Adirondack Sports April 2024

HEALTH & FITNESS
OPTIMAL MILD MODERATE SEVERE TOTAL
By Dr. Tim Maggs
Always Think Feet First
“Oh, everyone doesn’t need orthotics.”
This was the response I got from a top
chiropractic researcher after reading
an article authored by me and Dr. Terry
Yochum in 2011, “100% of My Patients Get
Orthotics. What About Yours?”
In 2011, this article was the by-product
of Dr. Yochum, a leading chiropractic
radiologist, and me lecturing together
many times, and him hearing my reasoning,
case studies and experience with
orthotics and patients. At breakfast one
morning, he suggested we write the article.
Evidently, it made sense to him.
Today, with much advanced technology,
I can now show with evidence-based
research that in fact, everyone does need
orthotics. That is, if the goal is to reduce
the likelihood of injuries and delay degeneration
of the musculoskeletal system.
2023 Research Study – Over a period
of three years, I accumulated digital
laser foot scans of 1,001 patients (Maggs,
2023). This is study number five and can
be found online: drtimmaggs.com. The
scan detects pixels, and pixels become red
when that portion of the foot makes direct
contact with the scanner. The optimal foot
is somewhat like a suspension bridge, and
the three arches (medial, transverse, lateral)
prevent the entire foot from making
direct contact with the ground.
The scan attaches a specific number to
the degree of collapse of the feet, ranging
from the optimal foot (0) to the most collapsed
foot (200). There are five categories
a patient’s feet can fall into, optimal (0),
mild pronation (1-34), moderate pronation
(35-84), severe pronation (85-124),
and total pronation (125+).
These scans were the scans I formerly
did on all patients who came into my office
as part of our biomechanical exam. Some
of the patients had no symptoms, while
some had either acute or chronic symptoms.
Scans were only done on patients
who could stand with their normal posture.
Patients with severe spasms in the
low back or significant pain that would
cause them to stand guarded or with any
degree of antalgia (abnormal pattern of
walking) were not scanned until their
symptoms were reduced and they could
stand with their normal posture.
Everyone is “Crooked Man” – The
above study plus multiple other studies
that have been published in the past
five years have proven that everyone has
some degree of foot collapse, and more
people have unlevel femoral head height
difference (FHHD) greater than 3mm
(64%) than people whose FHHD is less
than 3mm while barefoot. A staggering
42% have FHHD greater than 5mm while
barefoot. The conclusion is, everyone is
Crooked Man.
Some authorities claim that the inclusion
of orthotics in the shoes will level
femoral head height difference. Actually,
that only happens 21% of the time (Maggs,
2023). When orthotics are put into shoes,
61% of people have FHHD greater than
3mm while 40% have FHHD greater than
5mm. The fact that everyone has some
degree of collapse of the feet and more
have unlevel FHHD than level FHHD,
the importance of knowing the feet/hip
relationship on every patient cannot be
overstated. The standing antiphospholipid
syndrome (APLS) x-ray is necessary for
this information.
Case History – A 41-year-old healthy
and athletic male came into my office with
chronic low back pain that was getting
worse with time. This patient is a semipro
golfer who golfed four to five times per
week. His ability to play without pain was
becoming more difficult.
Our research study of the 1,001
patients concluded that FHHD was really
the critical variance when attempting
to get the low back healthy. Abnormal
loading was the underlying cause of most
low back conditions, so an APLS x-ray
while barefoot was compared to an APLS
x-ray while wearing orthotics. Research
has proven there is no need for custom
orthotics (Maggs, 2023), as the most
important purpose for orthotics is to create
symmetry of both feet while supporting
the arches of the feet. Both goals can
be addressed with high quality over-thecounter
orthotics. Once in the shoe, the
most important test to be done is now the
second APLS x-ray.
Earlier studies have shown there are
five versions of Crooked Man (Siozos,
2020). Due to the fact the FHHD worsened
once orthotics were put in the shoes, and
the patient’s FHHD was abnormal while
barefoot, this would categorize this patient
as a Crooked Man 2. Anecdotally, Crooked
Man 2 usually produces the worst injuries.
On the patient’s lateral lumbar spine,
there is much information. His Ferguson’s
gravity (weightbearing) line and sacral
base angle are both normal, however,
there is advanced narrowing of the L4/L5
disc space. All other disc spaces appear
to be normal, which could suggest some
form of injury and loss of normal motion
some years ago accelerating the degeneration
of the L4 disc.
APRIL 2024 47
Conclusion – The human architecture
in many ways is no different than
the building (home) you reside in. If the
foundation is off balance, there will be
many secondary issues that will occur
over the years. In the above patient, he’s
had 41 years of some degree of collapse
of his feet and uneven leg lengths. This is
in combination with the many slips, falls
and repetitive activities we all go through.
While his L4 disc shows signs of premature
wear and tear, and while his symptomatic
picture is getting worse with each
day, we can’t ignore his foundation if our
goal is to help his low back.
Orthotics must be the first step in
helping this patient to heal. Once the second
x-ray is taken, a 7mm lift is put under
the right orthotic to help level the hips as
much as possible. Then, once the structure
is supported and leveled, a treatment
program can begin. Our office provides
chiropractic adjustments, cold laser ther-
apy and spinal decompression. We set
this patient up for 10 visits to see how he
responds at which time we’ll do a re-exam.
The real conclusion is, if you’re confused
as to where to begin with preventing
and solving injuries, always think feet first.
Even if you’re a chiropractic researcher.
References – Maggs, B. a. (2023). “Each
Person’s Collapse of the Arches of the Foot
May Be Unique but its Correction is Standard.
A Large Study Explains Why.” Orthopedics and
Rheumatology Open Access Journal, 6. Siozos,
B. a. (2020). “When Correcting the Collapse
of Arches of the Feet with Custom Orthotics,
are Other Areas of the Body Effected? A
Revolutionary Approach towards Reduced
Injuries and Better Outcomes.” Orthopedic and
Rheumatology Open Access Journal, 001-008.
Dr. Tim Maggs (drt@drtimmaggs.com) is
a chiropractor in private practice for 45
years in upstate NY. He has specialized
in the diagnosis, treatment, and
investigation of sports injuries throughout
his career, some of it from his own injury
experience. Tim, his wife Trudy, and four
sons are runners, bikers, and actively
involved in fitness and a healthy lifestyle.