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Orthopedic surgeons, chiropractors, physical therapists and other healthcare specialists have been treating musculoskeletal disorders and the degenerative effects of these disorders the same way for the past four decades. They all steer their entire approach and thinking process towards the reactive model. They assume the patient in front of them is there as a result of some accident, fall or sprain. And while this is the case at times, they fail to look at the "why" and spend all of their time on the "what". The authors of this study have positioned themselves to claim that biomechanical faults, even when asymptomatic, are far more common than the average healthcare worker realizes. These are the very faults that are the precursors to many injuries as well as premature degenerative changes. In this study, we demonstrate the value of digital x-ray for the understanding of underlying musculoskeletal faults on all patients. These faults originate in the foundation of the patient, their feet. The biomechanical collapses found in the

Ankle 14(2):78-81, 1993) supports the mounting clinical evidence that improper shoes cause many forefoot illnesses. One professional foot health association still doesn't believe it. ' The authors assert that women need instruction in proper shoe fit. Good luck! The phrase "proper shoe fit" repels most women.4 Few will submit voluntarily to desexing out of the charmed circle of the youthful look. Tight shoes reflect a woman's psychosexual personality and contribute to proper psychic fit. Encouraging shoe salespeople to instruct women on proper shoe fit is unlikely. Most are mediocre by virtue of inadequate inventory, lasts, sizes, training, and interest. The pedorthic profession is the main hope to improve proper shoe fit to the public, although it is not one of their stated group objectives.' Appealing to foot health professionals to do the job is hopeless. Few really want to apply the knowledge of the foot-shoe relationship, even though more is known now than at any other time in history.The authors state the shoe upper should not bulge over the welt. This is rarely achievable except in custom shoewear. The majority of lasts (and shoes) found in specialty and everyday shoe stores are unequally divided at the midfoot and f~r e f o o t .~ Virtually all feet, except those with fixed structural deformities, are straight axis. That is, a line started at the rear-center of the heel and projected forward through the center of the midfoot and ball will exit approximately between the second and third toes. The foot divides into nearly two longitudinal halves. The "crooked" last (and shoe) construction is the most serious fault to proper foot fit. It automatically causes a faulty foot fit regardless of the correctness of shoe-sizing measurements. Observe your own shoe. It probably reveals a runover look at the outer ball area. The upper is overlapping the lateral outsole and welt, while the medial edge of the sole is visible. This is a direct consequence of the foot directed on a straight axis while the lopsided last (and shoe) is forcing the foot inward on a conflicting axis. This situation is a serious obstruction to normal foot function. Under these circumstances compromise foot fit is the only realistic expectation.

Orthotics and custom-made insoles have been used for decades for both professional and recreational athletes but are not always associated with a desirable outcome. In fact, more often than expected, they are associated with worsening of pain and ailments in the back and pelvis area. Our goal is to explain why some orthotics fail to tackle unevenly distributed weight-and load-bearing and to introduce a new measurement method that could help all healthcare professionals to identify, classify and finally treat their patients in a biomechanically optimal manner. To do so, we performed a 3D digital laser foot scan in each of the 351 participants in this study and ordered the custom made orthotic accordingly. Then, two A-P Lumbo-Sacral digital x-rays were obtained, the first with the patient being barefoot and the second while wearing the custom orthotics inside tied shoes. Our results showed a significant alteration in femoral head height difference (fhhd) which was consistent with each patient's clinical findings. That sequence also helped us to identify five different biomechanically flawed patterns and to conclude that each patient falls into one of these five categories. Should this be applied to every human being, it might be a giant leap in preventing most musculoskeletal injuries from happening in the first place.