Pediatric Myth Busters
Photo: @iStock.com/PavelRodimov
in 7 degrees of heel valgus. According to DeCaro,
the degree of heel valgus noted on weight bearing
should progressively diminish with age. A good rule
of thumb to follow when assessing the "appropriate
level" of heel valgus for a child is 7 minus their age.
For example, it would be normal for a 3-year-old
child to stand with 4 degrees of heel valgus (7-4=3).
By the time a child is 7 years of age their heels
should assume a vertical alignment to the ground
(7-7=0).
Dr. DeCaro also advises that aside from skeletal
issues, there are many other factors that should be
evaluated that could lead to, or negatively impact,
gait. These factors may include: genetics, sensory
processing disorders, gross motor delays, and low
muscle tone.
DeCaro states: “Overall there are 3 major factors
that go into considering whether or not to treat
pediatric flat foot: genetics, the age specific degree
of heel eversion, and functional impairments such
as endurance, fatigue and poor posture”.
As the author of this article, and based on my
professional experiences, I have found the "ideal"
adult heel-to-floor alignment to be approximately
4-6 degrees VARUS; and that this positional
alignment should be attained by adolescence
(approximately ages 9-12). This moderate varus
heel alignment helps to lock the midfoot, stabilize
the lateral column of the foot, and encourages an
effective windlass mechanism.
Myth Buster #2:
“Growing Pains Are Normal”!
When are growing pains normal? After a rapid or
excessive growth period, of course! Parents and
practitioners know and accept that growing pains
will sometimes happen. So, how do we know
when growing pains are NOT normal, or possibly
excessive?(3, 7, 9)
First, consider the fact that growing pains in kids
do not often occur in the foot. More commonly,
Current Pedorthics July/August 2016
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