Orthotics for children pose unique challenges and opportunities to help them. The first milestone for walking in children is generally at the age of 2. Toe walking is generally resolved by the age of 3. It is thought that the full arch develops by age 5.
It is not unusual for children to have issues with the rigidity of an orthotic. Sometimes any tactile stimulation is not tolerated by the child.
For toe walking some doctors like to use a full length orthotic for proprioception. Surgical solutions are sometimes necessary if the root of the problem is a tight Achilles tendon.
Intoeing can be caused by femoral anteversion, internal tibial torsion or metatarsus adductuus. The idea of a gait plate is to extend the break of the shoe laterally by extending a semirigid orthotic laterally past the 4th and 5th met heads. According to Schuster’s original article altering the break of the ball of the foot forces the hip to go external to complete the step. In order for the concept to work the shoe must be flexible.
Supermalleolar orthotics are used for more control. This can make shoe fit more challenging. For this reason a deep heel cup orthotic with a high medial phalange is often preferred.
When speaking to parents it is important to tell them that although there is no research to support that orthotics will reverse deformities, they can help improve their child’s walking. There is need for more research in pediatric orthotics to strengthen the validity of some of these concepts.
