A Comprehensive Review Of Pediatric Orthoses

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How Shoewear And Activity Levels Come Into Play

While shoewear can make orthotic prescriptions challenging for adults, shoes are rarely an issue when prescribing pediatric foot orthoses. Whether children are at school or at their leisure, they usually wear sneakers. Sneakers are frequently ideal environments for motion-controlling orthoses. The deep, firm counter and midsole, wide shank, roomy toe box and removable insole found in most sneakers make fitting controlling devices easy, eliminating one of the most troublesome problems when prescribing orthoses.
However, children who wear “school shoes,” often part of a required uniform, may benefit from a low-profile orthosis design. In these cases, modifications — such as extrinsic forefoot posts, full-length top covers and longitudinal arch fillers — that increase the bulk of the devices should be avoided whenever possible.
Children who participate in organized sports will often require devices selected for the demands of sport. The shell material should be more flexible and forgiving for the athlete’s foot. A Langer All-Sport device is an excellent choice for cross-training or children who are involved in a variety of sports. When your patient is dedicated to a particular sport, you should consider modifications and soft-tissue supplements designed for the needs of that sport.
An example of this is the Langer Soccer Sporthotic. This device, made of a thin, highly controlling composite shell, offers several key benefits:
• an intrinsic rearfoot post to improve fit in shallow-counter cleats;
• a cushioned heel insert for increased shock absorption; and
• a sulcus forefoot post with a first ray cutout to encourage plantarflexion of the first ray.
Using such a device can help manage forefoot deformities in a sport in which heavy forefoot demands are intrinsic to the way the game is played.

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In a study of 50 children, Jay and Schoenhaus, et. al., found that using the Dynamic Stabilizing Innersole System (DSIS) resulted in a statistically significant correction of hyperpronation.
The Dynamic Control Orthosis consists of a custom functional foot orthosis, a hinged ankle joint and custom molded medial and lateral leg uprights to control superstructural movements.
Using the Langer Soccer Sporthotic can help manage forefoot deformities in a sport in which heavy forefoot demands are intrinsic to the way the game is played.
A Comprehensive Review Of Pediatric Orthoses
A Comprehensive Review Of Pediatric Orthoses
46
Author(s): 
By Russell G. Volpe, DPM

Treatment Tips For Ankle Equinus
The fully compensated equinus foot, often characterized by pronation of the subtalar joint with consequent unlocking of the oblique midtarsal joint axis to allow for dorsiflexion and abduction to occur at the midfoot, is a major cause of pediatric pronation. It may be a primary cause or an aggravating factor that produces significant adverse effects on the foot.
Childhood ankle equinus may be developmental or pathologic. Developmental equinus typically accompanies a rapid bone growth spurt, resulting in relative shortening of the muscles. If you re-evaluate the foot and it has not shown improvement after four to six months, a pathologic equinus is likely. Pathologic equinus may be congenital or result from other etiologic causes. Developmental and pathologic equinus both exert detrimental forces on the foot, either initiating abnormal pronation or aggravating pronation already present in the child.
In addition to stretching the tight musculature, orthotic control of the abnormal midfoot is usually necessary. Adding heel raises to an orthotic device to plantarflex the foot and increasing the amount of available dorsiflexion of the ankle for midstance are effective at helping to reduce compensation in this foot type. In addition, the presence of equinus may limit the degree of control that can be tolerated by the child. If this is the case, selecting a more flexible, forgiving shell may be a better choice for the equinus patient.

Why The UCBL Is Good For Moderate To Severe Pronation
Podiatrists should also be well versed on pediatric speciality devices that can have an impact in treatment.

One such device is the UCBL, a polypropylene foot orthosis with high medial and lateral flanges and a deep heel cup. The flanges extend just proximal to the first and fifth metatarsophalangeal joints.
First developed in 1967 by Henderson and Campbell at the University of California Biomechanics Laboratory, the UCBL is the device of choice for the pediatric patient with a moderate to severely pronated foot as it enables you to apply corrective forces to the rearfoot, midfoot and forefoot. The extended flanges resist forefoot abduction and talar adduction often associated with moderate to severe pes valgus.
The UCBL is also an excellent choice for treating pediatric patients with a pes valgus complicated by conditions such as Down’s Syndrome and equinovalgus foot associated with cerebral palsy.

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