20th February, 2013

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Use of orthoses (a.k.a. orthotics) in children

Orthoses or ‘orthotics’ are devices that we use in shoes to modify the load distribution through the foot. Most people associate orthoses being prescribed only for people suffering from foot, ankle and shin issues, but research has shown that they are able to change the loads placed on knees, hips and the spine as well. Orthoses come in many different forms from the cheaper pre-fabricated ‘off the shelf variety’, to more expensive custom-made versions.

orthotic

In adult feet it is expected that the use of orthoses will create no significant long terms changes. However we have to be careful with the use of these in young developing feet, as they may have the ability to affect natural development. For younger bodies, there are times where orthoses may help physiotherapy treatment but also times when of the natural variances in development will sort themselves out as muscles adapt to new loads. It is important during this developmental stage to allow natural strengthening to occur and not always see these issues as problems that need orthotic intervention.

If it is necessary to fit foot orthoses in a child, it is advisable to intervene after the age of 7. This is because some natural bone movements occur in the development of the feet mostly between birth and around 7 years of age. The most common conditions that would merit some intervention before this age would be severe “in-toeing”, “out-toeing” and severe “toe walking” when very young. Referral to a paediatric specialist would be the best course of action in these cases.

Natural loads through the feet aid normal muscle development through the foot and leg. If motion is reduced significantly by foot orthoses, this may lead to adaptations in movement, and change muscle recruitment patters as well as overall strength. We recommend young children spend time with bare feet or wearing thin flexible footwear to maintain motion and help develop sensory input to the foot and ankle. If you are concerned with the movement patterns of your child or another child you are responsible for, we recommend you seek some guidance to see if their movements are normal, or if they would benefit from some treatment or aids. Often there is some simple exercises or soft orthoses which will help address the problem.

Written by Mark Fotheringham (physiotherapist) with recommendations from one of Melbourne’s best foot podiatrists Jason Agosta (http://www.ja-podiatry.com/podiatry.html)
– See more at: http://www.malvernphysio.com.au/information-sheets/use-of-orthoses-a-k-a-orthotics-in-children#sthash.OKkWGhm6.dpuf