff: I would estimate that close to 75% of our new patients has some sort of orthoses in their shoes. That may be related to the fact that we have a very active patient base that participates in various sport activities on both amateur and professional levels.

Ms Janssen: Usually the patientís only knowledge of orthotics is of pre-molded arch and heel supports, so theyíre usually pretty fascinated when I pull these out of the package and they see how simple they look and how little the adjustment really is. So we have to make them aware that it is a functional correction and explain to them that when theyíre walking, when their arch and heel are raised off the ground, is the time when this correction comes into play. Iím really educating them along the way. The patients are usually very receptive.

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What are your patientsí objections to wearing Posture Control Insoles™?

Dr. Hammons: The only objection I have had is, ďDo I have to take them in and out of my shoes, and how many pair do I need?Ē Many people are lazy and donít want to switch them around. I have provided them for more women than men in my office, and many of the women are concerned if they can wear them in pumps. ďCan I wear them in sandals?Ē So far Iíve only had a couple of issues with that and everybody has been very satisfied with putting them in their pumps and sandals because of the way they fit so nicely.

Dr. Jelstrup: None at all. They have been very pleased, and are very happy. We have been able to hit the platform so to say with almost all of our fittings. In a small percentage, there have been problems we have not been able to correct with the PCIs.

Dr. Cozzocrea: The only objection I have heard from my patients is having to switch them from one shoe to the other. Itís probably the only thing and then thatís just a reason for them to buy another pair so they donít have to switch them.

Some patients are reluctant to spend the money, they arenít sure if their insurance will cover it. Generally price isnít much of an issue because PCIs are so much less than orthotics.

Dr. Moroff: The only objection I hear here in Florida is that a lot of my patients want to wear thong sandals, and that is difficult, so I tell then that they have to get a different sandal. The ladies really give me the biggest looks when I take them away from their thong sandals.

Mr. Tyler: We spend a lot of time with our patients so they trust us. We explain the benefit of the PCIs, what their biomechanics are with and without them. We often donít start with these insoles right off the bat. We have a relationship with our patients and if, during the course of therapy, we determine that it would be helpful we recommend the insoles. We explain the benefits and inform them of the added cost. New York insurance companies donít pay for the PCIs. We tried to go that route but because itís not an orthotic made by an orthothist so we donít get paid for them, but since theyíre so inexpensive thatís not a big point.

Ms. Janssen: Some women may object that they canít wear them in their dressy high heels or some sandals and I tell them that theyíll need to make some sacrifices, but itís not mandatory that theyíre on them 24/7, so if theyíre going out to dinner and they want to wear that particular shoe and youíre only going to be out there for awhile its OK. I tell them from my own experience that I like wearing them; that if Iím home going around barefoot I find myself going back to my shoes cause it just feels better.

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Have there been any adverse reactions?

Dr. Russell: Very few: Four cases of sore feet. Three were break-in cases that resolved themselves, and one was a case of bad shoes.

Dr. Hammons: There has been no adverse reaction. In a couple of the cases they just did not notice any changes, or they were too subtle. It has all been positive changes or that they just didnít notice any change at all.

Mr. Tyler: No adverse reactions whatsoever. We have had a few people who did not benefit according to our expectations. One patient was not compliant even though they are easy to get used to. He just didnít like the way they felt in his shoe so he didnít wear them.

Dr. Jelstrup: There have been no adverse reactions.

Dr. Cozzocrea: As far as adverse reactions, some patients have said they were a little sore for a couple days. Their 1st metatarsal was sore or they felt a little bit of pain on the top portion of their foot for a couple of days that went away. I felt that also when I first started to wear them.

I tell my patients that thatís normal. As their foot adapts they may feel a little soreness and not to use them too long each day. Or just put up with the pain if they are going to use them all day at first (not following the break-in instructions.)

I describe the type of pain they might feel as a little bit of soreness like theyíve been exercising their feet or legs a lot.

Dr. Moroff: I have not had any adverse reaction because I follow the criteria for selecting the patients for PCIs. A lot of patients have the initial reaction to changes I expect. Some of them initially get upper back pain, or areas of myofacial or muscular pain elsewhere, but they understand that may occur due to the fact that we are changing their posture.

Ms. Janssen: There have not been any adverse reactions. The only rejection I can recall was from a lady that had had a lot of surgical structural rebuilding of her ankle. She was just not able to handle it.

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Why would you recommend other chiropractors consider using Posture Control Insoles™ in their practice?

Dr. Russell: Weíre supposed to be about dynamic stability of the spine. You canít protect your nerve tissues if you are struggling, straining, stressing and inflexible. Balancing the spine and keeping it flexible and happy is a means to an end. This fits our model very well. Itís a dynamic approach to things. If all patients stood still, weíd probably not need it.

Dr. Hammons: Just for patient case management. Not only for the cases that are hard to control as far as chronic problems, but also for the subtle ones and for people that are in acute pain. Most chiropractors have a good understanding that supporting the feet properly will impact the structures above.

Dr. Jelstrup: Itís a very effective method to relieve many problems in case handling in the practice.

Dr. Moroff: Once they understand the methodology and the reasoning behind the PCIs they make good sense. Theyíre easier to implement. Patients like them better than the more burdensome orthotics. They can wear them with open toe sandals here in Florida, and they are cost effective.

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6 months from now, what percentage of your patients do you think will wear Posture Control Insoles™?

Dr. Russell: As I use them and hear the response from the patients, I will gain more confidence. I have never been one to just jump into something and do it full bore just because it sounds like a good idea to me. Based on what I have experienced so far, I expect we will use PCIs for about 50% of our patients.

Dr. Hammons: A majority of my patients have low back issues whether the patient is aware of it or not. The results for the 30 patients we have fitted so far has been very good, and our feedback has been excellent, so when we have the program fully implemented, I believe about 60-80% of our patients should be wearing Posture Control Insoles.

Dr. Jelstrup: Close to 100%. Over the long term I believe a majority of my patients will be wearing PCIs because once someone gets that a simple process can solve a complicated problem, theyíre going to continue with it.

Dr. Moroff: I think 95%.

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How would you describe the benefits of wearing Posture Control Insoles™?

Dr. Russell: There are a lot of benefits. Saving time, money, getting well and stable faster. Immediate relief - Takes the bite out of low back or knee pain. Long-term stability - Helps the patient stay well with less personal effort.

Dr. Jelstrup: Less pain.

Dr. Moroff: I tell them that I am placing them in a neutral posture. I explain that the treatment to follow will be more effective, that their exercise programs will be more expedient and that the whole shift from passive to active care can be implemented in a shorter time.

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On a scale of 1-10 how much do PCIs help patient treatment versus the same treatment without Posture Control Insoles™?

Mr. Tyler: Whether itís a 4,6 or a 10 on a scale of 10 depends quite a bit on the patient and the issues so it is hard to say, but in general for musculoskeletal problems that originate with foot instability stability and poor posture , the PCIs help a lot.  For common shin splints which is an overuse issue, I think we are 10 for 10.  They work well for relieving plantar faciitis, and we see good results on back pain.

Dr. Russell: We havenít used them long enough to say for sure. With patients who complain of, for example, knee pain, and the problem goes away with PCIs, it will obviously get a 10, but we donít have enough experience yet. I expect it will be a high number on the scale.

Dr. Hammons: From an objective standpoint, I have seen a lot of positive changes. I would rate the effectiveness around an 8. Sorry that wasnít a 10, but thatís a lot better than what I was using before.

Dr. Jelstrup: I would rate Posture Control Insoles highly when it comes to helping us achieve our treatment goals for our patients. On a 1-10 Iíll give that an 8.

Dr. Moroff: 9 or 10.

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How did you decide to provide Posture Control Insoles™ to your patients?

Dr. Russell: I asked for the research. I wanted to read the manual. It had to make sense to me intellectually first. I had to understand why it was supposed to work. It is straightforward, it makes sense and you can see it working. In 12 years of practice, 4 years of college, the whole concept of the forefoot had never been discussed; unless that was the day I played golf.

Dr. Hammons: After reading the manual and after developing an understanding of the mechanics of the product.

Dr. Jelstrup: I read the handbook. It impressed me. I tested it and it worked out. I was also familiar with the concepts from past experience, as I had worked with Dr. Rothbart 10 years ago.

Being a chiropractor, my primary interest is structure. It has bothered me over the years that many practitioners in their field have not fully embraced the fact that structure does indeed affect function on many levels. I feel that if you are going to be a successful doctor today, with the enormity of foot problems that has affected this nation you have to integrate a full understanding of foot care. And you have to integrate a full understanding of dental care. As we see human beings start to go into degenerative patterns in the cranium as well as the feet, it has dire consequences on the health. There are too few doctors today that can appreciate this concept. Many chiropractors are adjusting strictly the spine. You cannot obtain a permanent result in the spine unless you also address the cranial problems and the problems of the feet.

Dr. Moroff: I worked with Dr. Rothbartís close knit colleagues that used the same model 12 years ago, and I had this high right hip that stayed high regardless of what treatment was proposed or what exercises I did. The combination of a 10mm pair of insoles and two or three myofacial sessions, gave me balanced hips for the first time. When practical products became available, I was ready to use them.

Mr. Tyler: My colleague and friend Phil Page asked me if I had seen these new insoles from Posture Dynamics. ďTheyíre shoe inserts that help your posture and better align the kinetic chain." So I went on your web site, and I became quite intrigued by the rationale and the theory behind your inserts. I thought about a few patients that had been having trouble getting better, who had definitely reached a plateau and decided to try them. Since theyíre so inexpensive, I got the starter kit, fit them with the PCIs and actually got those patients better. Thatís how I got started.

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How do you determine which patients need to wear Posture Control Insoles™?

Dr. Hammons: I do a gait analysis; a postural analysis and I evaluate the subtalar joint to assess the extent of hyperpronation.

Dr. Jelstrup: I study the feet of the patient and I study their gait pattern, how they walk and how the knees move in relationship to the feet.

Dr. Cozzocrea: So far Iíve fit patients that presented with complaints about hip, knee, leg and foot pain - people who are on their feet a lot. I have noticed a change in my shoulder since I started wearing them, so the range of complaints will probably expand.

Dr. Moroff: We perform an initial postural examination so Iíd have to say that anyone that shows hyperpronation or more specifically, anyone who shows a Mortonís foot structure will be evaluated for PCIs.

On the second visit a Report of Findings is given to the patient with regards to their evaluation, their diagnosis and what risk factors may preclude them from reaching a state of neutrality; or a state of feeling better and optimal health. If one of the risk factors was hyperpronation or Mortonís foot it would be suggested that this (PCIs) is what has to be done and they would go ahead and purchase them on the second visit.

Mr. Tyler: Anybody with abnormal foot posture is my criteria. Mortonís foot structure is quick to recognize and we look at the position of the calcaneus, the forefoot, and the subtalar joint.   People hyperpronate to varying degrees so I donít recommend it for everyone.  I donít think itís indicated for everybody but in my experience Posture Control Insolesô work well for 80-85%.

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What were the challenges in learning how to fit Posture Control Insoles™?

Ms Janssen: I would recommend to anyone thatís going to learn how to do this to get the manual, take it home, sit in a quiet place and read, Öand then read again. After I was fitted, I fit one of the doctors and the other people I work with here to get smoother in my flow in working with people, so that helped me learn.

One of the challenges Iíve found in learning the process is when to use the arches. For the most part they arenít needed but sometimes itís a fine line and I really have to listen carefully to the patientís feedback to make the decision to go ahead and apply an arch support. Itís interesting to do the follow-up when the patient has been wearing the PCIs for a week; some people have unique foot motions where the general rule of no arch support unless the foot is flat doesnít always apply. It can be a little gray area where arches can be helpful. The patientís feedback is key.

The important elements in fitting PCIs, I think, are really listening to the patient. My final choice of what level to go with is determined by what they say when I ask, ďWhat is your lifestyle?Ē If they are athletic, theyíll adapt quicker, but if theyíve been more sedentary their bodies wonít adapt as quickly. That helps me decide how aggressive to be with the technology in addition to the information on the worksheet.

The only challenge was gaining self-confidence. It helped to talk to the doctor and hear what he was saying to the patient from his chiropractic and structural knowledge and make sure that what I understood about it and what he was conveying to the patient was the same.

After about five fittings I felt pretty confident. It just gets better from there.

The process in general is well organized, easy to follow and easy to understand. Once you understand it, its just repetition and it becomes increasingly more efficient.

I think anyone with the interest can easily learn this process. Being in a chiropractic office and understanding structure and muscular interactions helps.

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Do you have a philosophy that predisposes you to use Posture Control Insoles™?

Dr. Jelstrup: Always check the gait pattern, because if you donít, youíre going to miss problems further up the spine.

I have seen generations of people. I have pointed this out to the mothers, and now the offspring is worse. Often the problems are related from mother to son and from father to daughter, so you can check this, and the scary part is that the problems are getting a lot worse. It is a little bit like diabetes. Before we had diabetes, it was a problem and many people were affected, but now it is pandemic and we are starting to look at diabetes as part of our civilization. We will also be starting to look at posture control and the need for Posture Control Insoles as part of our civilization. This is indeed part of the breakdown process of the structural system with far reaching neurological consequences.

I focus on gait pattern as well as the bite pattern. The movement of the feet provides a strong input to the central nervous system, and the bite pattern equally provides input to the central nervous system, so if you have the bite pattern and the gait pattern under control, your work as a chiropractor becomes immensely easier.

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Before using Posture Control Insolesô were you using anything to address your patients' posture issues?

Mr. Tyler: We are quite successful with therapeutic exercise, biofeedback.  We work with the patients to become aware of their posture and we train them so it becomes a subconscious thing.  From a visual perspective, some people respond dramatically to the PCIís, and others are barely noticeable.  We do see pain resolve, and we are aware that some times it is difficult to observe a small posterior rotation of the pelvisÖ.  not enough too see, but enough to resolve pain.

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Before recommending Posture Control Insolesô were you using any other orthotics to help reduce hyperpronation?

Mr. Tyler:As a last resort. Because of the Posture Control Insolesô weíre now more likely to give a foot insert earlier than in the past. My general satisfaction level with brand X was only fair, so I was totally open to evaluating other approaches when Phil Page from Hygenic Corporation introduced me to this technology. PCIs donít work for everyone but so far Iíd say the majority of the patients we have fit have been helped and like them, so weíre going to continue to using them.

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