Nolaro24, LLC Introduces the QUADRASTEP® E+ orthotic to its popular QUADRASTEP SYSTEM® Line
Nolaro24™, LLC, founded by Roberta Nole, CEO and Louis J. DeCaro, DPM, proudly introduce our 7th QUADRASTEP SYSTEM® orthotic, the E+, to our revolutionary QUADRASTEP SYSTEM® custom-to-foot-type prefabricated foot orthotics line. The QUADRASTEP SYSTEM® is a state of the art alternative to traditional custom orthotic management. A smash hit with physicians for over 10 years.
Many practitioners around the world already dispense the six original QUADRASTEP® orthotics effectively with great accuracy on about 80% of all patients. With the addition of our 7th orthotic (the E+), we believe practitioners will be able to effectively treat about 90% of all patients.
The QUADRASTEP® E+ orthotic offers more arch support, more forefoot equinus correction, and increased rearfoot posting over the existing E orthotic. The E+ orthotic will not replace the E orthotic, but will allow practitioners to treat virtually every variety of the highly common E QUAD foot-Type. The new E+ offers these alternative design features to more effectively treat the higher arched E’s!
The E QUAD foot-Type is one of the most common and unique looking feet, often with a reverse-lasted foot shape. This foot-type is the result of a combined Uncompensated Rearfoot Varus, coupled with a moderate to large Forefoot Varus. The E QUAD foot-type is one of the most destructive foot-types of all. The combined uncompensated rearfoot and forefoot varus deformities in this foot-type create a very rigid foot that is unable to provide the motions necessary to load the medial aspect of the foot during the stance phase of gait. The key note feature of this foot-type is by far the ballistic heel whip that is evident at heel rise. The larger the forefoot varus deformity the bigger the heel whip, the larger the toe sign, and the greater the chance of kicking themselves in the opposite leg. Our QUADRASTEP® E does a great job at controlling this foot but mostly for the lower arch variants. The QUADRASTEP® E+ will have all of the benefits of the QUADRASTEP® E, but with a more aggressive arch to control those feet with a higher arch.
In today’s practice, the “ideal” method of treating patients via custom orthoses is often time and cost prohibitive due to declining reimbursements. In contrast, off-the-shelf “arch supports”, although less expensive, usually lack adequate biomechanical support. The QUADRASTEP SYSTEM® bridges the gap between custom and non-custom orthoses.
Unlike other off-the-shelf orthotic systems that offer only a “one-shape-fits-all” arch support, the QUADRASTEP SYSTEM® offers 7 Quad specific functional orthoses in two widths, each biomechanically tailored to that of a true custom prescription.
Dr. Louis DeCaro at the 2017 Western Massachusetts annual Down Syndrome Buddy walk
On September 30th, 2017 the DeCaro Total Footcare Center joined up with the American College of Pediatric Foot & Ankle Specialists to sponsor the 2017 Western Massachusetts annual Down Syndrome Buddy walk. Over 800 attended the walk. ACFAP President Dr. Louis DeCaro was present to screen the participants for biomechanical issues associated with Down syndrome. “The combination of ligamentous laxity and low muscle tone in a majority of those diagnosed with Down syndrome contribute to a lifetime of orthopedic problems. Screening the feet as early as possible is imperative for successful prevention of these issues, “ said DeCaro. The Buddy Walk was established in 1995 by the national Down syndrome society to celebrate Down syndrome awareness month in October and to promote acceptance and inclusion of people with Down syndrome.
The Down Syndrome Patient
In a patient diagnosed with Down syndrome, there are a multitude of concerns which may be present involving the heart, digestive system, spine, eyes, intellect, joints and mobility. Individuals with Down syndrome typically have problems with collagen, which is the major protein that makes up ligaments, tendons, cartilage, bone, and the support structure of the skin. This creates significant laxity from the feet up, thus beginning at a young age the lifelong destruction of the kinetic chain. “Almost all of the conditions that affect the bones and joints of people with Down syndrome arise from the abnormal collagen found in Down syndrome.” The resulting effect in 88% of the Down syndrome population is hypotonia, with ligamentous laxity and/or hyper-mobility of the joints. The combination of this ligamentous laxity and low muscle tone contribute to orthopedic problems in people with Down syndrome.
Within the feet, the most common foot problems which can be found in the Down syndrome patient are “digital deformities, hallux abductovalgus, pes plano valgus, metatarsus primus adductus, hyper mobile 1st ray, brachymetatarsia, Haglunds’ deformity, syndactaly and Tailors bunion.” Genu valgus and subluxation and/or dislocation of the patella are another concern due to this condition. Hip and spinal issues are often seen as well.
Overall laxity of the feet has been reported in 88% of children with Down syndrome. This percentage is far higher than in those without, yet often their feet are ignored. The primary medical diagnosis seems to trump the importance of good foot health. They should not. All medical issues should be addressed.
Specifically the Feet
Typical foot type in those with Down syndrome: The D foot type (neutral forefoot with compensated rearfoot)
Many patients with Down syndrome have flat feet due to this laxity, which will not cure itself. We need to screen for this early. This troubling flexible flat foot can be spotted at a very young age. Unlike with many children though, this flat presentation does not go away by the age of three but continues, causing foundational destruction to the rest of the body as the years go on. Your young Down syndrome patients have an inability of the heel bone to come out of eversion. When that happens, the arch, the ankle, and inevitably the rest of the body stay flat and become “dragged down” toward the midline. This causes many kids with DS to have trouble sustaining good strength when they stand and building good core musculature.
Typical foot type in those with Down syndrome: The F foot type (rigid forefoot varus with compensated rearfoot
This “collapse” will impair normal external rotation of some long bones of the body, which leads to multiple postural changes. When physical therapy is called upon to strengthen the child, failure or delay of achieving a strong kinetic chain is inevitable. You can’t build on a poor foundation! Not only will the structure not support it, but due to poor foot alignment, the muscles during the exercises may not even fire.
