Q & A with Dr. Dan Moroff
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Dr. Dan Moroff, Exum Chiropractic, Orlando, FL has taken an active interest in the postural foundation since he started his practice 17 years ago. Among his heavily athletic clientele he has a large number of professional and amateur golfers. : Many patients are reporting that their golf coach has told them that thier golf swing is greatly improved and more balanced since wearing Posture Control Insole™. |
In the past we based everything on the podiatric model or the medical model where the patient’s rear foot was stabilized, the arch was fully supported. Using orthotics of this type worked all right for approximately 25% of our patients here in Florida, but many of our patients, especially those that were active, continued to present with the same myofacial postural deformations that we saw in earlier treatments. They would present with the same problems and plateau out.
Many of our patients liked them because they added comfort, but for somebody like me that treats postural problems, it wasn’t acceptable because those patients would still continue to come in with the same symptoms.
We’ve always used this methodology in determining whether a patient needed some sort of orthotic. We evaluate the patient, and if certain risk factors show up, fitting PCIs is quickly incorporated into the next visit. An intern examines the patient on the first visit but does not go into the actual measurements. She looks at the foot for Morton’s foot structure and evaluates for hyperpronation and other foot abnormalities and classifies them as risk factors. On the second visit I personally go over those risk factors and do the measurements. It only adds about five minutes to my time with the patient.
The person that fits the PCIs in the patient’s shoes is my back office chiropractic assistant, Kathy. She also takes patient histories on the first visit, and she takes the x-rays.
First off I tell them that their symptoms are arising from an overall whole body postural deformation rather than the old school “a blown out of place pinched nerve theory.” Many of the patients have had chronic ailments and pain for long periods of time. Once they understand our holistic approach and how their feet can change their posture, it’s easy to show them how, due to hyperpronation, a dropped foot leads to a twisting and alteration of posture all the way up to the neck.
I show them how and why I measured their foot and why it took a certain wedge height to bring the floor back up underneath their 1st metatarsal head to stabilize their foot. Then I show them how that in turn realigns their ankles, their knees and hips and how that also aligns the pelvis and how that in turn creates a better spinal symmetry all the way up to the neck and head.
The office staff really looks at the PCI program as a way for us to differentiate ourselves from other chiropractic offices by the fact that we take a holistic approach to the patient, starting at the feet. I see them being excited about telling our patients that the doctor will even be looking at your feet to determine why you still hurt. The PCI program has been a positive force in my office.
One of the main reasons is that it actually allows the body to be in a more neutral position so that any sort of treatment whether it be chiropractic, exercise, or other medical strategies will have optimal results.
I feel structurally secure. I feel balanced.
“Is that all.” So I tell then that the simplest things often hold the most promising results.
They first feel as if they are not falling forward, or not being pulled forward by gravity. Pelvic and hip pain is going away just from the postural shift, and they are surprised they don’t feel the insole under their big toe.
We’re in golf Mecca here, and I treat a lot of professional golfers. They tell me that their coaches have noticed that their spine angles have changed for the better and that has allowed them better balance throughout the golf swing. The majority, better than 80% of my patients are athletic and I get very positive reactions from active people.
I would estimate that close to 75% of our new patients has some sort of orthoses in their shoes. That may be related to the fact that we have a very active patient base that participates in various sport activities on both amateur and professional levels.
The only objection I hear here in Florida is that a lot of my patients want to wear thong sandals, and that is difficult, so I tell then that they have to get a different sandal. The ladies really give me the biggest looks when I take them away from their thong sandals.
I have not had any adverse reaction because I follow the criteria for selecting the patients for PCIs. A lot of patients have the initial reaction to changes I expect. Some of them initially get upper back pain, or areas of myofacial or muscular pain elsewhere, but they understand that may occur due to the fact that we are changing their posture.
Once they understand the methodology and the reasoning behind the PCIs they make good sense. They’re easier to implement. Patients like them better than the more burdensome orthotics. They can wear them with open toe sandals here in Florida, and they are cost effective.
I think 95%.
I tell them that I am placing them in a neutral posture. I explain that the treatment to follow will be more effective, that their exercise programs will be more expedient and that the whole shift from passive to active care can be implemented in a shorter time.
9 or 10.
I worked with Dr. Rothbart’s close-knit colleagues that used the same model 12 years ago, and I had this high right hip that stayed high regardless of what treatment was proposed or what exercises I did. The combination of a 10mm pair of insoles and two or three myofacial sessions, gave me balanced hips for the first time. When practical products became available, I was ready to use them.
We perform an initial postural examination so I’d have to say that anyone that shows hyperpronation or more specifically, anyone who shows a Morton’s foot structure will be evaluated for PCIs.
On the second visit a Report of Findings is given to the patient with regards to their evaluation, their diagnosis and what risk factors may preclude them from reaching a state of neutrality; or a state of feeling better and optimal health. If one of the risk factors was hyperpronation or Morton’s foot it would be suggested that this (PCIs) is what has to be done and they would go ahead and purchase them on the second visit.
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