Courtney's Corner Physical Therapy

Courtney’s Corner: Evaluating Your Child for Orthotics

As a physical therapist, I spend a lot of time looking at feet. I observe children’s feet during walking, running and jumping activities, as well as when they are sitting. I do this to evaluate their arches, strength and range of motion. In general, children are born with very flat and chubby feet, but by two years of age, their feet thin out and their arches begin to develop.
Why are flat feet in children with NF1 especially concerning? Children who continue to have poorly developed arches at three to four years of age tend to have an immature walking pattern. Their feet stay far apart while they walk because of the need for a wider base of support, yet they often still have decreased balance. Additionally, individuals with significantly flat feet throughout development are at high risk for long-term hip and knee pain.

Image courtesy of Cascade Dafo

Children with NF1 are also at risk for progressive pes planus deformity, a foot deformity in which the child not only fails to develop an arch, but their foot actually begins developing into an overly flat, or pronated, foot. This condition makes their feet very difficult to position properly, even with the support of a brace. It can cause significant fatigue and pain in the feet and lower legs, and in severe cases, may require surgery.
So, what can we do to help? At the NF Clinical Program at St. Louis Children’s Hospital, we pay close attention to feet! If a child is not developing an arch by three years of age, we will often fit the child with a shoe insert to help support the arch. The biggest goal at this young age is to improve alignment in the feet and, in turn, through the hips and legs as well. This improved position often also decreases the base of support while walking, and improves balance. As a child grows, he or she may need more aggressive support to help prevent an even more pronounced flat foot. At times, it is necessary to use a higher brace, called a supramalleolar orthotic (SMO).
If you are concerned with your child’s foot position while standing, or if your child is complaining of foot or leg pain, contact your health care providers. The answer may be as simple as placing an insert in the shoe.
Courtney Dunn, PT, DPT