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.
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
Fatigue or impaired function and orthotics for children
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?
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!