Podopaediatrics Group South Wales

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RS Scan junior
Application Mild/Moderate/ pronation
Description EVA med density 3/4
shell. Deep heel
cup.No forefoot post.
2-3 mm Kirby skive.
Theory Kirby STjt axis theory.
Utilizes research
on normal COP curves
Indications 2 Arch heights. N or F
Flexible Paed flat
foot. Mild
Cavoid foot
Contra- Narrow heel
cup Indications
Availability RS Scan.Size 8-13.
Adult 1-13
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Interpod Juniors / Peapods
Interpod soft
Interpod Flex
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Interpod Juniors/Peapods
Application Mild/Moderate/ severe
pronation
Description Soft density shell .
Full length or 3/4
Flex shell 3/4 length.
4,6or 8.

• Theory Utilizes medial wedge
• Facilitates
  Windlass mechanism

Indications Paediatric flexible flat
foot Heel
/Plantar fascia pain
Contra- Inadequate depth in
footwear Indications
Availability Order from Algeos.
Sizes child 9/27 up to
adult 11/12
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Junior F.I.M.S.
5
Junior F.I.M.S.
Application Mild / Moderate/ pronation

• Description EVA med /high density 3/4
  shell.
• 0,3 or 5 medial
  rear foot post.
• Deep heel cup.
  Thin walls.
• Red Right. Blue
  Left.

Theory Heel Cup Theory
Indications Asymmetric conditions
Flexible paediatric
flat foot
Contra- Wide heels Indications
Availability Sizes19/20 to 33/34.
Order from Cannonbury
Healthcare.
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Junior Formthotics
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Junior Formthotics
Application Mild/Moderate/
pronation
Description EVA Med density 3/4
shell
Intrinsic 6-8mm Kirby skive
Deep heel cup.Wide medial flange

• Theory Increased force
  medial to STjt.
• Reduces rear
  foot eversion.

Indications Flexible Paed flat
foot Can be
modified/additions added

• Contra-Indications Narrow heel
• Heavy child

• Availability To order from Mobilis.
• Size J1(8-9.5)
  to J4 (1-2)

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Talar made Orthotics.
Pro - Step
9
Pro - Step
Application Mild / Moderate/ pronation
Description Full length or 3/4 device
Med/high density
EVA. Integrated
0,3,5 posts to rear forefoot
Theory Medial Kirby skive

• Indications Paediatric Flexible Flat
  foot.
• Asymmetry

Contra- Medial heel
irritation. Indications
Availability Order from Talar -Made
Child size 13 - adult
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10
Talar Made Orthotics
Gaitway
11
Gaitway
Application Mild pronation
Description 3/4 length Med density EVA
Deep heel
cup.Integrated 3 post.
Extrinsic posting system 0 or 3 forefoot

• Theory Medial post imposes
  supinatory moment
• No forefoot post

• Indications Mild-moderate paediatic
  flex flat foot

Contra- Heavy child. Indications
Availability Talar made.Child 11-adult
11. Gaitway
slimline available for narrow
petite foot.
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GOLDEN RULE

• It is the responsibility of the clinician to
• 1. To recognise allow for normal development.
• 2.Whilst differentiating between self-limiting
  developmental conditions and significant
  persistent abnormalities.

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ORTHOSES-The Debate

• No high level evidence that orthoses improve
  function or reduce pain.(Whitford et al ,2007)
• Excessive pronation in a flexible foot causes
  failure of normal biomechanics leading to pain
  and dysfunction.(Blake1991,Franco 1987,Pratt1995
  etc.)
• Subotnick(1989) states that 80-85 of the overuse
  injuries of the lower extremity respond to
  biomechanical foot control.

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THE DEBATE

• Whitford et al(2007) found no evidence to justify
  the use of in-shoe orthoses in the management of
  flexible excess foot pronation in
  children.(7-11.)
• Coombs(1996 unpublished M.Sc.)found excessive
  sub-talar joint movement inc. postural pain.90
  subject study across 3 age groups(10-30,31-50,51-7
  0.)

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THE DEBATE

• Orthoses have been demonstrated to have a
  positive effect on MSK conditions (Redmond et al
  2004).
• CASTED OR PRE-FAB ORTHOSES
• -Whitford et al(2007) demonstrated little
  difference in outcome measures.
• -Redmond et al(2004) demonstrated comparable
  mechanical properties in contoured pre-fab to
  custom casted.

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SUMMARY-DO NO HARM

• What children seem to require , following a
  biomechanical examination, is not always what
  they are able to tolerate, or find the most
  beneficial.
• The influence an orthotic device will have on the
  child's foot and symptoms it is prescribed for
  will not be known until it is fitted and then
  worn.
• Orthotic therapy in children should be regarded
  as an ongoing treatment with the need for
  continual review with appropriate modifications
  where necessary.

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A little support may help?
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SUMMARY
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Thank you.
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• THANK YOU