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The QUADRASTEP SYSTEM® from Nolaro24®, LLC

QUAD

Severe Pes Cavus

Symptoms and Features of the A Quad

The A QUAD 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 a Uncompensated Rearfoot Varus is coupled with a Large Rigid Forefoot Valgus.

We fondly refer to this foot-type as our "chandelier shakers"! Why? Because this foot-type loads heavily on the ground and never seems to pronate, leading to poor shock attenuation.

The development of heel and lower back pain is common. The torque foot nature of this foot-type allows the valgus forefoot to offset the uncompensated inverted heel alignment that would normally lead to a toe out gait pattern (see C Quad foot-type). Overall, the foot progression angle for this person is such that the feet point relatively straight ahead during gait (no toe out) with a narrow base of support, much like a tight rope walker.

All Quadrastep Orthotics are available in Regular and Narrow Widths, and with a topcover an an additional charge. For more information see Customized Orthotics.

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Sizing for the A Quad from the QUADRASTEP® SYSTEM

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The A Quad from The QUADRASTEP® SYSTEM

A QUAD POSSIBLE CLINICAL SYMPTOMS

• Lateral Ankle Instability

• Peroneal Tendonitis

• Heel Pain

• 5th Metatarsal Base Pressure

• Lower Back Pain

• Sesamoiditis, Hammer Toes

• Knee Recurvatum

• Poor Shock Attenuation

• Excessive Supination

• Narrow or Cross-over Gait

CONTACT PHASE	MIDSTANCE PHASE	PROPULSION PHASE
MOUSE OVER THE PHASE FOR DETAILS OF THE A QUAD GAIT

SEE OTHER QUADS:

Article on the Cavus Foot

READ
Clinical Assessment & Orthotic Recommendations for the
Cavus Foot
By Roberta Nole, MA, PT, C.Ped
& Joe Coletta, PTA, C.Ped

info@Nolaro24.com

877.792.4669

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Propulsion Phase
As the heel lifts off the ground, the foot and ankle may continue to supinate (roll laterally) due to the forefoot valgus alignment and strong contraction of the gastrocsoleus muscle. The gastrocsoleus muscle not only propels us forward (plantarflexion), but is a heel and ankle inverter. The problem here is that our weight should already have shifted to the medial column and 1st metatarsal. As pressure is exerted on the head of the 5th metatarsal, the body realizes it must do something to prevent spraining the ankle. The foot and ankle may rapidly pronate back over the 1st metatarsal, or they will simply end their step early (short steppers.) Rapidly pronating the foot from the lateral to medial side of the foot creates pressure and instability across the metatarsal heads, often resulting in heavy callus formations (1st & 5th metatarsal heads), hallux valgus deformity and hammertoes. Imagine grinding a rolling pin back and forth the ball of your foot every step you take! This is referred to as the "supinatory rock."

Midstance Phase
As weight moves forward over the foot, the arch and midtarsal joint remain rigid, with excessive pressure borne along the lateral column and base of the 5th metatarsal. At this point in the gait cycle, weight normally begins to shift from the lateral side of the foot over to the medial side, but lateral pressure persists in this case. Lateral ankle instability is common, as well as peroneal tendonitis due to over-activity of the peroneal muscles trying to stabilize the foot. In cases with very large rigid forefoot valgus deformities, this lateral instability may be increased by compensatory sub-talar joint supination.

Contact Phase
At initial contact, the calcaneus strikes the ground in an excessively inverted alignment relative to the ground. Since the deformity is largely uncompensated, very little pronatory motion is observed as the forefoot is lowering itself to the ground to conclude the contact phase of gait. The head of the 1st metatarsal may be subjected to excessive pressure because of the forefoot valgus alignment and the prevalence of plantarflexed 1st ray deformities in this foot type. Also, because of the lack of pronation, there is significant force on the lateral side of the heel, coupled with poor shock attenuation. This may cause or contribute to heel and lower back pain. We fondly refer to this foot type as our "chandelier shakers" since this foot type loads heavily on the ground. It is easy to hear a person with this foot type approaching since they seemingly walk "heavily on their feet." Overall, the feet tend to point relatively straight ahead during gait (no toe-out) with a narrow base of support.