Innovations: Rollin' away the pain

Two young Israeli doctors are keeping the world unbalanced.

elbaz foot feat 88 298 (photo credit: Courtesy)
elbaz foot feat 88 298
(photo credit: Courtesy)
A miniature human skeleton shod with one small black shoe hangs from a metal pole in Dr. Amit Mor's Herzliya office. "Everything in the body is connected," he explains, bending one of the skeleton's knees to point out the movement of the surrounding joints and spine. "If you destabilize the skeleton, it crumples into a pile of bones. It's amazing that this frame is what we use to walk erectly and play football." But for 6 percent to 7% of the population, this skeleton is destabilized by joint problems, which leads to back pain and loss of mobility. "Basically, when the joint has too much tension on it, the surrounding muscles turn into a brace, creating tension. The surrounding muscles stop coordinating properly and atrophy, and this influences a huge number of injuries today," Mor says. For the last five decades, medical research has been treating osteoarthritis (OA), a chronic disease that causes the cartilage between the bone joints to wear away, in exactly the same way. The traditional treatment puts patients on a wobble board in a clinical setting. Working the muscles on this wobble board stimulates slight instability, which promotes healing. "The problem with treating patients in a clinical setting is that it doesn't imitate natural rehabilitation," says Mor. "We wanted to find a way to treat people that would simulate natural evolution and promote faster healing." He explains that neuromuscular control was not a problem experienced by our forefathers because they walked on uneven surfaces, such as sand and mud, which forced them to use their muscles equally on natural inclines and declines. Today, between the Nikes, Crocs and artificial flat surfaces like carpet and tile, every step we take is on an even surface. According to Mor, sitting at computers and working in unnatural settings also contributes to the problems with OA and back pain. Nevertheless, when Mor and his partner, Dr. Avi Elbaz, first introduced the idea of treating patients with special shoes that have balls attached to the heel and toe, everyone thought they were crazy. "The medical community wondered who these two young, stupid doctors were, putting people on balls." says Mor with a chuckle. "But we knew this multidirectional training and treatment system would work." Seven years ago, when they were both still students, the duo started developing the All Phases of Stepcycle (APOS). "This is the first and only rehabilitation device and treatment method that works through all phases of the step cycle, which is why we named it APOS," says Mor. The final product, a shoe that slightly resembles a roller skate, looks daunting at first glance. Two semispherical, biomechanical units are placed on the heel and forefront of the shoe. These units are individually calibrated and are capable of lateral, forward and backward movement. "This is not a shoe," says Mor, unscrewing one of the round, plastic domes from the heel of a sample device. "It's a biomechanical system that is adjusted for each patient to bring about proper alignment in the knees, improve control and stability and reduce pain." To test the effectiveness of the APOS system, the researchers (headed by Prof. Nahum Halperin, head of the Orthopedic Department of Assaf Harofeh Hospital and the former head of the Israeli Orthopedic Society) conducted a double-blind, randomized study involving 61 knee OA patients. The findings showed that 69% saw an increase in function, while 70% experienced a decrease in pain. "People find walking on the shoes strange at first, but the improvements they see make walking on balls worth it," says Mor. More than 3,500 patients have been treated using the APOS system, which the team claims is approved by the Health Ministry and the FDA in the US, and centers using the treatment will open in the US and UK next year. "There are 21 million Americans with OA and, according to statistics, 50% of people over the age of 50 in the Western world suffer from OA, but no one talks about it because it doesn't kill you," says Mor. "The World Health Organization has dedicated this decade, from 2000 to 2010, to improving joint rehabilitation treatment, and APOS is going to help." Right now, the treatment costs a hefty NIS 3,500, but Mor hopes it will eventually be covered by the health funds. "When you look at patients who can barely walk, even with a cane, and suffer acute pain with every step and see them walking normally and pain-free after six months of APOS treatment, you realize how rewarding this is. We have an unbelievable success rate, and this is the realization of our dreams," Mor says.