Expert Insights On Prescribing Pediatric Orthotics

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In his experience, Ronald Valmassy, DPM, notes that once children have worn an orthotic for a brief period of time, they discover they actually like wearing it.
Here one can see a motion controlling device with a deep heel made of polypropylene. This type of shell will reduce biomechanical compensations and the deep heel seat will increase natural cushioning of the heel by maintaining the fat pad under the calcan
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Author(s): 
Guest Clinical Editor: Eric Feit, DPM

   For children under 8 or 9, Dr. Jay not only creates a cast in the neutral position but holds the foot in the corrected abducted position at the same time. As he explains, this stabilizes the calcaneus in its neutral 0-degree position and abducts the forefoot on the rearfoot, reducing the metatarsus adductus deformity. The result is a negative cast of the foot in a corrected abducted position. Dr. Jay subsequently sends this to the laboratory with instructions to create an orthotic with a deep medial and lateral phalange, and a deep seated heel in a 5-degree rearfoot post.

   Since children older than 8 or 9 usually have a prominent fifth metatarsal base, Dr. Jay advises cutting out the first metatarsal base area of the phalange in order to prevent any irritation or abutment into the orthotic.

Editor’s Note: The second part of this column will appear in the April 2005 issue of Podiatry Today.

Dr. Feit is a Fellow of the American College of Foot and Ankle Surgeons, and practices privately in San Pedro and Torrance, Calif. He is the Past President of the Los Angeles chapter of the American Diabetes Association.
Dr. Jay is a Fellow of the American College of Foot and Ankle Surgeons. He is a Professor of Foot and Ankle Surgery at the Temple University School of Podiatric Medicine, and is board-certified in foot and ankle surgery. Dr. Jay practices at Cumberland Orthopedics in Vineland, N.J.
Dr. Kashanian is a Diplomate of the American Board of Primary Medicine and Podiatric Orthopedics, and is a consultant for ProLab Educational Institute. She is also in private practice in Northridge, Calif.
Dr. Valmassy is a Professor and Past Chairman of the Department of Podiatric Biomechanics at the California College of Podiatric Medicine. He is a staff podiatrist at the Center for Sports Medicine at St. Francis Memorial Hospital in San Francisco.
Dr. Volpe is a Professor in the Departments of Pediatrics and Orthopedics and Chair of the Department of Pediatrics at the New York College of Podiatric Medicine. He has a pediatric foot and ankle specialty private practice in Farmingdale and New York, N.Y.

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