Current Pedorthics | July-August 2016 | Vol.48, Issue 4 | Page 23

Pediatric Myth Busters

Side Tip:
I love to take photos of families’
feet: I call them family “Photoes”.
It is both fun and interesting to
share these images with families
and point out that their children
can look characteristically
similar to one of their parents
– just by looking at their feet!
This exercise is engaging and
interactive and gets the entire
family involved.

Myth Buster #4:
“Using Foot Orthoses Causes Dependency on
Them”!

Photo: © Roberta Nole

I often hear parents tell me they have their children
walk barefooted in order to “strengthen” their
ankles. Although there may be true benefit to a
structured therapeutic exercise program under the
direction of a trained physical therapist, athletic
trainer, or exercise physiologist, prolonged barefoot
walking on an overpronated foot may at times
exaggerate the deformity(4, 12, 14). Flatfeet can lead to
excessive muscle elongation of the foot supinators
and can cause muscle spindle inhibition and
increased production of sarcomeres. The change
in muscle length alters the length–tension curve
of a muscle and creates a “stretch weakness”,
or “positional weakness”, that is associated with
overuse injuries and postural dysfunction(6, 8).
A pediatric foot orthosis is recommended when
a child’s foot pronation is deemed excessive
for their age, especially when associated with a
familial history of foot-related conditions. The
orthoses should include a deep heel cup (30mm),
conservative medial rearfoot posting, a medial skive,
and medial and lateral flanges(4). Because of rapid
growth it is not always possible, nor is it necessary,

to use custom foot orthotics. Prefabricated orthotics
that incorporate these features will often suffice
and are a more affordable alternative for parents
that may (because of genetics) have a gaggle of
flatfooted kids to treat! Remember, when treating
kids with orthoses you do not always have to achieve
perfection. Medially post the rearfoot just enough
to bring the foot back to the child’s age-related
heel alignment. For example, remember that it is
normal for a 5-year-old child to stand in 2 degrees
heel valgus (7-5=2). So, if you are treating a 5-yearold child that stands in 5 degrees heel valgus, you
need only post 3 degrees to bring them back to their
age-related 2 degrees heel valgus position.
Russel Volpe, DPM and professor at the NY
College of Podiatric Medicine offers the following
guidelines to help ascertain the need to medically
manage a child with a flatfoot(13):
• Symptoms associated with abnormal foot posture
• A non-physiologic flatfoot at any age
• Abnormal weightbearing position of the foot
based on age and associated abnormal foot posture
• Changes in dynamic function in gait associated
with flatfoot

Current Pedorthics July/August 2016

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