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Archive for the ‘Orthotics’ Category

ICB Superior Biomechanics

Use the form below to book onto the Manchester Saturday 13th October Course.


Manchester Saturday 13th October

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ICB Superior BiomechanicsICB Courses 2018


This course will present a foundational understanding of lower limb biomechanics by independent pre-learning together with a workshop on practical orthotic therapy. Taught by Lawrence Dreifuss owner of Tuckton Chiropody & Podiatry Centre.

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This practical ‘hands on’ day will provide the manual skills to implement chairside orthotic therapy to fulfil a successful treatment plan for your patient.
Upon completion of this workshop, the participants will be able to:
▪ Identify Neutral Calcaneal Stance Position (NCSP)
▪ Assess for Structural Leg Length Discrepancy
▪ Heat and moulding orthotics to the patient’s STJN

Evaluate and treat forefoot mechanics, including:
▪ Forefoot Valgus
▪ Forefoot Varus
▪ Plantarflexed 1st
▪ Dorsiflexed 1st

Perform chairside orthotic modifications, including:
▪ Plantar fascial grove to treat tight Fascia
▪ Extrinsic and Intrinsic metatarsal Dome for Metatarsalgia and Mortons Neuroma
▪ 1st Metatarsal deflection to treat plantarflexed 1st
▪ Forefoot Varus and Forefoot Valgus posting
▪ Morton’s extension for HAV, Dorsiflexed 1st & Hallux limitus.

Attendees will receive a starter pack (worth over £100) which will include a pair of orthotics to heat mould, plus a set of products to deflect and customise in the workshop.

We provide prior learning 30 days before the course, to ensure all participants benefit from the subjects taught on the day.

Book Now

Dates are:

OR CONTACT RICHARD ON 07553 345 831OR EMAIL richard@dltpodiatry.co.uk


1 Day Course: £90 + VAT
INCLUDES ICB Starter Kit worth over £100 + VAT

Riverside Court, Stoney Battery Road, Huddersfield, West Yorkshire



Free entry and open to all, special offers and discounts available on the day. We bring our showroom to you, view new products and equipment. See product demonstrations by our friendly team who are happy to give help and advice.

1 Day Course: £90 + VAT
INCLUDES ICB Starter Kit worth over £100 + VAT

Doubletree by Hilton NORTH – NEWBURY – RG20 8XY
M4, Junction 13, Oxford Road, Newbury RG20 8XY



Free entry and open to all, special offers and discounts available on the day. We bring our showroom to you, view new products and equipment. See product demonstrations by our friendly team who are happy to give help and advice.


Saturday 15th September – Heathrow
1 Day Course: £110 + VAT
INCLUDES ICB Starter Kit worth over £100 + VAT

Premier Inn , Bath Rd, 15 Bath Rd, Heathrow, Longford, Hounslow TW6 2AB



13th October Manchester  

Saturday 13th October – Manchester
1 Day Course: £110 + VAT
INCLUDES ICB Starter Kit worth over £100 + VAT

Premier Inn Trafford Centre West – Old Park Ln, Stretford, Manchester M17 8PG





Lawrence Dreifuss

After graduating from the London Foot Hospital
in 1987, Lawrence worked within NHS Community and hospital clinics before establishing Tuckton Chiropody & Podiatry Centre in 1997 with his Podiatrist wife Sheila.

Expansion into a multi chair clinic and the recruiting of associates followed allowing Lawrence to specialise and further hone his knowledge & interest of Podiatric Biomechanics Tuckton Podiatry now boasts its’ own separate Biomechanical suite adjoining the main clinic, utilising up to the minute  technology and techniques, treating patients with the skeletal / muscle issues patients face as a result of their foot dynamics or trauma.

Lawrence specialises in treating musculo-skeletal conditions of the lower limb and postural abnormalities related to gait / pelvic dysfunction especially related to chronic sports injury.


This article will focus on lateral sprain and pain associated with a pes cavus foot structure and a forefoot valgus deformity. Repetitive lateral ankle sprain or lateral knee pain (or even lateral shin splints) is often diagnosed as ‘idiopathic’, closer examination of the biomechanical relevance needs to be pursued. The term ‘idiopathic’ is often used in this area as there seems no reason for the pain occurrence. Pes cavus foot (high arch) structures (Fig. 2) may have a predisposition to lateral ankle sprains and present as a rigid structure and a supinated foot structure.


Pes Cavus Foot Structure


This type of structure will usually exhibit a forefoot valgus deformity
meaning that, ‘the plantar plane of the forefoot remains everted relative to the plantar plane of the rearfoot when the subtalar joint is in neutral.’


This deformity will have an impact on the patient in heel strike, midstance and toe-off phases of gait.  The patient who exhibits a pes cavus foot structure will often present with a forefoot valgus (FFVL) greater than 10º and also often exhibit a plantar flexed 1st metatarsal

(Boyd & Bogdan, 1993) – encouraging the foot to strike laterally and eliciting pressure on the lateral aspect of the hip joint.  If the forefoot valgus deformity is greater than 10º, the foot will often continue to supinate through the cycle, having a ‘jarring’ effect on the upper structure, putting additional strain on the lateral aspect.

Fig. 3

Fig. 3: Use an ICB Protractor to assist in
measurement of Forefoot valgus.


When the foot is supinated it often exerts stress on the peroneals and may cause elongation of the muscles and tendons, thus weakening the retinaculum and lengthening the peroneals, often causing the tendon to sublux off the lateral aspect of the malleolar.

The forefoot valgus deformity (in gait) encourages the foot to invert the foot, propulsion is delayed causing lateral instability and results in tension and tearing of the peroneal muscles, causing inflammation and tenderness, and difficulty walking. Lateral ankle sprains are more common than medial due to the fact that ligaments are weaker on the lateral side.

Hence the lack of lateral stability can be caused by uncompensated or partially compensated rearfoot, a flexible forefoot valgus or osseous forefoot valgus (Boyd & Bogdan, 1993; Hollis et al, 1995; Shapiro et al 1994).

Fig 4

Fig. 4: Effects of Forefoot valgus during gait.

There are also certain biomechanical foot deformities that make some patients more susceptible to inversion sprains, such as, neurological deficits and supinated foot types which exhibit or function with a supinated calcaneus (Valmassy, 1996).


In summary, if a patient presents with lateral hip pain, knee pain, ankle strain or repetitive lateral inversion sprain, always check for a forefoot valgus deformity.  If a forefoot valgus if present, add an appropriate size ICB Forefoot Valgus wedge (available in 4° & 6°) to the selected ICB Orthotics using the 3M tape provided.  Next, heat mould the ICB Orthotics to the patient’s Neutral Calcaneal Stance Position. Being made from 100% EVA, ICB Orthotics can easily be heated and moulded to suit high arch foot structures.

ICB Orthotics

Prescribing ICB Orthotics.

ICB Heat Moulding Orthotics can be prescribed to assist in the treatment of excessive pronation and supination, and resultant biomechanical conditions.  With 5 densities, 5 styles & 11 sizes, there is an ICB Orthotic to suit all footwear styles, patient ages and activity levels.

ICB Orthotics


To enable quick and easy orthotic customisation in the clinic setting, ICB Orthotic Additions are also available, including: Forefoot & Rearfoot wedges, Heel Lifts, Metatarsal domes, medial flanges,
medial arch infills and more.

View the full ICB Orthotic range



Management of Achilles tendinopathy in runners-LER 
By Howard Kashefsky, DPM
Achilles tendinopathy is a common lower extremity injury in athletes as well as nonathletes. The Achilles tendon is often a site of injury in runners and is the second-most common running-related musculo¬skeletal injury, after medial tibial stress syndrome, with an incidence of 9.1% to 10.9%.
1 The lifetime risk in former elite male distance runners is 52%.
2 Factors that may contribute to Achilles tendinopathy include overuse, systemic disease, older age, sex, body composition, and biomechanics.
3 Elevated biomechanical load has been shown to cause both microscopic and macroscopic failures.4-6


1. Lopes AD, Hespanhol Junior LC, Yeung SS, Costa LO. What are the main running-related musculoskeletal injuries? A systematic review. Sports Med 2012;42(10):891-905.
2. Zafar MS, Mahmood A, Maffulli N. Basic science and clinical aspects of Achilles tendinopathy. Sports Med Arthrosc 2009;17(3):190-197.
3. Magnan B, Bondi M, Pierantoni S, Samaila E. The pathogenesis of Achilles tendinopathy: a systematic review. Foot Ankle Surg 2014;20(3):154-159.
4. O’Brien M. Functional anatomy and physiology of tendons. Clin Sports Med 1992;11(3):505-520.



Summer Orthotics

With Summer now in full swing, the warm weather and longer days brings a season of parties and outdoor activities.  With this in mind, our patients’ footwear will have undoubtedly changed – from winter boots and enclosed styles, to sandals and casual ‘slip-ons’. Often these summery footwear styles offer little or no support to the foot.  So what can be done to keep patients on track with their treatment regime, and reduce the re-occurence of existing biomechanical conditions or injuries, during the summer months?


For women, sandals and ballet flat styles of shoes can easily be fitted with ICB High Heel Orthotics.  Although, as the name suggests, this orthotic style was originally designed for fitting into high heels, its narrow slimline design makes them ideal for flat (or low) heeled sandals. Each pair of ICB High Heel Orthotics are supplied with velcro dots to hold the orthotics in place inside the sandal.


Ideal for fitting into summer sandals and ballet flats.

Ladies Orthotics

Tip: Add a 4° ICB Rearfoot Varus Wedge medially on the plantar surface of each orthotic – this will assist in providing additional pronation control.


ICB Rearfoot Wedges

Can be attached to the orthotic when additional rearfoot control is required (more than the 5° inversion built into 2/3 and full length ICB Orthotics). Patients who pronate more than 5° may require additional rearfoot posting to give optimum results. Sizes available: 2° & 4° (2 or 10 pack with double-sided tape).

Rear-foot Wedge


‘Boat shoes’ and slip-on mocassin styles are popular summer shoes for men. A common problem with these can be that they are often narrow through the shank of the shoe.  The ICB Dress Style Orthotic is a good choice for such styles, as the lateral skive (i.e. no lateral border) accommodates for broader feet, and fits much easier to narrow shoe types.  The dual density design offers excellent support and comfort for the burliest of blokes.

MENS ORTHOTICSDress Style Orthotics – Ideal for fitting into mens boat shoes and mocassins.





A common complaint amongst patient’s who have been prescribed foot orthotics is ‘pain in the arch’. This type of pain can be the result of 4 common issues:
1. Pain can be due calcification (similar to dupuytren’s contracture)
or a fibroma in the body of the Plantar Fascia, or a Ganglion cyst
may be present.


If there is calcification in the fascia, use manual therapy to break it down.
For a fibroma or Ganglion cyst, a deflection will need to be heated into the orthotic to accomodate and relieve any pressure from this area.




2. Plantar fasciitis pain can be experienced at the attachment to the calcaneus.


Control rearfoot pronation using orthotics with intrinsic rearfoot posting to realign the feet to the Subtalar Joint Neutral Position (STJN).  If additional inversion is required to control and achieve STJN, add extra rearfoot wedges (2° or 4°) to provide additional Calcaneal control2.


A medial arch infill can also be applied to the orthotic to provide increased arch support.

The Plantar fascia may be tight, and during gait (at mid stance to toe-off), compressing into the medial longitudinal arch of the orthotic causing discomfort and pain.  To test for a tight fascia use the ‘Windlass Test’ (pictured below).







TREATMENT: Create a plantar fascial ‘relief’ or ‘groove’ in the arch of the orthotic using heat or by grinding the orthotic. Place the groove 1cm from the medial edge through the arch contour.

4. The patient may exhibit unilateral excessive pronation as a possible compensation or due to plantar injury.


TREATMENT: Create a plantar fascial ‘relief’ or ‘groove’ in the arch of the orthotic using heat or by grinding the orthotic. Place the groove 1cm from the medial edge through the arch contour



Unilateral arch pain can be associated with a leg length difference3 due to long leg compensatory excessive pronation.  If a structural leg length discrepancy is identified, a heel lift will need to applied to the orthotic on the shorter leg.




1. FROWEN, P., O’DONNELL, M., LORIMER, D., BURROW, G. (2010) Neales Disorders of the Foot 8th Edition, p130
2. FROWEN, P., O’DONNELL, M., LORIMER, D., BURROW, G. (2010) Neales Disorders of the Foot 8th Edition, p127
3. MICHAUD, T.C. (1997) Foot Orthoses and Other Forms of Conservative Foot Care, Sydney: William & Wilkins, p.114



Plantar Fasciitis (PF) is a degenerative syndrome of the plantar fascia resulting from repeated trauma at its origin at the calcaneus1.

It is reported to be the most common cause of inferior heel pain in adults2.

Plantar fasciitis is also known as painful heel syndrome, heel spur syndrome3, runner’s heel, policemen’s heel, subcalcaneal pain, calcaneodynia and calcancal periostitis.

Treating the causative factors of plantar fasciitis is key to designing a treatment for your patient.Using the point of pain test will indicate if the pain is Lateral, Central or Medial.Valmassey refers to plantar fasciitis as affecting both pes planus and pes cavus foot types4 with opinion being that different pain regions may be suffered depending upon the foot structure (watch video).Generally speaking the following often applies:

Lateral Heel Pain is often associated with an uncorrected forefoot valgus and pes cavus foot type.

Central Heel Pain often indicates a forefoot valgus is present, in addition to rearfoot pronation.

• Medial Heel Pain generally indicates the patient will exhibit excessive rearfoot pronation.


 Point of Pain TEST


In each case, treatment will involve prescribing an orthotic device to control rearfoot pronation and provide biomechanical correction. In the cases of Central and Medial pain, a heel deflection (referred to as a ‘horseshoe deflection’) in the orthotic can also assist by relieving pressure on the attachment. Low Dye Strapping can be used to provide short term pain relief, as it mimics the support and control offered by an orthotic device.
Shockwave therapy has also been used to some effect in breaking up scar tissue. Anti-inflammatory medications, massage and surgery are generally less successful in the long term treatment of Plantar Fasciitis.



ICB Sports Orthotics  have an intrinsic 5° rearfoot varus angle to assist in controlling rearfoot pronation, and a horse shoe deflection making them ideal for treatment of Plantar Fasciitis.


1. Cornwall MW. McPoil TG., Plantar fasciitis : Etiology and Treatment.  Orthopaedic Sports Physiotherapy (1999);29:756-76
2. Singh D. Angel J. Becky G. Trevino SG.,Fortnightly review. Plantar fasciitis. BMJ (1997):315:172-17.S.
3. Lemont H, Ammiiati KM, Usen N. Plantar Fasciitis: A Degenerative Process (fasciosis)
Without Inflammation. American Journal Podiatric Medicine Assoc (2003); 93:234-237
4. R.L. Valmassey, Clinical Biomechanics of the Lower Extremities. (1996) p76

It’s estimated that up to 85% of the population suffer from pronation and related conditions.
Excess pronation is not an isolated condition – it contributes to causing mal-tracking and misalignment of the knee joint and hips, causing over compensation of the lower back muscles.
Such biomechanical dysfunction can affect patients of ALL ages and is not restricted to highly active people. Young children, adults, the elderly and even top athletes can suffer from pronation and its related effects.

Realignment of the lower limbs to the Neutral Calcaneal Stance Position (NCSP) with ICB Heat Moulding Orthotics integrated into the practitioners particular treatment modality, ensures correct foot function, and relief from painful biomechanical complaints, including:
• Bunions & Corns
• Plantar Fasciitis & Heel Spurs
• Metatarsalgia & Mortons Neuroma
• Achilles Tendonitis
• Shin Splints
• Tibial Stress Syndrome
• Achilles Tendonitis
• Patello Femoral Pain
• Ilio-Tibial Band Syndrome
• Tired Aching Legs
• Hip Pain
• Osteo-Arthritis
• Severs Disease
• Osgood Schlatters
• Growing Pains
• Lower Back Pain

Finding Subtalar Joint Neutral

Finding Subtalar Joint Neutral

ICB Anterior Line Method
1. Start with talo-navicular technique and find the mid point between the marked dots.
2. Mark the position of the 2nd metatarsal head and join with a line.
3. Draw a line down the trough on the lateral aspect of the tibial crest.
4. Palpate the subtalar joint until the lines are straight.

Talo Navicular Technique
1. Place forefinger and thumb either side of the Talo Navicular joint.
2. Palpate until joint feels congruent or even.
3. Subtalar Neutral will be achieved when the foot is neither pronating nor supinating.

Posterior Lower 1⁄3 Calcaneal Method
1. Bisect the lower area of the calcaneus
2. Bisect the lower posterior 1/3 tibia
3. Hold the talo-navicular joint and palpate whilst viewing the posterior view of the calcaneus.
4. Subtalar neutral is found when both lines are in line with each other.
NCSP: Neutral Calcaneal Stance Position RCSP: Resting Calcaneal Stance Position.

ICB Heat Moulding Orthotics

Heat mold orthotics


1. Attach any Forefoot or Rearfoot Additions prior to heat moulding.
2. Holding the ICB orthotic by the distal edge, heat the orthotic using an ICB Heat Gun. Hold the heat gun 15cm from the plantar surface of the orthotic – heating for 20-30 seconds in a ‘10-seconds-on, 3-seconds-off’ sequence until the surface has softened.
3. Heat the plantar surface of the orthotic until it gains elasticity. Overheating is not recommended.
4. Place the heated orthotic into the patients shoe – the patient must wear both orthotics and shoes during the moulding process.
5. As the patient stands, place the foot into the Subtalar Neutral Position and hold the orthotic to the arch for 30-40 seconds.
6. After molding, remove the orthotic from the shoe and allow to cool for 1-2 minutes then place back into shoe.
7. Repeat the process for the other foot.
8. Attach Heel Lifts and Metatarsal Domes as required after heat moulding.
NOTE: DO NOT apply heat to Talbrelle cover on the dorsal surface.

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Moulding and Grinding

ICB Orthotics are very versatile and can be custom fitted by heat moulding to the patient’s foot in the footwear or by moulding directly to the plaster cast and vinyl covers added, allowing for personal customisation.

ICB Orthotics are 100% EVA which enables them to be moulded completely for full correction and grinding is done in the workshop using a bench or hand held grinder. Pes Cavus foot types can be fully accommodated using the unique molding ability of ICB 100% EVA orthotics.

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