foot and ankle gpo - why treat all feet the same? · severe pes cavus the quad a foot type is...

TM

the alternative to custom orthotics

The in Foot Orthotic Design For the Entire FamilyNEXT STEP

STE SPttli elPrefabricated Custom To Foot Type Orthotics

QUADRASYSTEMSTEP

CBA FED

WHY TREAT ALL FEET THE SAME?

Introducing the Revolutionary

®The QUADRASTEP SYSTEM is based on a clinical assessment algorithm which identifies and differentiates the structural and functional aspects of the foot into 6 specific foot “types”.

Each foot type influences not only the patient’s gait but also the conditions and pathologies which may effect them throughout their lives.

®The QUADRASTEP SYSTEM approach to dispensing prefabricated functional foot orthoses is easy to use and brings immediate improvement to patient’s symptoms. The 4 steps to selecting a device with the correct features are based on many years of clinical experience and research. By following the steps the professional will be able to offer orthotic treatment that will be sensitive to the natural development of the patient’s feet and normalize the stresses that create pain and disability.

® QUADRASTEP orthoses are manufactured from an injection molded thermoplastic compound which has a unique combination of strength with a soft “edge feel” which gives incredible support while maintaining high patient comfort and therefore improving patient compliance. The devices are a single piece incorporating all of the required postings, recesses and heel cup/sidewall heights to effectively treat the specific foot type diagnosed requiring no additions or top covers. They can be easily cleaned with disinfectant without any loss of structural integrity.

SYSTEMQUADRASTEP

6 ‘foot type’ specific designs

No casting/impressions/scans required

Simple color specific design selection

Immediate patient results

Durable hygienic construction

New customer Starter Kits available

QUADRA SYSTEMSTEPThe offers:

Severe Pes Cavus Mild Pes Planus Neutral Foot ModeratePes Planus

Severe PesPlanovalgus

AbductovarusForefoot

FEDCBA

visit www.nolaro24.com email [email protected] Call 877-792-4669

THE

Great for In-Toeing!

Toe-In GaitNeuromasSesamoiditis1st Ray HypermobilitySacro-Illiac PainOften Unilateral if associated with leg length inequality

G A I T

Great for Ankle Instability!

Lateral Ankle InstabilityPeroneal TendonitisHeel Pain5th Metatarsal Base PressureLower Back PainSesamoiditis, Claw ToesKnee Recurvatum

G A I T

Great for Hip andBack Pain!

Hip Pa inLower Back Pa inI l io t ib ia l Band SyndromeRet roca lcanea l Hee l Pa inHag lund ' s Defo rmi tyMed ia l Ha l lux P inch Ca l lu s

G A I T

Great for Plantar Foot Pain!

P lanta r Fasc i i t i sMetata r sa lg iaFunct iona l Ha l lux L im i tusPate l lo femora l Pa in SyndromePos te r io r T ib ia l Tendon i t i sNeuromasDor sa l Bun ions

G A I T

Great for PTTD!

P o s t e r i o r T i b i a l D y s f u n c t i o nT a r s a l T u n n e l S y n d r o m eP l a n t a r F a s c i i t i sK n e e V a l g u s / D J DS u b f i b u l a r I m p i n g e m e n tH A V / B u n i o n sS p l a y f o o t

G A I T

Great for Heel, Shin & Knee pain!

Plantar Fasciitis / Heel PainShin SplintsKnee PainTailor's BunionetteCalcaneal Apophysitis (Sever's Disease)Osgood-Schlatter Disease

G A I T

SEVERE PES CAVUSThe Quad A foot type is commonly thought of as an over-supinated or Severe Pes Cavus foot. This condition, also known as a Torque Foot, occurs when an Uncompensated Rearfoot Varus is coupled with a Large Rigid Forefoot Valgus.

MILD PES PLANUSThe Quad B foot type is a mildly over-pronated foot. This is the result of a Compensated Rearfoot Varus with a Flexible Forefoot Valgus deformity. It is often unilateral and may be associated with a leg length discrepancy.

NEUTRAL FOOTThe Quad C foot type is sometimes referred to as a Subtle Pes Cavus foot or an under-pronator. This foot type exists when an Uncompensated Rearfoot Varus is coupled with a relatively neutral forefoot alignment. A key

A

B

C

The different shapes and positions of our feet should allow us to move naturally as we walk and run. Observational evidence has shown that there are four key features that will influence how our feet work.Different combinations of these features can lead to common painful symptoms.

®The QUADRASTEP SYSTEM shows how these physical and functional patterns can be identified to allowpractitioners to treat problems with an orthosis that is uniquely suited to each combination.

Four simple steps to choosing a custom to foot type orthosis…

distinguishing feature of this foot-type is an obvious toe-out gait pattern.

MODERATE PES PLANUSThe Quad D foot type is a moderately over-pronated foot. This foot type occurs when a Compensated Rearfoot Varus exists with a neutral forefoot alignment.

D

ABDUCTOVARUS FOREFOOTThe Quad E foot type is one of the most unique looking feet, often with a reverse-lasted foot shape. This foot type is the result of a combined E

deformity because of its very poor alignment to the ffoot.” The condition occurs when a Compensated Rearfoot Varus is coupled with a large Flexible Forefoot Varus (also called Forefoot Supinatus).

F

Uncompensated Rearfoot Varus, coupled with a large Rigid Forefoot Varus.

SEVERE PES PLANOVALGUSThe Quad F foot type is commonly referred to as a Pes Planovalgus foot

loor. This is a true “flat

A key distinguishing feature of this foot-type is a narrow gait pattern.

A key distinguishing feature of this foot-type is a toe-in gait pattern.

A key distinguishing feature of this foot-type is an MTJ instability.

A key distinguishing feature of this foot-type is an obvious heel pivot.

QUADRASYSTEMSTEP

CBA FED

ARCH HEIGHT TOE-SIGN GAIT STYLE CALLUS SIGNS®QUADRASTEP

MODEL

Narrow GaitHigh

Externally rotated tibia/Adducted forefoot

Toe-In Gait

Toe-Out Gait

Medial Heel Pivot2nd & 5th

MTH

2nd MTH

Medial Hallux

1st & 2th MTH

1st & 5th MTH

Large Central

MetAbducted Gait

Internally rotated tibia/Adducted forefoot

MediumNormal externally rotated

tibia/Straight forefoot

Internally rotated tibia/Abducted forefoot

Neutral Gait

Severe internal tibialrotation/Abducted forefoot

STEP 1IdentifyToe-Sign

STEP 2Identify medial

arch height

STEP 3Identify

gait style

STEP 4Check against callus pattern

A

B

C

D

E

F

LowInternally rotated tibia/

Straight forefoot

Medium - Low

Flat

Medium - Low

Neutral Gait

SEVERE PES CAVUSThe Quad A foot type is commonly thought of as an over-supinated or Severe Pes Cavus foot. This condition, also known as a Torque Foot, occurs when an Uncompensated Rearfoot Varus is coupled with a Large Rigid Forefoot Valgus.

PROPELS FORCEFULLYFROM 1st METATARSAL

LARGELY INVERTED HEEL ALIGNMENT

LARGE EXTERNAL

“PEEK-A-BOO” HALLUX

TIBIAL/FIBULAR ROTATION

CAVUS/HIGH ARCH

VALGUS FOREFOOTALIGNMENT

FOOT PROGRESSION ANGLE

CALLUSES

• Poor Shock Attenuation• Excessive Supination• Narrow or Cross Over Gait

A

QUADRASYSTEMSTEP

CBA FED

Available in Regular and Narrow Widths, both with optional topcover

G A I T

For more information

please visit or email

[email protected] call 877.792.4669or fax 203.758.1011

or to order QUADRASTEP®

Item Code Description Women’s Men’s Euro SizeSize 1 Type A - Adult Size 1 6.5 - 7.5 5 - 6 37 - 38Size 2 Type A - Adult Size 2 8 - 9 6.5 - 7.5 39 - 40Size 3 Type A - Adult Size 3 9.5 - 10.5 8 - 9 41 - 42Size 4 Type A - Adult Size 4 11 - 12 9.5 - 10.5 43 - 44Size 5 Type A - Adult Size 5 12.5 - 13 11 - 12 45 - 46

KEY ORTHOTIC FEATURES• Lateral Biaxial Forefoot Posting• 1st MTH Cut-out•

Deep Lateral Heel Cup•

Equinus Correction

REVERSE

Great for Ankle Instability!

Lateral Ankle InstabilityPeroneal TendonitisHeel Pain5th Metatarsal Base PressureLower Back PainSesamoiditis, Claw Toes

••

• • • • • Knee Recurvatum

POSSIBLE CLINICAL SYMPTOMS


MILD PES PLANUSThe Quad B foot-type is a mildly over-pronated foot.This is the result of a Compensated Rearfoot Varus with a flexible forefoot valgus deformity. It is often unilateral and may be associated with a leg length discrepancy

TOE IN GAIT

MILDLY INVERTED HEEL ALIGNMENT

TOE IN

B

GAIT

MILD-MODERATE INTERNALTIBIAL/FIBULAR ROTATION

LOW-MEDIUM ARCH

VALGUS FOREFOOTALIGNMENT


CALLUSES

• Pronates through Mid-Stance

• Re-supinates in Propulsion• Propels off 1st

and 2nd MTH’s

QUADRASYSTEMSTEP

CBA FED


For more information

or call 877.792.4669or fax 203.758.1011

or to order QUADRASTEP®

KEY ORTHOTIC FEATURES

• Intrinsic Lateral FF Posting

• Mild Medial Skive

• Medial RF Posting

REVERSE

Item Code Description Women’s Men’s Euro SizeSize 1 Type B - Adult Size 1 6.5 - 7.5 5 - 6 37 - 38Size 2 Type B - Adult Size 2 8 - 9 6.5 - 7.5 39 - 40Size 3 Type B - Adult Size 3 9.5 - 10.5 8 - 9 41 - 42Size 4 Type B - Adult Size 4 11 - 12 9.5 - 10.5 43 - 44Size 5 Type B - Adult Size 5 12.5 - 13 11 - 12 45 - 46


[email protected]


Great for In-Toeing!

POSSIBLE CLINICAL SYMPTOMSToe-In GaitNeuromasSesamoiditis1st Ray HypermobilitySacro-Illiac PainOften Unilateral if associated with leg length inequality

NEUTRAL FOOTThe Quad C foot-type is sometimes referred to as a subtle Pes Cavus foot or an under-pronator. This foot-type exists when an Uncompensated Rearfoot Varus is coupled with a relatively normal (neutral) forefoot alignment. A key distinguishing feature of this foot-type is an obvious toe-out gait pattern.

MODERATELY INVERTED HEEL ALIGNMENT

NORMAL TOE SIGN

C

TOE OUT GAIT CAUSES“FALSE POSITIVE” TOE SIGN

GAIT

NORMAL EXTERNALTIBIAL/FIBULAR ROTATION

MEDIUM ARCH

NORMAL FOREFOOTALIGNMENT


CALLUSES

• Poor Shock Attenuation

• Restricted STJ Pronation

• Propels off Medial Hallux

QUADRASYSTEMSTEP

CBA FED


For more informationor to order QUADRASTEP®

or call 877.792.4669or fax 203.758.1011


• Medium Arch

• Neutral RF Posting

• Standard Depth Heel Cup

REVERSE

Item Code Description Women’s Men’s Euro SizeSize 1 Type C - Adult Size 1 6.5 - 7.5 5 - 6 37 - 38Size 2 Type C - Adult Size 2 8 - 9 6.5 - 7.5 39 - 40Size 3 Type C - Adult Size 3 9.5 - 10.5 8 - 9 41 - 42Size 4 Type C - Adult Size 4 11 - 12 9.5 - 10.5 43 - 44Size 5 Type C - Adult Size 5 12.5 - 13.5 11 - 12 45 - 46Size 6 Type C - Adult Size 6 14 - 15.5 12.5 - 14 47 - 49


[email protected]



Great for Hip and Back Pain!

Hip Pa inLower Back Pa inI l io t ib ia l Band SyndromeRet roca lcanea l Hee l Pa inHag lund 's Deformi tyMedia l Ha l lux P inch Ca l lus

MODERATE PES PLANUSThe Quad D foot-type is a moderately over-pronated foot. This foot-type occurs when a Compensated Rearfoot Varus exists with a normal or neutral forefoot alignment.

PROPELS OFF 2ND & 3RD METATARSAL (DUE TO TRANSVERSE METATARSAL ARCH REVERSAL)

VERTICAL HEEL ALIGNMENT

NEUTRAL TOE SIGN

D

GAIT

MODERATE INTERNALTIBIAL/FIBULAR ROTATION

LOW ARCH

NEUTRAL FOREFOOTALIGNMENT

• Neutral Toe Out

• Pronation through Midstance

• Midtarsal Joint Instability


CALLUSES

QUADRASYSTEMSTEP

CBA FED



or call 877.792.4669or fax 203.758.1011



• Deep Heel Cup

• Moderate Medial Skive

• Medial and Lateral Flare

• Metatarsalgia

• Plantar Fasciitis

• Functional Hallux Limitus

• Patellofemoral Pain Syndrome

• Posterior Tibial Tendonitis

• Neuromas

• Dorsal Bunions

REVERSE

Item Code Description Women’s Men’s Euro SizeSize 1 Type C - Adult Size 1 6.5 - 7.5 5 - 6 37 - 38Size 2 Type C - Adult Size 2 8 - 9 6.5 - 7.5 39 - 40Size 3 Type C - Adult Size 3 9.5 - 10.5 8 - 9 41 - 42Size 4 Type C - Adult Size 4 11 - 12 9.5 - 10.5 43 - 44Size 5 Type C - Adult Size 5 12.5 - 13.5 11 - 12 45 - 46Size 6 Type C - Adult Size 6 14 - 15.5 12.5 - 14 47 - 49


[email protected]



Great for Plantar Foot Pain!

ABDUCTOVARUS FOREFOOTThe Quad E foot-type is one of the most unique looking feet,often with a reverse-lasted foot shape. This foot-type is theresult of a combined Uncompensated Rearfoot Varus, coupledwith a large Rigid Forefoot Varus.

MILDLY INVERTED HEEL ALIGNMENT

ABDUCTED TOE SIGN

E

MILD INTERNALTIBIAL/FIBULAR ROTATION

MEDIUM/LOW ARCH

VARUS FOREFOOTALIGNMENT


CALLUSES

• Narrow Heel Base Gait

• Restricted Subtalar Pronation

• Pivots at 5th MTHin Propulsion

ABDUCTED FOREFOOT

GAIT

MEDIAL HEEL PIVOT

QUADRASYSTEMSTEP

CBA FED



or call 877.792.4669or fax 203.758.1011

Medial RF & FF Posting

•

•

5th MTH Cut-Out

•

•

1st MTH Relief

Mild Medial Flare


Item Code Description Women’s Men’s Euro SizeSize 1 Type E - Adult Size 1 6.5 - 7.5 5 - 6 37 - 38Size 2 Type E - Adult Size 2 8 - 9 6.5 - 7.5 39 - 40Size 3 Type E - Adult Size 3 9.5 - 10.5 8 - 9 41 - 42Size 4 Type E - Adult Size 4 11 - 12 9.5 - 10.5 43 - 44Size 5 Type E - Adult Size 5 12.5 - 13 11 - 12 45 - 46

REVERSE


[email protected]



Great for Heel, Shin & Knee pain!

Plantar Fasciitis / Heel PainShin SplintsKnee PainTailor's BunionetteCalcaneal Apophysitis (Sever's Disease)Osgood-Schlatter Disease

SEVERE PES PLANOVALGUSThe Quad F foot-type is commonly referred to as a PesPlanovalgus foot deformity because of its very poor alignmentto the floor. This is a true “f lat foot.” The condition occurswhen a Compensated Rearfoot Varus is coupled with a largeFlexible Forefoot Varus (also called Forefoot Supinatus).

LATERAL COLUMN INSTABILITY

EVERTED HEEL ALIGNMENT

ABDUCTED TOE SIGN

F

GAIT

LARGE INTERNALTIBIAL/FIBULAR ROTATION

FLAT ARCH

VARUS FOREFOOTALIGNMENT


CALLUSES

• Pronates through Propulsion

• Severe MTJ Instability

• Propels from Central MTH’s

LARGE TOE SIGN

QUADRASYSTEMSTEP

CBA FED



or call 877.792.4669or fax 203.758.1011

REVERSE

Posterior Tibial Tendon Dysfunction

•• Tarsal Tunnel Syndrome

• Plantar Fasciitis

• Knee Valgus/DJD

• Subfibular Impingement

• HAV/Bunions

• Splayfoot

Item Code Description Women’s Men’s Euro SizeSize 1 Type F - Adult Size 1 6.5 - 7.5 5 - 6 37 - 38Size 2 Type F - Adult Size 2 8 - 9 6.5 - 7.5 39 - 40Size 3 Type F - Adult Size 3 9.5 - 10.5 8 - 9 41 - 42Size 4 Type F - Adult Size 4 11 - 12 9.5 - 10.5 43 - 44Size 5 Type F - Adult Size 5 12.5 - 13 11 - 12 45 - 46


[email protected]




Depth Orthosis Heel Cup

•

•

Large Medial Skive

• Medial RF & FF Posting

•

1st MTH Cut-Out to assist Peroneal Functioning

Great for PTTD!

REVERSE


• Deep Medial and Lateral Flanges

• 30mm Heel Cup Depth

UCBL TYPE DESIGN:


• Medial Skive

Introducing the Revolutionary

STE SPttli elFor more information

or to ordervisit www.nolaro24.com

or call or fax 203.758.1011

877.792.4669

TM

littleSTEPS. . .Big Results!

Designed to:

STEPSttli el

SYMPTOMS

• Growing Pains

• Developmental Flat Foot/Pes Planus

• Sever’s Disease/Heel Pain

• Idiopathic Toe-In or Toe Walking Gait

• Shin Pain

POSSIBLECLINICAL

SIZE MODEL U.S. KIDS U.S. MEN EURO9876543210

00

YOUTH/ADULT*YOUTH/ADULT*YOUTH/ADULT*

CHILDRENCHILDRENCHILDRENCHILDRENCHILDRENTODDLERTODDLERTODDLER

41 to 4239 to 4037 to 3835 to 3633 to 3431 to 3229 to 3027 to 2825 to 2623 to 2421 to 22

7.5 to 8.56 to 7

4.5 to 5.53 to 4

1.5 to 2.513 to 1

11.5 to 12.510 to 11

8.5 to 9.57 to 8

5 to 6.5

7.5 to 8.56 to 7

4.5 to 5.5

U.S. WOMEN 9 to 107.5 to 8.5

6 to 7

*Youth sizes are roughly equivalent to Men's sizes in length.


Support Flat Feet and Improve Posture Control Heel Pain/Sever's Disease Help Reduce Growing Pains Help Treat Toe Walking Improve Low Muscle Tone and Strength


• Deep Medial and Lateral Flanges

• 30mm Heel Cup Depth

UCBL TYPE DESIGN:


• Medial Skive

• Extends laterally beyond MTH's 4 & 5

Introducing the Revolutionary For more informationor to ordervisit www.nolaro24.com

or call or fax 203.758.1011

877.792.4669

Designed to:

STEPSttli el

• Idiopathic Toe-In Gait• Growing Pains

• Sever’s Disease/Heel Pain

• Shin Pain

SYMPTOMS

POSSIBLECLINICAL

SIZE MODEL U.S. KIDS EURO76543210

00

YOUTH/ADULTCHILDRENCHILDRENCHILDRENCHILDRENCHILDRENTODDLERTODDLERTODDLER

37 to 3835 to 3633 to 3431 to 3229 to 3027 to 2825 to 2623 to 2421 to 22

4.5 to 5.53 to 4

1.5 to 2.513 to 1

11.5 to 12.510 to 11

8.5 to 9.57 to 8

5 to 6.5

STE SPttli elit pa latg es fo sr d ik

TM

littleSTEPS. . .Big Results!

Reduce In-Toeing Improve Hip & Lower Extremity StrengthReduce Destructive Torsional ForcesCreate a Straighter, More Normal Gait


80 Turnpike DriveSuite 2BMiddlebury, CT 06762

For more information or to order please visitwww.nolaro24.comEmail [email protected] call 877.792.4669or fax 203.758.1011

TM

Using the

Quadrastep System – Educatio n

Take the next step... Learn more about the revolutionary Quadrastep® System – Foot typing methods, on our ONE DAY COURSE ‘Functional Gait Analysis: The Quadrastep System - Pre Fabricated Orthotic selection by Foot Type’

The Quadrastep® System is based on a clinical algorithm identifying unique foot types. Each quad has its own very specific foot and gait characteristics. A patient’s foot type influences not only their gait, but the conditions that may afflict them throughout their lives.

The one day program examines pathological gait conditions, resulting from the occurrence of rearfoot varus deformities (compensated and uncompensated), forefoot varus and forefoot valgus deformities, as well as their combined effects.

The professional will learn to perform visual static and dynamic gait analysis and interpret key weight bearing compensations, in order to determine a patient’s foot.

Participants are taught how to implement the Quadrastep® algorithmic process to classify an individual’s foot into one of 6 major foot types and understand how the specific gait sequencing of each foot type may predispose an individual to a certain set of pathologies.

The workshop sessions will include foot typing of fellow students and actual fitting of foot type specific prefabricated functional foot orthoses.

At the conclusion of this program, each student will have a detailed comprehension of assessment of foot type, without the need for complicated goniometric measurements. The student will leave this program skilled in a more functional approach to foot and gait assessment, allowing them to return to their clinic with the ability to offer their patients a more immediate and cost effective orthotic solution.

A Quadrastep® Fit Kit is available which contains one pair of each size in the 6 different foot type specific designs(total 30 pairs).

The kit comes complete in a 5 drawer clear plastic wheeled chest which is clearly labeled and provides for accurate immediate selection of your patients required orthosis.

The Fit Kit is available at a significantly reduced cost inrelation to the cost of individual products. This allows the practitioner to ensure the patient has the right orthosis type and size before ordering the selected product. The use of the fitting kitalso reduces the inconvenience in having to return for fittings andpotential return of unsuitable product.

Customized kits are also available containing specific devices of your choice.

®For more information regarding the Quadrastep System Fit Kit please contact us at 877.792.4669

®If you would like to see the Quadrastep System demonstrated by one of our sales team please contact our customer services team to arrange an appointment.

Quadrastep System Assessment Kit

SYSTEMQUADRASTEP

foot and ankle gpo - why treat all feet the same? · severe pes cavus the quad a foot type is...

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