We have to remember that a lot of biomech is subjective.
Does it apply? Yeah.
Is it exact? Not at all.
So, we have to recognize that planus pain or planus + heel pain needs functional insole. Cavus with sub 1 and 5 overload needs more accommodation arch fill insole. Forefoot overload stuff (neuroma, metatarasalgia, etc) needs gastroc stretch and met pads. Anterior ankle pain needs gastroc stretch if no osseous block.
The main utility of knowing normal biomech is mostly to recognize the real abnormal stuff (coalitions, pathologically cavus or planus foot types, etc). Gait plate or reverse for intoe or wide angle of gait. Heel lift for symptomatic limb length. Most ulcers are due to neuropathy + a biomech fault such as equnius, malleus, lateral overload... and calluses are absolutely pre-ulcers for neuropathic pts. We have to know the non-op and surgical fixes. That is also why we should know that things like Chopart and 3+4+5th ray amps and the like are hot garbage. That stuff.
As to whether PureStride or full customs are better for most run-of-the-mill plantar fasciitis, PTTD, etc... who knows. I think the customs can be definitely more durable, but that's seldom needed. If it's a rockin cavus foot or a post-ulcer/amp or a s/p calc STJ fx... then yeah, that's a Rx for the custom shop, no doubt.
I think we can retire the Harris Mat, goniometer, RCSP quantification, etc... but that's each DPM's choice. It's basically common sense. Gait exam and WB clinical exam have their obvious place in certain cases.
...and even if we basically know the dx and our plan from XR or HPI, I am always going to be pretty convinced that a solid physical exam builds rapport with the patients, shows attentiveness, builds trust, gives impression of a thorough visit, etc.
