Should you be recommending children’s orthotics?

There is now a significant body of evidence showing that children access complementary medicine care at increasing levels.

According to the Center for Disease Control & Prevention Control (CDC), approximately 12 percent of American children had accessed some form of complementary health care in 2012.¹

More specifically, approximately 3.3 percent of these children were under chiropractic care in 2012. This translates into slightly less than 2 million children who saw a chiropractor at some time in 2012.¹

What might these statistics mean to you, as a practicing DC?

First off, it will not be unlikely for you to see a number of pediatric patients in your practice. In particular, problems with gait and foot growth will be one of the most common reason parents bring their children to your office. There’s a sizeable body of research stating that such foot problems must be caught as early as possible, while it is still easy to correct them, to avoid more serious problems later on in adolescence, and even into adulthood.^2,3

It should be self-evident, based on this, that offering pediatric orthotics is a great way to provide care to your younger patients, as well as improve your bottom line.

Common signs of pediatric foot and ankle problems

Toes pointed too far in or out: Although this is relatively common in toddlers just learning how to walk, most children will straighten out their gait by about age six. If this is not the case, orthotics may be needed to straighten out the toes before the abnormal gait becomes habitual and places stress on the ankle, knees, and hips.

Flat feet: This occurs when there is either none, or very little, arch to the bottom of the foot. A good indicator is whether or not you can slide your index finger past the first knuckle underneath the arch while the child is standing. This can also occur with the entire foot rolled inward our outward. (hyperpronation).

Bowed legs or knock knees: Hyper-pronation can also lead to either bowed legs (in which the knees roll too far outward) or knock knees (in which the knees roll too far inward). If you look at the angle of the Achilles tendon, it is easy to spot this condition.

Special considerations

Abnormal shoe wear: The amount of wear on the shoe soles can often give important clues to possible foot problems. For example, if the heel of the shoe is more worn on the inside, this may very well indicate inward pronation of the feet. If the toes of the shoes are worn the most on the outer edge of the sole, this may indicate that the child is pointing their toes outward as they walk.

Compliance: Children may balk at the thought of wearing orthotics, particularly as they get older and their appearance becomes more important to them. It will certainly be easier to convince a child of the value of orthotics if one or the other parents has used them, which may not be uncommon due to the genetic component of the foot structure. Have the child start slowly easing into wearing the orthotics to avoid irritating the foot. This is particularly important if the child participates in sports activities that depend on being able to move at high speed, such as baseball, basketball, or track and field.

Caring for pediatric patients is definitely more than just addressing neck or shoulder pain. Correcting abnormal gait as early as possible with the use of orthotics will help prevent a host of other musculoskeletal problems later in life.

References

1. Black LI, Clarke TC, Barnes PM, et al. Use of complementary health approaches among children aged 4–17 years in the United States: National Health Interview Survey, 2007–2012. National Health Statistics Reports. 2005 Feb 10; (78).
2. Schuster RO, Skliar JD. Outgrowing trends in the lower extremities of children. Journal of the American Podiatric Medical Association 1991;81(3):131-135.
3. Sass P1, Hassan G. Lower extremity abnormalities in children. American Family Physician 2003 Aug 1;68(3):461-8 [Erratum in American Family Physician 2004 Mar 1;69(5):1049].
4. Feit E (Ed.). Expert insights on prescribing pediatric orthotics. Podiatry Today 2005 Feb;18(2).