Orthotics: shoe inserts that modify the forces going through the feet and lower limbs during weight bearing activities.
Children are diagnosed with a ‘foot abnormality’ when the foot tends not to function in an ideal pattern during walking, running or stance. Conditions can be described as flat feet/ pronation, toe walking or pigeon toes, and can be painful or look funny. But do these conditions need early treatment or are they something children simply ‘grow out of’?
Is it the feet that are the main culprit?
*Did you know that kids don’t actually start to heel strike (when the heel hits the ground as you place the foot down to walk each step – a ‘normal’ foot pattern in walking) until grade 1?! That’s 6-7years of development!
The decision to trial orthotics can be based on a global lower limb assessment and the amount of work that ‘wants to be put in’ to get results.
In some cases orthotics may be required, however, in the majority of cases they would be an adjunct to other strategies that may include strengthening and teaching good movement patterns. The aim of course is to remove the problem all together. Most often, children are provided with specialised orthotics when they present with a foot pathology or significant pain in the foot. These issues are usually unable to be fixed with regular movement retraining strategies and may benefit from a change in foot posture.
Now in saying this, orthotics do not work alone; they work best with a combination of lower limb strength, movement training and gait re-education provided by physiotherapist’s, podiatrist’s, exercise physiologists or other movement specialists.
Recent evidence based guidelines can be followed and implemented to aid clinicians in the proper assessment of children with ‘foot abnormalities’, and decide what, and if any, action is needed.
*Red flags* to look out for could be changes in foot posture and issues like a family history of problematic flat feet.
Guidelines explain the clinician is advised to
1) TREAT symptomatic paediatric feet
2) MONITOR (or with discretion simply treat) asymptomatic non-developmental paediatric feet
3) IDENTIFY and advise asymptomatic developmental paediatric feet
The ‘Abnormalities’ explained:
– Flat-feet (over-pronation): a loss of the inside foot arch, +/- the ankle ‘falling’ inward. Some degree of flat footedness reduces with age, and this is normal up until around the age of 8-9yr. Symptomless flat feet that are assessed as being purely developmental should be left alone, but need monitoring over time “to see which way they are heading”.
– In-toeing (Metatarsus adductus); the front half of the foot is turned inward. Also known as Pigeon toe; can be caused by a variety of joints not working in alignment. Orthotics used for temporary aiding of foot alignment (6/12) with combination of hip training and gait re-training.
Treatment
After an assessment of the lower limb and walking pattern, a variety of treatment options are available to address the specific issues causing pain, discomfort or movement abnormalities. Depending on the therapy chosen, different interventions will be provided, and may include; stretching, mobilisation (movement of joints), strengthening and muscle balancing, exercise, gait retaining, postural alignment or hands on therapy. All of which are evidence based, condition specific and have proven results. Orthotics may be trialled in conjunction with these treatment options.
Sometimes, simple footwear advice is all that’s required, as a well-fitted, supportive shoe can assist in normal foot mechanics (further info on footwear in an upcoming article)
Physiotherapist Marissa Seeley
