Expert Insights On Prescribing Pediatric Orthotics
There is an array of special considerations one must take into account when prescribing pediatric orthotics. In addition, it is important to work with both children and their parents to encourage compliance so the child does not develop problems later in life. With this in mind, our expert panelists share their experience on prescribing pediatric orthotics. Q: When prescribing an orthotic for a child, how do you explain to the parents that the child may need to wear these devices for many years or the rest of his or her life? A: Alona Kashanian, DPM, uses a kid glove approach when discussing any type of treatment or therapy with parents. She educates her patient’s parents about the genetic component of the child’s foot and ankle problem. Dr. Kashanian notes these parents often have worn corrective devices or corrective shoes as children themselves so they are familiar with the treatment. She assures the parents she will follow up with the child on a six- to 12-month basis in order to assess the effectiveness of the orthotics. However, she also points out that just as eyeglasses do not change a person’s eye but help prevent further eye problems, a pair of orthotics will prevent further damage and slow down the progression of the pathology. Ronald Valmassy, DPM, also uses this analogy with parents, saying orthotics will compensate for problems and allow a child to exercise or participate in sporting activities comfortably without any secondary injuries. When prescribing pediatric orthotics, Dr. Valmassy tells parents he may utilize a device for a few years while monitoring the child’s development and may stop utilizing the device at a specific point. However, he also notes that some patients may need to wear these devices for the rest of their lives. Since most of the parents’ concern is that they will need to change the orthotics annually, Richard Jay, DPM, points out that orthotics usually last anywhere between two and three years. During some instances in the early growth patterns, between about 1 and 1/2 to 2 and 1/2 years, he says the orthotic does have to be changed. However, Dr. Jay says if you properly explain the need to control the foot and maintain it in the corrected neutral position, parents “usually have no problem understanding the need for replacement.” Dr. Jay adds that most of the orthotic laboratories provide a protection type plan that allows patients’ parents to pay just the cost of casting and replace the orthotics as needed. Until the age of 7, the child’s foot is continuing to unwind from in utero positions and Russell Volpe, DPM, explains to parents that he will reassess the need for orthoses once children outgrow them. Dr. Volpe emphasizes that the sooner the child starts orthotic therapy, the greater the chances of influencing the shape of the arch and the development of the foot permanently. “However, I am careful not to tell them that if devices are worn early on, then a child will not need them later when he or she is older,” cautions Dr. Volpe. “Certainly, many toddlers and young school age children who need, and benefit from, motion controlling orthoses continue to benefit from them as they get older.” In the absence of symptoms, Dr. Volpe says one must carefully evaluate the structure and function of the foot in order to determine whether the patient should continue orthotic therapy. Q: How do you improve compliance in a child? What do you advise the parent who states the child doesn’t like to wear orthotics? A: For the most part, once children have worn an orthotic device for a brief time, Dr. Valmassy has discovered they actually like wearing it. Parents will commonly return for follow-up visits and tell him children are very consistent with moving their orthotics from shoe to shoe. Occasionally, Dr. Valmassy says patients may have a problem with fit or the hardness of the orthotic. If the problem is a poorly fitting shoe, changing the shoe may make the orthotic feel more comfortable. In regard to the hardness of the orthotic, Dr.