Your Feet Aren’t
The Problem.

Alignment and appropriate control of that alignment when completing a task is the key to efficient mechanical performance.  In the same way this functional alignment optimization concept is true for an automobile to drive in a straight line with the least amount of energy “cost” to the engine and the least amount of “fatigue” wear to the tire treads, the same concept applies for optimized biomechanical alignment of the human body with upright activity.  

This functional, anatomic alignment is something that occurs through the interaction of our skeletal structure and the muscle-tendon units that provide dynamic support of this alignment with both mobile and stationary activity.  It is for this reason that musculoskeletal support interventions aimed at achieving and maintaining optimized alignment have been a mainstay of prevention efforts to minimize musculoskeletal related overuse and fatigue in the workplace.  

Unfortunately, current offerings as it relates to shoewear, inserts, and other footwear-related interventions/prevention efforts have failed to consistently and effectively alleviate this burden of disease in the workplace, particularly for the upright worker.    

Specific to biomechanics of the human body, fatigue is a consequence of deviation from optimal mechanical alignment during various activities.  While there is a natural amount of deviation from optimal alignment and resultant muscle fatigue that occurs during natural movements, it is excess deviation from this optimized alignment and the body’s continual attempt to restore and correct that alignment that potentiates early, excess fatigue and overuse stress on the body.

As a result, frequent interventions in preventive healthcare space have aimed at optimizing alignment both through postural exercises and strength training, external bracing/supports, and other modalities to help “control” and optimize alignment while still facilitating and importantly not limiting normal function.

As it relates specifically to interventions for the foot, a fallacy of modern day shoewear and inserts is that theoretical “control” comes from midfoot “arch support” rather than at the hindfoot during heel strike and the early stance phase as force moves from the hindfoot (heel) to the midfoot (arch).  The unfortunate reality is that when this external “support” is initiated only during this later phase of walking/stance, it is less efficient AND less effective at true alignment control.  Furthermore, it is much more difficult to accomplish in this manner without sacrificing perceived comfort in many individuals.  Interestingly, some of the most successful clinical study interventions related to limb alignment control and/or correction have historically focused on modalities such as heel wedges providing corrective forces to the heel and posture of the hindfoot when attempting to provide symptom relief for certain conditions such as osteoarthritis of the knee.  Unfortunately, while frequently clinically effective at modifying pathologic alignment of the knee and lower limb, these more simplified and archaic means of “correction” have sacrificed perceived comfort of the patient and as such have not gained universal adoption.  It is this fundamental understanding and appreciation of where true control and support of functional alignment resides, however, that UNIQUELY differentiates ProTalus’ patented technology from the remainder of the OTC insert market.  Rather than just perceived “arch support” existing purely from relative prominence and pressure provided to the plantar midfoot that ultimately fails to exert effective control on the functional lower limb, Protalus’ TOTAL FOOT CONTROL establishes this support first and foremost at the heel/hindfoot.  This hindfoot control then secondarily transitions this support to the midfoot in a much more effective manner than the competition not only biomechanically but from a comfort perspective of the user as well. 

Comfort is a natural byproduct of alignment, not simply cushion.  While impact attenuation/cushioning is certainly an important function of shoewear and a consideration of a variety of workplace environmental changes such as the use of fatigue mats, there is a significant amount of “cushioning” that naturally occurs through the various joints of the hindfoot and midfoot with weightbearing activity, particularly when anatomic alignment is optimized.  This inborne shock absorption allows the body to naturally accommodate to a variety of surfaces without immediately passing that impact and force sequentially to the knee, hip and lower back.  

As such, it remains critically important to facilitate and optimize this natural function of the foot.  This concept is why we believe that rigid, midfoot ONLY based “arch support” with inserts is so frequently intolerable to patients, and also unfortunately rarely leads to an optimized natural functional alignment as seen in numerous studies.  

Instead, our patented TOTAL FOOT CONTROL system is based upon first and foremost providing functional control and establishing a regime of natural motion of the hindfoot while avoiding extremes of pathologic alignment.  With this established and subtalar neutral alignment optimized, ProTalus inserts secondarily also provide support to the midfoot as a natural progression from the hindfoot rearfoot control.  

From both conceptual design and subsequent biomechanical testing, we have seen this leads not only to a more consistent biomechanical control of the foot, but also allows for optimization of the lower limb alignment as the foot engages the ground that is UNIQUELY different than other market insert offerings.  

In optimizing TOTAL FOOT CONTROL from the hindfoot through the midfoot, ProTalus allows for natural accommodation of the various joints for impact attenuation, functional CONTROL and SUPPORT of the ENTIRE foot, and ultimate comfort as perceived by the end user.

While the foot remains that mainstay of how we as upright, ambulatory individuals interact with our work environment, despite an emphasis within the industry historically focused on shoe wear alone to answer the “need” for optimizing this environmental interaction, we believe the shoe wear industry is not positioned to provide the answer to this market need.  Not only is the apparel industry unable to provide consistency of manufacturing necessary for a medical device, they also wish to avoid the liability of any claim as it relates to mitigation of disease.  Instead, the focus on perceived satisfaction with the aesthetics and comfort/feel of the product, or the basic protection against external factors such as moisture with waterproofing or trauma protection with hard toe covers has primarily driven the shoe wear market not unlike other apparel items.  With this understanding, it is our firm belief that the fundamental basis to optimizing lower extremity alignment and overall upright function is through the most effective means of establishing a consistent foundation and efficient interaction between the foot and shoe-surface environment with a Protalus insert that provides TOTAL FOOT CONTROL.

June 14, 2022

Dr. Kirk McCullough, M.D.