09/14/2022    Jeff Root

Why Aren’t Orthotics Covered By Insurance? (Dennis Shavelson, DPM)

Dr. Shavelson wrote “Podiatry cannot remain tagged
to the biomechanical and orthotic genius of Dr.
Root and the gifts he gave us 45+ years ago.
Subtalar joint neutral, rearfoot valgus, and over-
pronation have had their runs”. He also said “We
have no proven definition of our orthotics, how to
cast them, and what their goal sets. Part of my
father’s “genius” was in recognizing that in order
to make foot orthotic therapy more scientific,
there needed to be terms to describe motion,
position, structure and function of the foot. Dr.
Root set out to do just that.

Dr. Root developed the concept of the neural
position of the subtalar joint. This enabled him
to differentiate between a foot that was supinated
and a foot that was pronated. Dr. Root then began
to compare feet and foot structure by placing the
STJ in the neutral position and the midtarsal
joint in a fully pronated position. Using this
standard positioning technique, he was able to
classify or better define over twenty structural
conditions of the foot. This knowledge also
enabled him to develop a standardized casting
technique and standard techniques for modifying
the model of the foot for producing highly
efficacious, functional foot orthotics. Those
techniques remain a significant part of the
foundation of modern day foot orthotic therapy.

I’m curious what system Dr. Shavelson would
recommend to replace Root’s terminology,
techniques and systems that are more
scientifically accurate and clinically
efficacious. I’m not sure what Dr. Shavelson means
by “Subtalar joint neutral, rearfoot valgus, and
over-pronation have had their runs”. Is Dr.
Shavelson suggesting that we abandon these terms
and concepts entirely? In my experience, pronation
related pathology is more common than supination
related pathology. In spite of that, foot
orthotics should be designed to treat the
individual patient’s pathology which may require
anti-pronation, anti-supination or other anti-
pathology design features.

In the March-April 1982 edition of CCPM’s
publication Pacesetter, Dr. Root wrote “An
orthosis that is prescribed to resist specific
abnormal forces identified by examination and is
designed to promote improved function of the foot
is called a functional orthosis. A functional
orthosis does not support the arch of the foot. A
functional orthosis does not "balance" a foot. A
functional orthosis does not hold a foot in any
position. A functional orthosis does not
accommodate lesions or painful areas of the foot.
A functional orthosis only resists abnormal forces
and promotes improved foot function”. This
statement was written forty years ago and yet the
goal of foot orthotic therapy remains the
prevention of pathological forces. If there are
better systems and techniques for treating lower
extremity pathology that do not involve the
concept of STJ neutral position, neutral position
suspension casting, forefoot and rearfoot varus
and valgus, STJ supination and pronation, etc., I
w could be very interested in learning about them.

Jeff Root, President, KevinRoot Medical

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