Abstract:
An adjustable dynamic, removable, mechanical foot leverage orthotic system is disclosed having a plate member positioned on top of one or more fulcrum member that are placed inside of a shoe. The plate is free to move within the shoe about the fulcrum to provide the wearer with mechanical improvement of abnormal, functional and associated foot pathology and can directly and indirectly effect the entire gait cycle. The foot leverage system can be integrated into the shoe design or can be inserted within a conventional shoe to create a foot leverage system. Methods of use and treatment are disclosed for the treatment of pes planus, pes cavus and tendonitis. The foot leverage system may also be used with the disclosed foot mapping system and method.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     This application is a continuation-in-part of application Ser. No. 09/266,911, filed on Mar. 12, 1999 now abandoned, that is a continuation-in-part of application Ser. No. 08/879,658, filed on Jun. 20, 1997, now U.S. Pat. No. 5,921,009, issued Jul. 13, 1999. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates to the field of orthotic devices. More specifically, the present invention relates to a self-adjustable, or easily modified functional orthotic device and method of using the orthotic device. 
     BACKGROUND OF THE INVENTION 
     Orthotic inserts have been used for many years in an effort to correct the alignment and functional pathology of the human foot. U.S. Pat. No. 454,342 shows one of the earliest orthotic inserts used for the supportive, static, correction of a flat foot deformity. Such an insert is generally known as an “arch support.” 
     More recent orthotic inserts allow for the variable placement of static components. For example, in U.S. Pat. No. 4,800,657, the insert provides adjustment plugs to “fine tune” the supportive contour of the insert. Another recent example is U.S. Pat. No. 4,841,648 which shows a supportive insole that can be modified by the user. The insole consists of different attachable insole pieces which vary in size, shape and density. 
     Although modern insert design, which is generally supportive in structure, can be indirectly effective in treating lower extremity functional pathology, they also can and often do fail to achieve a noticeable functional improvement. Ideally, a foot orthosis should be functional, supportive and comfortable. A foot orthosis should also be self-adjustable or easily modified to account for the variable lower extremity mechanical factors. The orthosis should treat the leg, ankle and foot as a system complex functioning through the total gait cycle. The foot orthosis should not be limited to the treatment of positional static biomechanical microcosms of the lower extremities. For example, static orthotic inserts, having a depression or a support, are commonly used to accommodate a callus. A callus however, should usually be treated dynamically because a callus is predominantly a functional foot problem. Unfortunately, the knowledge currently available does not include a direct treatment method to accomplish the results that the instant invention provides. 
     Sophisticated clinical examination techniques and, in some cases, computer monitored “pressure data” studies are used to establish a biomechanical basis and to confirm the effectiveness of the prescribed treatment using shoe inserts. Yet, in many instances, the supportive orthotic treatment prescribed does not correct the patient&#39;s foot disorder. It is not unusual for a foot specialist to make an illogical, if not questionable adjustment to an insert, based upon current treatment options and knowledge, and find that the adjustment corrected the symptomatic condition. This is because treatment knowledge has overlooked direct functional application of the orthosis, which is sometimes serendipitously achieved. 
     Because most patients can actually feel the normal neurological responses of the foot and lower extremities, they can often know when their body is more or less working properly as a result of their symptomatic conditions. Moreover, even when there is initial discomfort caused by an orthosis, the patient can often correctly predict future tolerance of the orthosis and improvement of the symptomatic condition. Although the foot specialist uses objective factors to correct foot disorders, he or she also uses subjective factors in evaluating the patients comfort with the prescribed orthosis. Therefore, the patient&#39;s subjective perspective can often be as important to correct treatment as the foot specialist&#39;s objective perspective. 
     Ideally, the objective of orthopedic foot treatment is to improve functional alignment and symptomology of the foot and lower extremities through as much of the gait cycle as possible. Generally speaking, even regarding mild foot pathology, an appropriate surgery is more likely to achieve the long-term goal of treatment in comparison with the use of a contemporary foot orthosis. The reason for the higher success rate of surgery is at least in part, because surgery can provide a more permanent functional alignment and symptomatic improvement. In addition, the combination of wear changing characteristics of a shoe and a conventional supportive orthotic insert which flattens with use, can be unpredictable. Another reason is because there is no conveniently effective positive adjustment mechanism for the inevitable deteriorating change of the shoe or insert. 
     Because of the expense, discomfort and potential risks associated with surgery, orthotic treatment devices are widely used to improve symptomatic conditions of the foot and lower extremities. Even with our most advanced analytical techniques however, we have only a basic idea of how each individual biomechanical system works as an efficient unit. This is especially true with respect to the foot and lower extremities. We know that we can alter the walking surface by using a shoe insert. The change in a walking surface creates a biomechanical system reaction extending from the foot proximally to the axial skeleton. In time, changing the position of the foot&#39;s anatomical alignment by supporting it with an insert can modify system function with the possibility of influencing the biomechanical activity through the total gait cycle. Nevertheless, current insert adjustments, even when effective, almost universally are considered by patients and doctors to be inconvenient, time consuming and costly. The result can be that the patient who needs to be treated will avoid seeing a foot specialist for as long as possible. This delay can cause the condition of the patient to deteriorate further. 
     What is needed is a shoe insert design and method of treatment that will allow the wearer to experience direct and immediate functional benefit and to make simple adjustments for improved function. Improved function should result in improved anatomical alignment. The patient should be able to take an active responsibility in the empirical treatment of themselves, with respect to varying circumstances. The device should allow a dynamic interaction between the wearer, the shoe and the insert to place the patient in more effective control of his or her treatment plan. Further, the orthosis should be adaptable to many types of conventional foot orthoses to enhance their capability to improve function and comfort to the wearer. 
     SUMMARY AND OBJECTS OF THE INVENTION 
     This invention relates to a new dynamic, removable, mechanical foot orthosis and shoe insole leverage system that is comprised of a plate overlaying a fulcrum upon which the plate functionally “see saws.” The foot leverage system can be used together with conventional shoes by inserting the fulcrum and foot plate within the conventional shoe. The foot leverage system is a functional mechanism that can move the foot from one position to another without direct assistance from extrinsic or intrinsic muscle activity. Instead, it utilizes the naturally occurring displacement of the center of body pressure to create torque variations around the fulcrum which creates a resultant rotation of the plate and the foot about the fulcrum. 
     The rate of rotation of the inventive plate about the fulcrum can be changed by: 
     1. changing the rigidity of the plate; 
     2. adding or removing variable density materials or compressible spring-like materials on either side of the fulcrum; 
     3. modifying the modulus of elasticity of a hinge type fulcrum member that is positioned between the plate and the inner sole; or 
     4. modifying the dimensions, position and design of the inventive fulcrum. 
     The initiation of rotation in the stance phase as well as the direction or angle of movement of the foot-supporting plate, relative to the shoe, can be altered by changing the shape of the fulcrum in height, width, radius of curvature, length or position beneath the inventive plate. 
     In a preferred embodiment of the present invention, a uniform fulcrum is removably attached to the shoe sole or to the plate. The plate is positioned on the top of the fulcrum and typically extends from the heel to the forefoot area. In another preferred embodiment, the fulcrum has an I-shaped cross section and has resilient, flexible material at the relatively narrow center section. In another preferred embodiment, the fulcrum varies in width, height and radius of curvature along its length. Another preferred embodiment includes resilient material, of desirable density, between the shoe sole and the inventive plate, in front and back of the inventive fulcrum. The resilient material is generally less dense than the density of the fulcrum material. The resilient material in front of the fulcrum is nearly always less dense than the density of the fulcrum to allow for the forward rotation of the plate and the wearer&#39;s foot. The density of the resilient material in front of the fulcrum can also be different than the density of the resilient material behind the fulcrum to allow for a different rate of rotation to the rear than to the front of the fulcrum. 
     In another preferred embodiment, the fulcrum is formed with a step-shaped ledge either on the inventive plate or integral with a shoe sole insert. Resilient material of desirable density, generally less than density of the fulcrum, may be positioned in the gap between the inventive plate and the top of the inner shoe sole or welt. The fulcrum member may also be configured to include multiple segmented units to create a rotatable fulcrum axis. 
     In another preferred embodiment, the inventive plate is molded to the identical or approximate shape of the user&#39;s foot. 
     The invention also describes a method for changing the force curve manifestation of the foot. The force curve, which is an indicator of function, can be changed by adjusting the inventive plate and fulcrum to arrest the abnormal force-related symptomatic conditions of the foot. An object of the present invention is to create a significant functional displacement of the force curve, either medially or laterally, from a pathologic path of progression to one that is more biomechanically and symptomatically desirable. As will be explained in more detail herein, this is achieved by creating torque variations around an artificial functional axis with the facility of simple positional reorientation. The positional reorientation is capable of directly or indirectly affecting the function of all of the periods of the gait cycle. 
     The invention also describes a method for treating different foot pathologies including: pes planus (excessively pronated low arched foot), pes cavus (excessively supinated high arched foot) and achilles tendonitis. By treating pes planus, the inventive method can prevent, reduce or eliminate many of the pathologic excessive pronatory sequelae such as: bunions, neuromas, hammertoes, hallux limitus, forefoot supinatus, plantar calluses, plantar fasciitis, cuboid syndrome, heel spur syndrome, tibialis posterior tendonitis, shin splints, medial knee retinaculitis and chondromalacia patella. By treating pes cavus, the inventive method can increase the stability of the lower extremities and improve the positional relationships of the foot structure to the leg. By treating achilles tendonitis, the inventive method can reduce stress and decrease or eliminate inflammation of the achilles tendon. 
     The invention also describes a mapping feature that directs the treating practitioner or the wearer to adjust the orthosis according to the symptomatic condition of the foot. 
     Another object of the present invention is to align more properly the foot and lower extremities which results from more efficient movement throughout the entire gait cycle. During the contact period, a plate in combination with a fulcrum of variable width and height supports the calcaneus posteriorly. During the midstance period, force displacement in the foot creates a shift of torque across the fulcrum which causes a rotation of the plate and produce appropriate associated motion and positional change in the foot and leg. During the propulsive period, the alignment and function of the foot and leg are improved relative to prior orthotic treatment systems and this alignment can carry into the swing phase. 
     Another object of the invention is to create a significant displacement of the force curve, either medially or laterally, from a pathological path of progression to one that is associated with less symptomology and that is more desirable. This is achieved with the present invention by creating torque variations about an artificial functional axis with the facility of simple positional reorientation of the fulcrum. The torque variations are capable of directly or indirectly affecting all periods of the gait cycle. An interplay of ground reactive force, plate reactive force and center of body pressure results in motion around the axis of the fulcrum. Sagittal, transverse and frontal plane motions of the inventive plate are directly influenced by fulcrum axis placement and shape which results in the simultaneous pronation or supination of the supported foot to variable degrees and within the variable time frame of the total gait cycle. 
     The present invention offers advantages over existing orthotic devices in that the instant orthotic device can: 
     1. directly generate mechanical foot function, primarily during midstance, which can be corrective and beneficial; 
     2. directly or indirectly affect the function of all periods of the gait cycle; 
     3. accommodate the wearer&#39;s needs as circumstances change by performing a simple adjustment; 
     4. be used to facilitate an existing shoe insert; 
     5. be worn by itself; and 
     6. be adjusted to fit with different shoe types that would otherwise not accept a standard type of insert. 
     The present invention changes the midstance function and position of the foot. The midstance period, during walking is the only complete time frame segment that a single foot supports the entire body weight. As such, midstance foot function has a significant impact upon the remainder of the gait cycle lower extremity function. By changing the midstance function and position of the foot, the rest of the gait cycle, including the swing cycle, can be indirectly effected. 
     Another advantage of the present invention is its facility to assist the venous pump mechanism of the lower extremity. Ankle swelling and related circulatory conditions associated with venous stasis can be improved by the repetitive movement of the inventive orthotic device and the associated change of foot function. 
     Another advantage of the present inventive orthotic system is that the orthotic can be adjusted by the wearer to modify the shoe wear pattern. The resulting adjustment can reestablish foot balance in the worn shoe and redirect foot mechanics for more evenly worn shoes to enhance the shoe life and improve comfort. 
     Another advantage of the present inventive orthotic system is that the orthotic can be adjusted by the wearer to accommodate different physical or sport activities that are dependant upon efficient and specific lower extremity biomechanical function. For example, a golfer&#39;s swing may be improved by modifying the golfer&#39;s push-off shoe insert to provide better foot propulsion and an improved drive swing. The same individual may have a different propulsive requirement during a running activity and a simple adjustment to the fulcrum position can provide the desired change in function. 
     Pedobarographs are provided which illustrate the dramatic change in center of pressure curves (force curves) when the inventive device is used by a patient who has objective findings of excessive pronation. When using the inventive device, the center of pressure curves change from an undesirable pronated walking center of pressure distribution to a more desirable, and more normal walking center of pressure distribution. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIG. 1A is a top view of the inner side of the shoe sole with the fulcrum attached thereto. 
     FIG. 1B is a side view of the inventive plate with the fulcrum attached to the top of the inner shoe sole and positioned between the plate and the top of the shoe sole. 
     FIG. 1C is a bottom view (plantar-dorsal) of the inventive plate with the fulcrum attached thereto. 
     FIG. 1D is a side view of the inventive plate with the fulcrum attached to the plate and positioned between plate and the top of the shoe sole. 
     FIG. 1E is a sectional view of one embodiment of the present inventive fulcrum. 
     FIG. 1F is a sectional view of another embodiment of the present inventive fulcrum. 
     FIG. 2A is a perspective view of the uniform fulcrum. 
     FIG. 2B is a perspective view of the first variable fulcrum. 
     FIG. 2C is a perspective view of the second variable fulcrum. 
     FIG. 3A is a side view of one embodiment of the inventive plate with one embodiment of the fulcrum and with variable density material between the plate and the shoe sole. 
     FIG. 3B is a top view of the embodiment shown in FIG.  3 A. 
     FIG. 4A is a side view of an embodiment of the present invention having a step-like fulcrum plate. 
     FIG. 4B is a top view of the embodiment shown in FIG.  4 A. 
     FIG. 4C is a side view of an embodiment of the present invention having a step-like fulcrum shoe sole. 
     FIG. 4D is a top view of the embodiment shown in FIG.  4 C. 
     FIG. 4E is a side view of the embodiment shown in FIG. 4C including a fulcrum modifier of, adjustable, variable density material beneath the plate. 
     FIG. 4F is a top view of the embodiment shown in FIG.  4 E. 
     FIG. 5A is a plantar-dorsal view of a left foot plate showing a force curve of a supported foot when the foot is excessively pronated without the inventive fulcrum. 
     FIG. 5B is a plantar-dorsal view of a left foot plate showing an improved force curve of the foot when the plantar-attached inventive fulcrum and plate are being used. 
     FIG. 5C is a plantar-dorsal view of a left foot plate showing the best, improved force curve of the foot when the inventive fulcrum and plate are being used and when the position of the plantar-attached fulcrum has been adjusted. 
     FIG. 6A is a bottom view (plantar-dorsal) of the left foot position relative to one embodiment of the inventive plate and fulcrum. 
     FIG. 6B is a right side view of the left foot position relative to one embodiment of the inventive plate and fulcrum. 
     FIG. 6C is a left side view of the left foot position relative to one embodiment of the inventive plate and fulcrum. 
     FIG. 6D is a bottom view (plantar-dorsal) of the right foot position relative to a contoured embodiment of the present inventive plate and fulcrum. 
     FIG. 6E is a side view of the right foot position relative to a contoured embodiment of the present inventive plate and fulcrum. 
     FIG. 7A is a top view (dorso-plantar) of a contoured plate showing a force curve when a right foot on the plate is excessively supinated without the inventive fulcrum. 
     FIG. 7B is a dorso-plantar view of a contoured plate showing an improved force curve of the right foot with the plantar-attached inventive fulcrum in position. 
     FIG. 8A is a side view of a foot in a contoured embodiment of the inventive plate and fulcrum with the heel and ball of the foot in the rearward position. 
     FIG. 8B is a side view of a foot in a contoured embodiment of the inventive plate and fulcrum with the calcaneus and midtarsal joints of the foot in the forward rotated position. 
     FIG. 9A is a bottom view of a plate for the right foot and a fastening surface for fulcrum placement without an attached fulcrum. 
     FIG. 9B is the reference positional map showing an illustration of the bottom view of the left foot plate and directing fulcrum placement on the inventive plate relative to specific symptomatic conditions. 
     FIG. 9C is a bottom view of the inventive plate for the left foot showing a fastening surface for fulcrum placement and a fulcrum in the appropriate position to treat a low arch foot. 
     FIG. 10A is a top view of the inner side of the shoe sole with variable fulcrum elements attached thereto. 
     FIG. 10B is a side view of the inventive plate with variable fulcrum elements attached to the top of the inner shoe sole and positioned between the plate and the top of the shoe sole. 
     FIG. 10C is a bottom view (plantar-dorsal) of the inventive plate with the variable fulcrum elements attached thereto. 
     FIG. 10D is a side view of the inventive plate with the variable fulcrum elements attached to the plate and positioned between the plate and the top of the shoe sole. 
     FIG. 11 is a bottom view (plantar-dorsal) of the inventive plate with multiple fulcrums attached thereto. 
     FIG. 12A is a pedobarograph showing the pressure distribution of a barefoot patient who has marked pronation during walking. 
     FIG. 12B is a pedobarograph showing the pressure distribution of a patient with shoes on who has marked pronation during walking without using the inventive device. 
     FIG. 12C is a pedobarograph showing the pressure distribution of a patient wearing shoes who is using the inventive device and has a more normal walking center of pressure distribution. 
    
    
     DETAILED DESCRIPTION 
     The following table lists the part numbers and part descriptions as used herein and in the drawings attached hereto: 
     
       
         
               
               
               
             
           
               
                   
                   
               
               
                   
                 Part No: 
                 Description: 
               
               
                   
                   
               
             
             
               
                   
                 12 
                 Inner Shoe Sole 
               
               
                   
                 14 
                 Left Foot Plate 
               
               
                   
                 15 
                 Right Foot Plate 
               
               
                   
                 16 
                 Uniform Fulcrum 
               
               
                   
                 18 
                 Flat Side of Fulcrum 
               
               
                   
                 19 
                 Arcuate Side of Fulcrum 
               
               
                   
                 20 
                 Flexible Hinge 
               
               
                   
                 22 
                 Narrow Section of Flexible Hinge 
               
               
                   
                 23 
                 Pin Fulcrum 
               
               
                   
                 24 
                 First Variable Fulcrum 
               
               
                   
                 25 
                 Fulcrum Seat 
               
               
                   
                 26 
                 Second Variable Fulcrum 
               
               
                   
                 28 
                 Forward Cushioning Material 
               
               
                   
                 30 
                 Rearward Cushioning Material 
               
               
                   
                 32 
                 Stepped Plate Fulcrum 
               
               
                   
                 34 
                 Ledge 
               
               
                   
                 35 
                 Inner Step 
               
               
                   
                 36 
                 Lower Step 
               
               
                   
                 38 
                 Stepped Sole Fulcrum 
               
               
                   
                 40 
                 Pivot Ledge 
               
               
                   
                 42 
                 Variable Pivot Ledge Modifier 
               
               
                   
                 42a 
                 Secondary Axis of Rotation 
               
               
                   
                 42b 
                 Forward Surface of Variable Pivot Ledge Modifier 
               
               
                   
                 44 
                 Force Curve 
               
               
                   
                 46 
                 Contoured Insole Plate 
               
               
                   
                 48 
                 Metatarsal Heads 
               
               
                   
                 50 
                 Medial Side of Foot 
               
               
                   
                 52 
                 Lateral Side of Foot 
               
               
                   
                 54 
                 Heel Lift 
               
               
                   
                 58 
                 Right Plate - Front Region 
               
               
                   
                 60 
                 Right Plate - High Arch Line 
               
               
                   
                 62 
                 Right Plate - Low Arch Line 
               
               
                   
                 64 
                 Right Plate - Achilles Tendonitis Line 
               
               
                   
                 72 
                 Left Plate - Low Arch Region 
               
               
                   
                 74 
                 Left Plate - Low Arch Line 
               
               
                   
                 76 
                 Left Plate - Front Region 
               
               
                   
                 78 
                 Left Plate - High Arch Line 
               
               
                   
                 80 
                 Left Plate - High Arch Region 
               
               
                   
                 82 
                 Achilles Tendonitis Region 
               
               
                   
                 84 
                 Left Plate - Achilles Tendonitis Line 
               
               
                   
                 85 
                 First Variable Fulcrum Element 
               
               
                   
                 86 
                 Second Variable Fulcrum Element 
               
               
                   
                 87a 
                 Center of Pressure for Left Foot on Pedobarograph 
               
               
                   
                 87b 
                 Center of Pressure for Right Foot on Pedobarograph 
               
               
                   
                   
               
             
          
         
       
     
     In FIG. 1A the top of the inner shoe sole  12  is illustrated with the uniform fulcrum  16  attached thereto. The uniform fulcrum  16  has a flat side  18  and a curved side  19  as shown in FIG.  2 A. Fulcrum  16  is attached to the top of the inner shoe sole  12  with a hook and loop faster material such as Velcro™ or other affixing means. FIG. 1B shows a side view of the left foot plate  14  positioned on top of the inner shoe sole  12  with the uniform fulcrum  16  sandwiched between the shoe sole  12  and the left foot plate  14 . The uniform fulcrum  16  can be attached to the bottom of the inner shoe sole  12  as shown in FIGS. 1A and 1B or to the bottom of the left foot plate  14  as shown in FIGS. 1C and 1D. 
     It should be understood that the fulcrum members described herein, including fulcrum variations, fulcrum elements and pivot ledge modifiers, can be of variable constructions including but not limited to: solid, porous, strutted, braced, arched, laminated and bladder-type structures. Furthermore, it is contemplated that various geometric shapes can be used which structurally define an axis of rotation around which a plate can rotate. Illustrative examples of fulcrum compositions include but are not limited to: 
     i. natural substances such as leather, wood, rubber and metal; 
     ii. thermosetts and thermoplastic synthetic materials such as polymers of monomers (e.g. polyethylene and polypropylene) or composites of different monomers (e.g. acrylonitrile, butadiene and styrene); 
     iii. composite synthetic materials such as fiber and/or particle (e.g. carbon, fiberglass, aramids and polyethylene), reinforced polymer matrix resin (e.g. polycarbonate, acrylics, epoxies, polyesters, polyolifins); and 
     iv. hollow bladder-type construction with an encapsulating sheet of synthetic material surrounding a filler of gas, liquid (e.g. silicone) or particles, which may be sealed or pressure adjusted with a valve mechanism. 
     The left foot plate  14  rotates forward and backward about the uniform fulcrum  16 . The left foot plate  14  is typically made of a solid semi-rigid polypropylene material or a rigid graphite composite material. It is contemplated that the left foot plate  14  may also be constructed of a material similar to polypropylene or other similar thermoplastic material. A more rigid plate material such as one constructed of graphite or fiberglass composite material may also be used. 
     Although the left foot plate  14  is shown and described variously throughout this specification, the description applies equally to the right foot plate  15 . The rigidity of the material is determined by the desired conditional response to the inventive foot leverage system. For example, if the wearer exhibits plantar fasciitis or is playing tennis, a less rigid foot plate  14 ,  15  may be appropriate whereas if the wearer exhibits cuboid syndrome or is running long distances, a more rigid foot plate  14 ,  15  may be appropriate. 
     The fulcrum may also be shaped with a tapered surface depending upon the desired functional characteristics between the foot plate  14 ,  15  and the fulcrum  16 ,  24 ,  26 . FIGS. 2B and 2C show two (2) possible variations in the taper of the fulcrum. Each of the fulcrums  16 ,  24 ,  26  includes a flat surface  18  for attaching a hook and loop fastener and a curved surface  19 . As the foot plate  14 ,  16  moves forward and backward, it rotates about the curved surface  19 . 
     An alternative flexible hinge  20  may also be used in place of a fulcrum (see FIG.  1 E). The flexible hinge  20  allows the inventive plate  14 ,  15  to rotate dynamically in a forward and rearward direction. The flexible hinge  20  is approximately I-shaped and has a flexible, narrow section  22  at the center of the I-shape. The flexible hinge is removably attached to the inner shoe sole  12  on one side and to the foot plate  14 ,  15  on the other. The flexible hinge  20  allows the foot plate  14 ,  15  to rotate forward and backward as the narrow section  22  flexes. 
     The fulcrum may also be constructed as a pin fulcrum  23  in combination with a fulcrum seat  25  as illustrated in FIG.  1 F. The pin fulcrum  23  is removably attached at its upper face to the lower surface of the foot plate  14 ,  15 . The fulcrum seat  25  is removably attached at its bottom surface to the inner shoe sole  12 . The orientation of the pin fulcrum  23  and fulcrum seat  25  may also be reversed wherein the flat surface of the fulcrum seat  25  is removably attached to the bottom of the foot plate  14 ,  15  and the flat side of the pin fulcrum is attached to the inner shoe sole  12 . The pin fulcrum  23  and fulcrum seat  25  combination allows the foot plate  14 ,  15  to rotate forward and backward as the convex surface of the pin fulcrum  23  rotates within the concave surface of the fulcrum seat  25 . 
     It is also contemplated that the fulcrum seat  25  may be suspended from the bottom of the foot plate  14 ,  15  by hook and loop fastener material or other desired material whereby the pin fulcrum  23  and the fulcrum seat  25  cooperate together with the foot plate  14 ,  15  relative to the shoe sole  12 . 
     The fulcrum members described herein may be oriented in a range substantially aligned in the horizontal plane in an oblique orientation range between the longitudinal and frontal axis of the foot. In a preferred embodiment the fulcrum is oriented in a range of between five degrees to eighty-five degrees from the longitudinal foot axis, but it is contemplated that the orientation may vary from less than five to more than eighty-five degrees. 
     Other variations in the configuration of the inventive fulcrum and plate are contemplated. For example, either the uniform fulcrum  16  or variable fulcrums  24 ,  26 , or fulcrum elements  85 , 86  may be used in combination with a fulcrum seat  25  as illustrated in FIG.  1 F. The fulcrum seat  25  is normally attached to the inner sole of the shoe while the curved portion of the fulcrum  16 ,  24 ,  26  engages the upper, arcuate surface of the fulcrum seat. 
     FIG. 3A shows an embodiment similar to the embodiment shown in FIGS. 1A and 1B. In FIG. 3A a cushioning material  30  is positioned behind the uniform fulcrum  16 , between the bottom of the left foot plate  14  and the top of the inner shoe sole  12 . Cushioning material  28  is positioned in front of the uniform fulcrum  16 , between the bottom of the left foot plate  14  and the top of the inner shoe sole  12 . The density and resiliency of the cushioning materials  28 ,  30  can be varied according to the needs of the wearer. If desired, the properties of each cushioning material  28 ,  30  can be different. For example, it may be desirable to have less density in the rearmost cushioning material  30  and more density in the forward-most cushioning material  28  or visa-versa. Generally, the density of the forward-most cushioning material  28  is less than the density of the fulcrum thereby allowing for the forward rotation of the inventive plate and foot. 
     Another preferred embodiment is shown in FIGS. 4A,  4 B,  4 C,  4 D,  4 E and  4 F. In FIG. 4A a stepped plate fulcrum  32  is positioned on top of the inner shoe sole  12 . The stepped plate fulcrum  32  is free to rotate forward about the ledge  34  and rearward to the position illustrated. The angle of the ledge  34  can be changed according to the desired functional reaction between the stepped plate fulcrum  32  and the inner shoe sole  12 . FIG. 4C shows a modification of the ledge fulcrum feature wherein the fulcrum is created by forming a ledge  40  on a stepped shoe sole  38 . The left foot plate  14  is free to rotate forward about the ledge  40  and rearward to the position illustrated. The angle of the ledge  40  can also be changed according to the desired functional reaction between the stepped shoe sole  38  and the inner shoe sole  12 . A variable pivot ledge modifier  42  that is constructed of material of a desired density can be positioned in front of either ledge  34  or  40 , between the stepped plate  35  and the sole  12  or between the left foot plate  14  and the stepped sole  38 , respectively. FIG. 4F shows the variable pivot ledge modifier  42  positioned in front of the ledge  40 , between the left foot plate  14  and the lower step portion of the stepped shoe sole  38 . The variable pivot ledge modifier could also be placed in front of the step  34 , below the inner step  35  and on top of the shoe sole  12 . The density and resiliency of the variable pivot ledge modifier  42  can be changed to create the desired functional relationship between the stepped plate fulcrum  32  and the shoe sole  12  or between the stepped sole fulcrum  38  and the left foot plate  14 . Typically, the forward surface  42   b  and the top of the variable pivot ledge modifier  42  about the secondary axis of rotation  42   a  is flat. 
     The variable pivot ledge modifier  42  provides a secondary axis of rotation  42   a  which can also be applied in front of any of the fulcrum applications described herein. 
     A secondary axis of rotation may also be created by including multiple fulcrum elements as illustrated in FIG.  11 . Although fulcrum elements  16  and  24  are shown in FIG. 11, it is contemplated that any of the fulcrum elements described herein may be used in combination. Yet further, it is contemplated that more than two fulcrum elements may be used in combination to create the desired positional and functional relationship between the fulcrum members and the foot plate. 
     The inventive concept establishes a prescribed rotational effect around an axis of rotation. This concept may be further understood to include a functional fulcrum, comprising multiple variable, structural fulcrum elements ( 85 , 86 ) when combined in alignment as illustrated in FIGS. 10A,  10 B,  10 C,  10 D. The combined effect of separate fulcrum elements creates a rotational axis around which the effected plate rotates, precisely as if it was a single fulcrum, as previously described herein. 
     In FIGS. 5A,  5 B and  5 C the plantar-dorsal view (from the bottom looking up) of the left foot plate  14  is shown. The force curve of a foot  44  is shown along the medial line of the inventive plate. The force curve  44  represents the path in which body weight is transmitted through the foot during the stance phase of the walking gait cycle on the left foot plate  14 . As previously indicated, an important objective of the present invention is to create a significant displacement of the force curve  44 , either medially or laterally, from a pathological path of progression to one that is more desirable. This is achieved by creating torque variations around the artificial functional axis created by the left foot plate  14  or right foot plate  15  and fulcrum  16  system. The axis of rotation about the fulcrum  16  is applied externally to the plantar aspect of the plate  14 ,  15  relative to the foot. An interplay of ground reactive force, plate reactive force and center of body pressure results in motion about the axis. Sagittal, transverse and frontal plane motions are influenced by axis placement and shape resulting in a simultaneous pronation or supination to variable degrees within the variable time frame of the total gait cycle. In FIG. 5B, the improvement in the alignment of the force curve  44  from the medial side  50  toward the lateral side  52  of the foot is shown as a result of incorporating the uniform fulcrum  16  (shown in its relative position) beneath the foot plate  14 ,  15 . If the position of the uniform fulcrum  16  is adjusted for the specific functional pathology of the wearer&#39;s foot, the force curve  44  can be further improved as illustrated in FIG.  5 C. Force curve realignment can result in relief of areas of excessive focal plantar foot pressure which can cause dermatologic lesions such as blistering, calluses and ulceration. 
     FIGS. 6A,  6 B and  6 C illustrate the desired position of the left flat plate  14  position relative to a left foot. The distal end of the left foot plate  14  extends to the area of the metatarsal heads  48 . This allows the foot leverage system to support properly the entire weight of the body while allowing the wearer to exert pressure directly on the shoe insole with his or her digits during the propulsion stage of the gait cycle. 
     The forward edge of the left foot plate  14  or right foot plate  15  or other foot plates described herein typically extend transversely across the forefoot in an orientation which may range from an alignment totally proximate to the metatarsal heads to an alignment which is totally distal to the metatarsal heads. It is envisioned that variations of the forward edge of foot plate  14 , 15  can include embodiments whereby a portion of the foot plate can extend directly beneath or distal to one or more metatarsal heads while the remaining portion of the forward edge of the foot plate  14 , 15  extends proximal to the remaining metatarsal heads. 
     When a conventional technique is applied to a preferred embodiment shown in FIG. 6A, the forward edge portion of the foot plate  14  extends to a position beneath the first metatarsal head, while the remaining portion of the forward edge portion extends beneath or proximal to the fourth and fifth metatarsal heads. The left foot plate  14  can also be exchanged in the shoe according to a conventional technique with the opposite paired foot plate  15  and applied to the right foot whereby direct functional support of the right fourth and fifth metatarsal heads is more beneficial to comfort and function. Such an exchange of opposite paired foot plates may be appropriate when the right first metatarsal head does not require direct functional support from the forward edge of the foot plate  14  relative to the foot plate rotation about the fulcrum  16 . 
     The invention may also use a conventional contoured plate  46  as shown in FIGS. 6D and 6E. The contoured plate  46  may be molded to a generic shape to approximate the size of the wearer&#39;s foot or may be custom molded for maximum comfort. The distal end of the contoured plate  46  may extend to a point proximal to the metatarsal heads  48 , but may also extend to a position beyond the toes with a flexible insert extension. A cushioned, resilient material may also be placed about the top of the contoured plate  46 . The cushioned, resilient material may also be used together with the other inventive embodiments described herein. 
     In FIGS. 7A and 7B the result of using the present inventive foot leverage system on the force curve  44  is illustrated and is representative of a person who has a high arch. A person who has a high arch has a propensity to experience inversion ankle sprains for which this invention is intended to prevent, reduce, or correct. In FIG. 7A, the center of force curve  44  of a supinated right foot on the contoured plate  46  is shown. In FIG.  7 B, the effect of the use of the contoured plate  46  with the plantar inventive uniform fulcrum  16  is shown. It should be understood that when desirable, either of the variable fulcrums  24 ,  26  may be substituted for the uniform fulcrum  16 . The interaction between the contoured plate  46  and the uniform fulcrum  16  creates a desirable net pronatory torque around the uniform fulcrum  16  during the midstance period. The resulting force curve  44  illustrates the change in the pressure caused by the wearer&#39;s body weight upon the contoured plate  46 . The change in pressure illustrated in the force curve  44  helps to reduce the tendency for late mid-stance and propulsive period inversion ankle sprains, lateral shoe wear and fifth metatarsal head callus by leveraging the weight medially. 
     FIGS. 8A and 8B present a side view of the left foot with a cutaway view of the shoe to show clearly the position of the foot relative to the contoured plate  46  as it rotates about the uniform fulcrum  16  relative to the inner sole  12  of the shoe. As the wearer enters the late midstance period, or the early propulsive period of the gait cycle (depending upon fulcrum used and fulcrum placement), the foot rotates forward about the fulcrum as shown in FIG.  8 B. The metatarsal heads  48  and the digits fully contact the top of the inner sole  12  of the shoe. The contoured plate may also include a heel plate  54  on the bottom of the contoured plate  46  to engage uniformly the top of the inner sole  12  above the calcaneus region for a prescribed heel contact period orientation of the plate  46 . 
     METHOD OF SPECIFIC TREATMENT 
     The present inventive foot leverage system is effective to treat excessively pronated low arched foot types (pes planus). In FIG. 5A the force curve  44  reflects the pressure on the left foot before treatment relative to a left foot plate  14 . The force curve  44  indicates excessive pronation of the foot. The fulcrum  16  is oriented in a position substantially aligned with the subtalar axis as shown in FIG.  5 B. Also illustrated in FIG. 5B is the partially corrected force curve  44  that is aligned closer to the central portion of the plate as compared with FIG.  5 A. FIG. 5C shows a more desirable force curve  44  that is generated when the position of the fulcrum  16  is adjusted according to the specific functional pathology of the wearer. The resulting supination is mechanically produced by the inventive foot leverage system during the midstance or during the propulsive period (depending upon fulcrum used and fulcrum placement); or both. The resulting supination is a triplanar motion that is described by an axis of rotation oriented posterior, plantar and lateral to anterior, dorsal and medial. The motion of supination is the opposite of pronation. The weight bearing, closed kinetic chain, subtalar joint supination produces calcaneal inversion with talar abduction and talar dorsiflection. The resulting desirable and directed foot supinatory motions occur simultaneously and facilitate more normal lower extremity function during the midstance and propulsive periods of the gait cycle. Pathological conditions associated with midstance and propulsive pronatory motion may be lessened or eliminated with the present invention and method of use, include: bunions, neuromas, hammertoes, hallux limitus, forefoot supinatus, plantar calluses, plantar fasciitis, cuboid syndrome, heel spur syndrome, tibialis posterior tendonitis, shin splints, medial knee retinaculitis and chondromalacia patella. 
     The present inventive foot leverage system is also effective in treating excessively supinated high arched foot types (pes cavus). In FIG. 7A, the force curve  44  is shown of a wearer who is afflicted with pes cavus. The force curve  44  is positioned excessively toward the lateral side  52  of the right foot plate. The present invention and method of use can restrict excessive subtalar joint supination through the generation of a pronatory torque across the subtalar joint axis using the proper placement of the fulcrum  16  as shown in FIG.  7 B. After the wearer applies weight to the inventive foot leverage system, the resulting force curve  44  shown in FIG. 7B is produced. The resulting force curve  44  is generated by leverage to approximate a more normal orientation of the foot and lower extremity weight bearing forces. Pathological conditions associated with excessive midstance supination that may be lessened or eliminated with the present invention and method of use include: a sprained ankle, cuboid syndrome, peroneal tendonitis and lateral foot column calluses. 
     The present inventive foot leverage system is also effective to treat achilles tendonitis. The achilles musculotendinous complex passes the knee, ankle and subtalar joints. Normally, during the midstance period the ankle is dorsiflexing and generating a mild amount of internal leg rotation which contributes adversely to an abnormally pronated subtalar joint and its associated pathology. As dorsiflexion progresses, eccentric contraction of the gastrocnemius muscle provides knee flexion tension and the soleus decelerates the tibia which helps to extend the knee in smooth preparation for the propulsion stage of the gait cycle. The present inventive foot leverage system generates a reduced net amount of ankle joint dorsiflexion during the midstance period around the fulcrum which facilitates a more uniformly stressed and less physiologically strained achilles tendon. The leverage system can be adjusted to reduce the tendon strain without interfering significantly with the knee extension mechanism. The fulcrum can also be oriented or shaped to facilitate subtalar joint supination to improve the alignment effect on tendon fiber torque. The fulcrum can also be adjusted to initiate ankle acceleration into plantarflexion which creates an inertial reduction in the force required by the achilles tendon to flex the knee and lift the heel as the propulsive period is established. The rate of plantarflexion acceleration can be adjusted by: 
     1. altering the position of the fulcrum from a position proximate to the calcaneus to a position toward the midtarsal joints, 
     2. adding or modifying the durometer of resilient, spring-like material, anterior to the fulcrum, or 
     3. changing the rigidity of the plate. 
     Stress on the achilles tendon can be reduced by adding a heel lift heel plate  54  as shown in FIGS. 8A and 8B. The heel lift  54 , lifts the heel off the inner sole  12  of the shoe. In combination with the foot leverage system, the heel lift  54  reduces the torque that is typically associated with the use of a static heel lift device alone. Conventional static heel lift devices simply maintain the heel in a static weight bearing position and can generate contractured, shortened states. Alternative conventional treatment involves stabilizing the tendon by casting or by realigning the tendon with an orthotic device. In contrast to a static heel lift, the instant invention allows the foot to enter the midstance period approximately perpendicular to the leg which allows a prescribed beneficial physiological stretch to the leg muscle during the contact and early midstance periods. As the foot dorsiflexes through midstance and the leg muscle is further stretched, the contoured insole plate  46  plantarflexes over the fulcrum  16  and rotation occurs lifting the heel and effectively reduces the force acting on the achilles tendon (see FIG.  8 B). Foot and plate rotational modification can be achieved by adjusting height to the heel lift  54 , by moving the fulcrum  16  forward or backward, beneath the contoured insole plate  46 , by providing a thicker or thinner fulcrum  16 , by lengthening or shortening the plate, or by forming a contoured insole plate  46  having an upward foot-contouring curvature relative to the plate-contact dimensions of the foot. 
     FIGS. 9A,  9 B and  9 C illustrate a new mapping method that is described herein relative to the embodiment illustrated in FIG. 1B, which can be used to facilitate proper and efficient application of the instant inventive foot leverage system. FIG. 9A illustrates the underside of the right foot plate  15  without a fulcrum  16  and FIG. 9C illustrates the underside of the corresponding left foot plate  14  with a fulcrum  16 . FIG. 9B illustrates a directive map for placement of the fulcrum on the underside of the left foot plate illustrated in FIG.  9 C. In FIG.  9 A, the area between lines  60 ,  62  and  64  is generally covered with a fastener material such as hook and loop fasteners. In FIGS. 9B and 9C, the fastener material is indicated on the map (FIG. 9C) between lines  74 ,  78  and  84 . The corresponding side of a hook and loop fastener is attached to the flat side  18  of the fulcrum  16 . In FIG. 9B the high arch line  78 , and the low arch line  74  are used as guide lines for properly adjusting the position of the top end of the fulcrum  16  to the plate shown in FIG.  9 C. In FIG. 9B, the achilles tendonitis line  82  is used as a reference guide for properly adjusting the position of the fulcrum  16  on the left foot plate  14  shown in FIG.  9 C. For example, to treat a patient who exhibits symptomatic conditions of a flattening arch, with respect to the left foot, the fulcrum  16  would be placed on the left foot plate  14  shown in FIG. 9C generally parallel to the line  74  as directed by the map shown in FIG.  9 B and confirmed by line  74  on the plate shown in FIG.  9 C. In FIGS. 9B and 9C, the position of the left low arch line  74  and high arch line  78  are reversed relative to the orientation of the corresponding lines  62 ,  60  on the right plate shown in FIG.  9 A. The most specific beneficial adjustment of the fulcrum on the left foot plate  14  would be accomplished on the left foot plate  14  according to the symptomatic response of the patient&#39;s foot to the position of the fulcrum. 
     The mapping method directs both professionals and laymen alike, to adjust the fulcrum  16  to achieve the most beneficial symptomatic orientation of the fulcrum on the plate  14 ,  15 . The mapping method may similarly be used with fulcrums  22 ,  23 ,  24 ,  26 ,  85 ,  86  in combination with the desired foot plate  14 ,  15 ,  46 . Because of individual biodynamic uniqueness, further refined adjustment to the fulcrum position, based upon personal comfort and effect, may assist to further reduce symptomatic conditions and to establish the desired patient comfort. 
     It is also contemplated that the inventive mapping method may be used on the Internet or as a part of a software application. 
     PEDOBAROGRAPH DATA ILLUSTRATIONS 
     FIGS. 12A-12C illustrate three pedobarographs which show the dramatic improvement of the pressure curves (force curves)  87   a ,  87   b  of a patient who uses the inventive device. FIG. 12A shows the pressure curves  87   a ,  87   b  for a barefoot patient who excessively pronates during walking. In FIG. 12B, force curves  87   a ,  87   b  are shown for the same patient who is wearing shoes but is not using the inventive device. FIG. 12C shows force curves  87   a ,  87   b  for the same patient who is using the inventive device. 
     The force curves  87   a ,  87   b  change from an undesirable, very pronated walking center of pressure (FIGS. 12A and 12B) to a more desirable and more normal walking center of pressure distribution (FIG.  12 C). 
     Because many varying and different embodiments may be made within the scope of the inventive concept herein taught, and because many modifications may be made in the embodiments herein detailed in accordance with the descriptive requirements of the law, it is to be understood that the details herein are to be interpreted as illustrative and not in a limiting sense.