Orthotics for kids

[Magali]

My son has flat feet and it's causing his toes to curl under when he walks.  Our podiatrist recommends custom orthotics to correct it.  Does anyone have any experience with this?  My son is five.  We homeschool, so he'd wear his shoes during the day. Until we save up for the orthotics, the Dr. suggests to wear just regular shoes during the day, because some support is better than nothing.

[grahamsmom98]

Are the curling toes causing difficulties when he walks?  Is he in pain?  

Our son, too, wears arch-support orthotics (one flat foot, one with a high arch). He complained of foot pain (when he was 10) and the orthotics have helped with it. They are custom-made (happily, our insurance covers them 100%. But, if not, we'd pay $500, out-of-pocket). We also homeschool. But, really dislikes wearing shoes in the house and goes barefoot indoors. So, he only uses his orthotics in his outdoor shoes. He says his feet feel fine the rest of the time, so this works for him.

He inherited his feet from us (I have incredibly flat feet, dh has incredibly high arches).  My feet have always given me problems (I had severe bunions as a child and had to have multiple surgeries for them when I was 14, lasting over 6 months).  I have had multiple surgeries for Morton's neuromas, as well, as an adult.  My feet are very sad! 

I have had custom-made orthotics and they have always been very uncomfortable for me (and didn't change a damn thing). So, I stopped wearing the custom and switched to an OTC brand available at better shoes stores.  These have been much more comfortable and are inexpensive enough, at $35, to change every 6 months.  Voila, no more foot pain. 

Several podiatrists (and, two orthopedists) told us that orthotics won’t change the way a foot develops. It will do what it will do, orthotics or not. Orthotics will help support the arch and are needed if there is foot pain due to lack of arch support. But, orthotics will NOT change the foot, they only offer support.

I have a few friends that also have flat feet and have no problems whatsoever. They don’t wear orthotics or better quality shoes (I’m jealous that they can get away with wearing strappy little sandals and I must wear my chunky Chacos!).

Many children have flat feet and they only become a “problem” when a doctor steps into the picture and speaks up! Here are some things to look for:

Does your child’s arch re-form when he bears weight and stands on his toes? Does the arch appear when the foot is dangled in the air, as the seat of a chair? Is he complaining about pain? Does your child walk normally (lifts feet up when walking, not dragging; ankles straight, not bowing inward or out; has normal feeling, no sensory issues)?

For curling toes, he may only need something simple to keep his toes in-place, not arch support orthotics.  Does he complain about his feet?

Honestly, unless your child has special needs (walking difficulties that have nothing to do with flat feet), is very overweight or is complaining of severe foot pain from routine activities, I’d skip any orthotics until they were much older. Make sure he has comfortable shoes with toe wiggle room and check them, frequently, for growth wear-&-tear. Give him foot massages in the evening (I’ve yet to meet a child that doesn’t like them!). Listen to your child!

[Magali]

Thank you so much for all of your information and experience!  Initially, we took him to the podiatrist because we were concerned that when he walks and stands, we can't even see tops of his toes...they are curled right under.  Her explanation is that because of the flat feet he doesn't have the muscle support and is compensating for balance by curling his toes under.  The flat feet in and of themselves are fine, but the curling toes could give him pain in the future and I'm really worried about them being stuck that way.  Right now I can straighten them out, but as his feet grow I don't know.  He isn't in any pain, and can move around just fine.   From what I understand, the orthotics are to give support to his feet so he won't have to compensate for balance and curl his toes under.  If it wasn't for the toes, and just the flat feet, I wouldn't have even taken him to the Dr. ykwim?  I like the idea of the massage, and I think I will start doing that.  And, I'll also be really bummed if we spend he money on the orthotics, out of pocket, and they do nothing to help.  

[superspatula]

i would look into the idea of barefoot shoes as well.  the natural gait is supposed to strengthen those muscles.  I dont have any personal experience in any of it but it may do some good to google about barefoot walking/running.

[DariusMom]

My son has incredibly flat feet. His left foot is especially flat. His feet have caused him problems in a few ways. The extreme flatness exacerbates the problems caused by his hypermobility and his legs often hurt, especially after a hard day of playing and running around a lot. We used to think it was "growing pains" but the pain is far more extreme and has lasted for the last 6 years. He is also incredibly clumsy.

Thankfully, our insurance pays for 100% of custom made orthotics every 2 years. They really do help because they give him better balance and stability. He trips less and has less pain in his legs and feet at the end of the day.

The prevailing wisdom here (in N. Europe) was to wait til children are around 6 or so because so many children have flat feet when they're young + flat feet don't necessarily have to cause problems. However, DS' physio sent us to get them when he was 5 because she could see that he really needed them for balance and stability.

What Grahamsmom says is completely accurate: orthotics won't change the foot. They will only help someone have less pain, more stability and balance, etc. with the feet s/he has.
 

[aurora_skys]

Hi there :) I suffered for ten years at the hands of a pediatric podiatrist and felt compelled to offer my perspective.

Your son is only five? How many hours a day does he spend in shoes?

Your podiatrist said "Her explanation is that because of the flat feet he doesn't have the muscle support and is compensating for balance by curling his toes under" But it is important for you to know that orthotics will do absolutely nothing to build muscles strength in your child's feet. They are an expensive crutch and a huge cash cow for podiatrists. They convince you that the child's feet are inherently defective and then continue to sell you new orthotics every year. Orthotics will not strengthen his feet. The podiatrists statement is completely flawed and actually makes no sense. Flat feet in a five year old does not indicate lack of muscle support. 

Flat feet is not unusual or harmful at the age of five, but the toes curling under is a sign of something else. Are both of his legs equal length? Have this checked. Massage therapy, stretching exercises and foot strengthening exercises should be applied daily throughout the next several months and you need to record your son's progress. 

Can your son extend his toes fully when at rest? Can he extend his toes fully while standing? Has he always curled them?

This sounds like a physical therapy issue, seeing a podiatrist is barking up the wrong tree (a tree that is all too happy to soak up your money for years to come). Frankly pediatric orthotics (except in rare cases of physical deformity) are akin to modern snake oil.

I spent ten years in custom orthotics because of my flat feet. The pain they caused my knees, hips and spine was a daily torture. My mother was told that my feet could not support themselves and she believed it. I believed it too for many years. I finally stopped wearing orthotics and almost all shoes at the age of 21. At that time, my arches laid so flat that they completely touched the ground. I was plagued by constant plantar fasciitis pain throughout the time spent in orthotics and afterward which affected my ability to work, participate in most recreational activities, and sleep. It has been five years since I abandoned orthotics and conventional shoes. My arches now rise a fingers width above the ground and the searing pain of plantar fasciitis is years in the past. "Flat feet" is not a terminal, unfixable condition, especially in young people.

I am worried that allowing a podiatrist to put your son in orthotics (and it will be forever, trust me) will set him down the same destructive path. Now is the time to seek out alternative treatments that work with the natural foot and truly strengthen his feet.

[APToddlerMama]

I dont mean to hijack the thread but I'm very curious about the idea that orthotics don't change how the foot develops. My 4.5 year old has them (we had a$500 copay) and he hates them. I've given up making him wear them but feel so guilty because they have told me that if he wears them for a couple years, he won't need them anymore and they've said they will make his feet develop normally. Even his physical therapists who stand to make no money from us having these have suggested them. He has hypotonia and his motor skills are delayed. Do you all think they're still a waste of money? I'm kind of hoping so...

[aurora_skys]

I think for something like hypotonia it is good to intervene so that it can be corrected. There are times when pediatric orthotics are helpful and that seems like one of them. It seems with hypotonia it's good to catch it early and intervene before the foot can deform. There are conflicting schools of thought on it, as you probably know, but it does seem like one of those cases where intervention may be what works best...

But in the case of a normally developing flat footed child I am very suspicious of the use of orthotics.

[Magali]

I've been reading all of your posts, just don't have time to comment.  Lots to think about.  Should have time to reply next week.. Thanks so much!

[dakipode]

Originally Posted by aurora_skys 

orthotics will do absolutely nothing to build muscles strength in your child's feet. They are an expensive crutch and a huge cash cow for podiatrists.

toes curling under is a sign of something else. Are both of his legs equal length? Have this checked. Massage therapy, stretching exercises and foot strengthening exercises should be applied daily throughout the next several months and you need to record your son's progress. 

Can your son extend his toes fully when at rest? Can he extend his toes fully while standing? Has he always curled them?

This sounds like a physical therapy issue, seeing a podiatrist is barking up the wrong tree (a tree that is all too happy to soak up your money for years to come). Frankly pediatric orthotics (except in rare cases of physical deformity) are akin to modern snake oil.

I am worried that allowing a podiatrist to put your son in orthotics (and it will be forever, trust me) will set him down the same destructive path. Now is the time to seek out alternative treatments that work with the natural foot and truly strengthen his feet.

Yes

Orthotics are designed to take over the role that the muscles should be providing but they will not teach the muscles to support the foot properly. The problem is that orthotics are made to support the foot in ONE specific position but the foot is made to adapt and change position during the gait cycle. Pronation and supination aren't bad, issues arise when the muscular system can't properly control them. But when you put an orthotic under a foot to "support" the arch, you're essentially taking away the foot's ability to adapt and change positions. By taking away mobility at one end (at the foot) the body will be forced to compensate elsewhere in the body (knees, hips, pelvis, low back, etc.) and you might unknowingly cause issues there.

Strengthening exercises are a good place to start: picking up marbles with your toes, scrunching a towel with your foot etc. Also try standing pronation and supination (arch your feet and then flatten them out) and go back and forth between the two extremes then start playing with limiting the extremes, i.e. show how much you can control the motion at your feet. Also seated with knees bent, feet flat on the floor, make windshield wiper movements with your feet, sweep them side to side.

A good physical therapist can show you these exercises and more. I believe orthotics should be a last ditch effort to correct something that can't be addressed any other way.

[Magali]

Here are his toes.   This is what he looks like when standing.  He can uncurl them if I ask.  If he tries to walk with them uncurled it is really awkward.  The podiatrist did say that we don't need to rush out and get orthotics asap.  My son is barefoot almost always.  Maybe about 10 hours a week on average he wears shoes.  Any ideas why is he curling the toes under if it isn't because he is compensating for something by grasping with his toes?  Our Family Dr. totally brushed it off, and focused on the flat feet and was all like "he needs orthotics and shouldn't go barefoot".

[philomom]

My daughter wore orthotics for years as a kid. She has JIA, arthritis which caused her one foot to turn out some. The orthotic trained her foot gradually to go the right direction without surgery or serial casting... the latter we did have to do with her knees.

Insurance paid for it. The only biggie was she wore sneakers most of the summer when other kids wore sandals. You always knew which shoes were hers because the orthotics were bright pink in the shoes.

Just going by the pictures, the toes do bother me with your son. As he gets older and heavier he'll put more weight on those toes and they aren't meant to hold so much curled.