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A complex issue: Do children need orthotics?
01 January 2013
I suppose the first question to answer is: What are orthotics? They are quite simply specially designed, often custom made, insoles that are worn within shoes to gently correct any biomechanical issues with the feet and help keep them in a relatively normal position. Probably the most common biomechanical issue I see in my clinic is what is known as ‘over pronation’. This is when the feet roll inwards causing the arches to collapse. Over time this can lead to many widespread problems such as Plantar Fasciitis and Achilles Tendonitis but usually also cause problems in other parts of the body such as the knee pain, hip pain and lower back pain amongst other symptoms.
When assessing an adult we can usually quickly establish whether orthotics are indicated and can be pretty confident that they will help correct any issues and provide quick relief from symptoms. With children it is a more complex issue with a lot of things to consider. Firstly, it is no secret that custom made orthotics can be expensive. At my clinic we endeavour to keep our prices extremely competitive and usually an adult pair of orthotics will last several years and so the cost is not such a big issue.... With children whose feet are still growing, cost can become a problem as new orthotics will need to be made roughly every time the feet grow 1 to 2 shoe sizes. The next thing to consider is that before the age of around 6 or 7 childrens feet naturally change shape, as does the way that they walk (their gait). If you're a parent concerned by a less-than-perfect arch on the bottom of your child's foot, you're far from alone!! Often parents will bring their toddlers to me, extremely concerned that they are walking just on their toes or heels or that they seem to have very flat feet. In many of those cases I am able to reassure them that it is part of natural development and something they may “grow out of” and that we only need to keep an eye on things rather than headlong into prescribing orthotics. So the burning question is really, “when DO kids need orthotics?”.. In my opinion several factors need to be taken into account. Firstly if the child is complaining of any pain or they appear to be more clumsy or to move very differently from other children, they need to be assessed. Secondly if there is a known hereditary problem, such as one or both parents requiring orthotics, it is likely that the child may need early intervention. Another thing that I take into account when examining children under the age of 7 is whether they are particularly sporty. If they are already playing sports more than simply running around a school playground I would be more inclined to prescribe orthotics. In most cases when young children are brought to me for gait analysis I am able to reassure parents that we only need to keep an eye on things and assess every 6-12 months. Sometimes these children do not need any intervention and in other cases often we can prescribe an inexpensive ‘off the shelf’ type orthotic that will support these young feet through development.Childrens 'off the shelf' orthotic In summary, I believe that often very young children do not require orthotics but SOME do.. As parents we can worry too much about our children but I would always counsel parents to have their children checked out and assessed. These are the main symptoms we would be concerned with:· If a child begins to walk oddly or clumsily, for example on the outer edges of the feet· If a child limps· If he or she feels foot pain or fatigue during walksImportantly.. Even if children do need orthotics it doesn’t have to be a costly exercise... and if they don’t need orthotics at least we can put parents minds at rest.To make an appointment call my clinic on 02082038977 or you can contact me by email: firstname.lastname@example.org