Discerning the Truth About the Twisted Plate

At the 2023 New York State Podiatric Medical Association Clinical Conference, Samantha Landau, DPM, MPH, FACPM shared key insights on the concept of the twisted plate with attendees. Podiatry Today had the chance to learn more about what she hopes DPMs will learn from her session.  

Q: Can you briefly summarize the basic concept of the twisted plate?

A: Dr. Landau, who completed a year of post-graduate training in biomechanics and gait-related disorders of the lower extremity in children and adults at NYCPM, shares that the twisted plate was originally called the lamina pedis by anatomists in the 1940s. She says it was originally described as a spring-like mechanism as a precursor to the windlass mechanism of arch lowering and rising.

Q: What do you feel are some of misconceptions clinicians have when it comes to this concept? 

A: As a result of improper understanding and significant shortcomings of previous studies and study design, there is an incorrect assumption that every foot will benefit and should be made to conform to this concept, says Dr. Landau, a current faculty member of the Orthopedics and Pediatrics Department at NYCPM.

“The problem with this conclusion is that it uniformly promotes a varus position and posting of the rearfoot and a valgus position of the forefoot whether or not there is a valgus deformity present,” she explains. “The application of a valgus post in an attempt to mimic twisting of the lamina pedis misses the crucial and commonly occurring biomechanical examination findings of forefoot varus, when it is noted.” 

Recognizing structural imperfections is an essential step in optimal design of prescription foot orthoses to neutralize the inherent compensatory pathomechanical forces that normally accompany the deformity, she adds.  

Q: How can clinicians apply this concept to their practices?

A: Dr. Landau stresses that proper understanding of the twisted plate and current concepts will allow physicians to correctly apply forefoot and rearfoot postings in order to alleviate concerns of lower extremity pain often associated with poor mechanical function. 

“Clinicians should be wary of creating a valgus position of the forefoot in those individuals with an observed forefoot varus deformity,” she says.