Orthotics for Children | Does My Child Need Orthotics?

Orthotics for Children are an ethically sticky topic among the podiatry community. Similarly, public opinion can sometimes be wary when orthotics are being discussed.

This conjecture has come about from a number of factors including; the cost; differing opinions between podiatrists; the selling of orthotics by other professions such as doctors, chiropractors and physiotherapist; over selling; and the differing evidence surrounding orthotics. These concerns can be magnified when its a child who is being treated.

Orthotics for children, children's feet

Parental concern about their child’s feet

Toddlers, children and teenagers are brought to Podiatrists for a range of reasons, such as;

  • Concerns about foot shape; flat feet or high arches,
  • Family history of foot problems such as bunions,
  • Undesirable walking style or gait patterns such as pigeon-toed gait, or walking up on tip toes,
  • Repeat injuries such as ankle sprains,
  • Pain or poor function.

Determining a child’s need for orthotics can be a complex process. This article is aimed at going through some of the steps of assessment and why they may be used to assess a child’s need for orthotics.

The Podiatrist’s approach to orthotics for children

When considering whether orthotics are needed, there are a number questions which I will commonly ask myself. These questions are aimed at assessing necessity, urgency and if there are other treatment options which could be tried first. Some of these questions include;

  • Is there pain?
  • Is the child reporting tired legs, poor function (tripping) or showing signs that they aren’t able to keep up with their friends?
  • Are there signs of bone or structural changes?

Other questions that I will also take into consideration are;

  • Will the issue self resolve with time?
  • Is the level of activity about to increase or decrease i.e. start or end of a sporting season or school year?
  • Can the problem be addressed in other ways such as stretching and strengthening?
  • Is a medical condition also impacting this child and their feet? i.e. Down Syndrome, Cerebral Palsy, Charcot Marie Tooth etc.
  • Is this child hypermobile or do they have poor motor control (coordination or balance issues)?
  • Does this child compete at an elite or representative level?
  • Could the issue be resolved with different footwear?

Assessing foot pain in children

Pain and its cause can be difficult to evaluate particularly in young children. Unlike adults, children may not be able to explain their symptoms clearly or describe the circumstances around when their pain comes on. Parents play an important role in filling in the gaps when taking clinical history during an appointment.
Some of the questions we may ask, include; When does it hurt? How bad is the pain? Did it occur during play or sporting activities? Does it hurt at night or is you child waking up because of pain? If your child is experiencing foot, ankle or leg pain it is worth while trying to find out exactly where and when it hurts, as children will often forget come the appointment!

football-injury-kids

Pain can sometimes be caused by soft tissues or muscles working hard to stabilize a foot. Other factors like hypermobility (being very flexible), flat feet or being restricted in joints can also lead to pain.
Children also go through significant bone growth and development, sometimes quite quickly. In fact its only once you’ve turned 5 have you finished growing all 26 bones in your foot! Up until the age of 14, bones and more specifically the growth plates can become sore.
Commonly, growth plate issues will self resolve with time however it is worth getting them assess to make sure it is not something more serious.  Injuries, whether they be once off or reoccurring can of course, also cause pain.+
Repeat ankle sprains is one of the most common injuries I see in children, particularly in those who play sports like netball, basketball, soccer and football. If your child is struggling with reoccurring injuries or reporting foot pain, an assessment should be done by a podiatrist.

 

Fatigue or impaired function and orthotics for children

With younger children, tiredness and poor function (tripping over) can sometimes be a sign their feet or legs are working too hard to keep up and running.
Wanting to be carried or sit in the pram may be an indicator that a child’s legs or feet are tired. Seeing that a child is failing to keep up with peers, or avoiding activities may also indicate their legs aren’t carrying them as well as you would hope.
While these signs give us clues that something may be wrong – they only reveal  part of the story. As part of an assessment joint range, muscle strength, coordination and balance are also looked at.
Child anxiety orthotics

 

Another aspect which I take into consideration when assessing the need for orthotics is a risk to benefit ratio. To put it simply, if a child is to continue without intervention (orthotics) is it likely that they may come to harm?
For example, if a child is a real go-getter, however is constantly tripping over due to their feet – are they likely to end up with a broken arm from falling over? As with assessing pain, this is an area in which parents play a large role in providing clarity on function.

 

Bone or structural changes and orthotics for children

If a child presents to me with a foot shape that makes them prone to problems long term I will look to use an orthotic to slow progression or prevent these changes from getting worse. Adolescent Bunions are one example of a change that can occur in kids feet.

While bunions are less common in children than in adults, they may be prone to developing if the child has a very flexible or flat feet. Environmental factors may also increase the risk of developing bunions including poor footwear or sports or dancing such a ballet. Family history of bunions may also be an indicator of the risk of a child developing bunions.

What about flat feet?

Another common reason for parents to bring their child in for an assessment is because they believe their child has flat feet.

Orthotics children flat feet

When babies are born they have very flexible feet. As a result arches often wont be visible and the foot will be quite flat to start off with. Foot shape and arch height will develop and continue to change up until the age of 7 or 8.
This development of foot shape can be monitored to see that it is progressing in the right way. Having flat feet can sometimes lead to overuse injuries. If you have any concerns about your child having flat feet it is best to have it assessed properly by a podiatrist.

Shoe support vs orthotics for children

Do shoes help? It is less common to find shoes which have “support” as you do when looking at adult sizes, however there are a handful of supportive kids shoes out there. Ascent , New Balance and ASICS are some brands which offer supportive shoes for kids.

Orthotics for Children: The Process

If an orthotic is needed, a podiatrist will use either a prefabricated or custom device to address the issue with your child’s feet. Orthotics can perform many different functions. Some as simple as offering arch support or as complex as changing foot functions. Keep and eye out for an article by our other podiatrist Luke  on “What is an Orthotic?”

  • Custom Made Orthotics are made to an individual’s foot. This will involve either a plaster cast, foam imprint or a 3D scan. These are then sent to an orthotics laboratory who will make the orthotic specifically for that person, with any changes in design requested by the podiatrist.
  • Prefabricated orthotics come as a standard shape which can either be heat molded or modified to suit a patients foot.

Some factors which influence our recommendation as to whether a prefabricated or custom orthotic is required include; the shape of the child’s foot (unique foot shape), child’s weight and size, stage of growth, or the complexity of the injury or problem.

In summary, an orthotic can act as a solution to many common foot complaints. If you have any concerns about your child’s feet or legs a Podiatrist may be able to offer you advice such as shoe recommendations or exercises even if an orthotic isn’t required.   If an orthotic is needed a Podiatrist can help design and fit an orthotic for your child. We want to help your kids to run and play pain free, so if you need help or advice, call in to your local podiatrist!

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