Foot Orthotics for Children

Children's Feet

The foot is a complex structure of 26 bones and 35 joints, held together and supported by scores of ligaments. Children begin to walk at anytime between 8 and 18 months of age. Most toddlers are flat-footed when they first start walking and won't achieve heel toe walking until the age of 6 or 7.

Why do foot problems start?

The sole of a normally developed foot has an arch, called the medial arch, formed by the shape and position of the bones supported by muscles and ligaments. In a young child feet appear to be flatter as the medial arch is less well developed.

As your child masters walking the medial arch begins to appear. By around 6 years of age, your child should have normal arches in both feet. Many children who appear flat-footed have a normal arch but flatten it when they stand. This movement is called 'pronation' and if it becomes excessive may cause painful symptoms and make the child tire easily.

In this case orthotic devices may be useful to improve the foot posture and relieve painful symptoms.

The problem

The arches of children's feet tend to be lower due to the fact that the heel bone is not yet fully developed. This is most noticable on the inner side of the heel. As a result when many children walk the heel tends to roll towards the inner side of the foot(excessive pronation). Whilst this occurs children describe symptoms of fatigue and aching within the foot, leg, and around the knee. These symptoms are sometimes described as growing pains but it often indicates instability of the foot. If the heel bone tends to lean towards the inside symptoms can become increasingly painful and the foot is more likely to develop problems in the future.

All toddlers have flat feet because of a low angle of calcaneal inclination, by five to six years this angle has increased, and in most cases, a medial longitudinal arch becomes apparent.

Inclination of the calcaneus is vital to the foot, because if there is a reduced or negative calcaneal inclination the plantar aponeurosis will be lengthened, the windlass mechanism will not occur, and the foot will not achieve supination at the propulsive phase of the gait.

The most significant feature of pediatric pes plano-valgus (pathological flat foot) is medial bulging in the area of the talonavicular joint. The medial longitudinal arch is usually low, but not always completely absent. A collapse of the mid-tarsal joint indicates that the calcaneus has been forced to rotate posterolaterally under the talus. The talus will assume a more medial and vertical position as the sustentaculum tali loses its supporting position beneath the neck of the talus. These changes render the foot ineffectual at withstanding the forces of ground reaction, which are highest at the propulsive phase of the gait.

The Concept

Early treatment is vital, for if a child continues to walk on this foot type, the condition rapidly becomes irretrievable. Control of the child's foot needs to be achieved quickly and comfortably by utilising a triplanar wedge directed against the talonavicular bulge and medial arch, which will increase the calcaneal inclination angle. As the calcaneus is dorsiflexed it will also adduct, restoring talo-calcaneal congruency.

Restoring alignment in this way helps to maintain the stability of the foot. Support of the foot also controls the internal leg rotation associated with subtalar joint pronation and thereby reduces other symptoms such as knee pain (e.g. Osgood Schlatters disease). Prevention of the of the collapse of the medial arch will reduce the strain on supportive ligaments and other soft tissues, thereby allowing the patient to enjoy running and walking whilst remaining symptom-free.