To orthotic or not to orthotic, that is the question

A concerned mother of this 3 year old boy came in, wondering if her son should have orthotics. What do you think?

Pros for orthotics:

  • will make calcaneii more vertical
  • will make feet look better
  • will decrease progression angle while walking
  • will halt most of the midfoot pronation you see on the single leg standing views
  • will make left calcaneal valgus better that we see on the post view

Cons for orthotics:

  • may interfere with derotation of the talar head, causing a permanent forefoot varus deformity or Mortons foot (need to more about development? click here)
  • will make the child use their intrinsic muscles less, weakening the feet, causing problems later on in life
  • will inhibit descent of 1st ray, and peroneus longus function (if you don’t use it, you lose it. More on peroneus here)
  • will alter gait and affect motor development

What did we do?

  • have the mother have the child walk barefoot more, especially in the sand
  • have the child hop on one leg and do tandem gait walking
  • have the child balance on one leg at a time
  • place the child in flexible shoes
  • recheck the child in 6 months to assess progress

Does this mean kids should NEVER be in orthotics? No, certainly not, but we fell this is neither the time or the place. A lot of development (and learning) occurs in the 1stf five 5 years of life. How about we let nature do its thing, try and stay out of the way of normal development and monitor?

The choice is yours

The Gait Guys. Offering firm, but gentle clinical guidance through the maze of gait information out there.