Childrens insoles

What is asymptomatic? Is it no pain? Is it no deformity? Is it no effect on gait/balance/coordination? Is it no pain but a strong familial history of lower limb pain/deformity associated with gait/biomechanical issues that the child also exhibits???

 

Even though she was 16 years old when I made foot orthoses for her, this patient, who sent me the following unsolicited e-mail last week, has worn custom foot orthoses for 19 years, demonstrating how valuable foot orthoses are for many of our patients....children or not.

Even though I hear this type of thing every week, I thought this thread would be a good place to display this note which highlights the therapeutic usefulness of foot orthoses for our patients.

 

I consider underlying biomechanical precursors, a strong family history and a history of early deformity, poor functional skills, pedal and postural fatigue and shoe fit problems when considering treating an asymptomatic patient.

I have not dealt with "flat feet" in decades. I profile all patients and subdivide them into foot types that lead me to the underlying locations of pedal weakness and collapse.

IMHO, "Flat Feet" are for charlatans, RF Varus posters, medial skivers, TSers and EBM experts with little or no EBM. Waiting for problems and evidence while the child in front of me is led to a lifetime of suffering is just not a logical process for me.

Foot Typing, in opposition, with anecdotal EBM, leads the way to prevention, performance enhancement, quality of life upgrading and improved outcomes.

Dennis

 

Just see the first image of your web site : a big bulky shoes (rigid, more than 10mm drop, high stack, TRC rating of 50) : It is TOTALY unethical to give this type of shoes to asymptomatic children!!!!!!!!!!!

 

There are two overwhelming factors that are being overlooked here by both camps.
Gravity (imagine how important podiatry would be on on Jupiter) and underlying natal, foot type-specific biomechanics.

Gravity is Newtonian and all feet are not alike biomechanically. Some are destined for more problems than others. Gravity is a constant but foot structure and function differs.

Neither camp can overcome gravity in all cases, for all feet.

Neither camp can overcome severely dysfunctional biomechanics in all cases, for all feet.

What I see happening is that both sides are focused on pointing out each others failures when debating rather than look at their successes in ordr to grow the body of our biomechanical science . This false debate tactic then implies that theirs is better, or even worse, flawless when neither actually is and makes both sides look bad.

There are foot types that will never be "saved" by a heel or a zero drop. That's why we have reconstructive foot surgery.

There are feet (the rigid RF types) that predictably do better in a 10mm drop heel or higher than a zero one.

There are feet that with a sensible break-in period become internally stronger positionally and functionally in a zero drop, Midstance or FF Contact ambulation lifestyle.

However, on both sides, there are feet that are so dysfunctional in both the RF and/or the FF that regardless of the heel height or gait pattern they attempt, they get callused, stress fractured, deformed, degenerated and weaker over their lifetime.

I fabricate Barefoot Trainers as well as Foot Centering Props for those unfortunate individuals in both camps as I assist them in making lifestyle adjustments that logically and anecdotally offer them healthier biomechanical timelines because I am reducing the negative impact of gravity on their structural and functional equilibrium.

Statements that there are more stress fractures with "barefootin" and warnings on the dangers of zero drop shoes coming from "experts" who feed their families on the injuries that conventional shoes produce overlook the biomechanical structural and engineering problems that all feet and postures encounter on a case to case basis.
I suggest we would serve the foot suffering public and asymptomatic flat feet better if we focus on all the architectural and engineering both sides have in common.

Dennis

 

:bang:

We are talking about treating symptomatic kiddies, or kiddies that are expressing pathology due to pathomechanical foot function. I have seen lots of children with changes over the metatarso-cuneiform joints with pes planus. Should i tell them to walk barefooted?

 

Gentleman, Pease let us clear the air.

1) Treatment of Symptomatic kids; surely no one of sound mind is going to argue with this in terms of mechanical intervention. "Pain - intervention - pain goes away" - no worries.

2) Treatment of asymptomatic kids - well that is a whole different ball park that invokes huge issues in medical ethics. First to have to show - to Cochran Standard - that you are doing only good, and also, that you are doing no harm. Second, you should be able to refer to the systematic reviews (back to Cochran again) that support your stance in treatment. Can you?

 

QUOTE=Blaise Dubois;306011]Just see the first image of your web site : a big bulky shoes (rigid, more than 10mm drop, high stack, TRC rating of 50) : It is TOTALY unethical to give this type of shoes to asymptomatic children!!!!!!!!!!![/QUOTE]

What are you looking at Blaise............the brown ankle boot at the top? or the black one bar? or maybe the runner?

l just want to be clear before l reply

 

I respect your titles, your age, your 20+ year old article on the biomechanics of the diabetic foot. I respect your opinions and your comments and critique of the opinion of others.

You are not clearing the air with this posting. IMHO, you are voicing the opinion of a seasoned expert in EBM, research and hard science which has little to do with clinical medicine and which frankly has little authority when it comes to asymptomatic juvenile flat feet.

You work to "Cochrane Standard", I do not. Your standard allows for sacrifice, collateral damage, cold and callused insensitivity to your fellow man and many other "seemingly uncaring" qualities that are not supposed to trump the art and science of caretakers and healers like me from practicing our callings.

Cochrane level Studies impersonally deny half of the cohort from drugs that will potentially cure them of incurable cancers. Which group would you place your son in?

As a rude awakening, Dr Kidd, Healers sometimes do harm as part of our collateral damage as we try to help every patient we sit in front of! We do our best to limit the level and intensity of harm and we weight that to the overall good that we do for our communities and humanity.

Sackett tried his best to keep you from being the judge and jury of Evidence Based Medicine because if left unchecked, medicine would end its artistic nature. It would stop depending on the opinions of experts, teachers and textbooks. It would make all healers peer regarding the physician just out of schools the same as a 40 year practiced professor. He wanted to offer his community and mankind better medicine. His goal was to allow medicine to expand safely and scientifically while never forgetting the patient and the practitioner as you seem to have. His goal was never to eliminate healers causing harm. His goal was never to stifle and smother prevention, performance enhancement, quality of life upgrading and in the podiatric sense, foot and postural suffering mandating Cochrane Level Studies as a prerequisite to care. His goal, IMHO was to make us better healers and to improve the health, performance and comfort of mankind.

When you unwaveringly state

Learned professor, when it comes to diagnosing and treating asymptomatic (no pain, no localized or compensatory complaints) flat feet and Cochrane Level Studies and your stance on the subject. Can you?

Hypothetical Dr. Kidd:
You and your son (and your grandson or daughter) have flat type feet (see photo).
You have been a poorly competitive athlete your entire life. You have had foot fatigue, weakness, postural complaints and lower back problems and seen them worsen as you have aged. You have always had a hard time wearing the stylish shoes of your generation. You have had a left knee replaced and you have stopped taking long walks with your wife.

I explain that there are inherited biomechanical pathologies related to your son's natal foot type that are most likely going to progress because of gravity, hard ground and hard shoe boxes just like you. I reveal the weaknesses in your child's rearfoot and forefoot using a functional foot typing and a foot centering pad test drive in real time. I reveal closed chain weakness in his PT and PL muscle engines that are inhibited even though asymptomatic, in real time.

I admit that there are no Cochrane studies on the subject. I interject that the existing low level evidence backed with my personal experience dictates that I would like to hold your sons foot in a less collapsed position (more optimal) using the best science available and then add exercises and lifestyle adjustments as I remain available professionally to ensure that "we will do no harm" to Billy.

I discuss the existing plan and how we intend to monitor improvement along with a time frame and a reasonable set of expectations to achieve.

I add that I am practicing this for 42 years and that my personal experiences backed by testimonials of pleased children, parents and grandparents make me a well selected person to consider working with until actual evidence either for or against treating asymptomatic flat feet surfaces from famous researchers the likes of Kidd, Spooner, Nester, Dananberg, Payne, Esquinazi, Nigg and Mentz.

Do you get up with your son and leave stating that I have no "Cochrane Level Studies" and that you are concerned that I will do him harm or do you invest in my care?

Which gift, based on your expert opinion, your life experience and the current valid and applicable evidence at your side do you gift your child with?

Hypothetically.

Dennis

 

What are you looking at Blaise............the brown ankle boot at the top? or the black one bar? or maybe the runner?

l just want to be clear before l reply[/QUOTE]

A Shoe for every foot

 

A Shoe for every foot[/QUOTE]

You also said "Just see the first image of your web site : a big bulky shoes (rigid, more than 10mm drop, high stack, TRC rating of 50) : It is TOTALY unethical to give this type of shoes to asymptomatic children!!!!!!!!!!!"

Okay we will start by letting you know that that is a Mens X-Trainner size 10, by Vasyli, its not a child shoe, assume nothing Blaise.

l will also tell you it is a very light weight Pylon sole,

l will also tell you that heel drop is an incorrect term applied by the uneducated, we are talking about footwear, it is heel pitch, a term given about 200 yeas ago, it doesnt need a new name.

 

You also said "Just see the first image of your web site : a big bulky shoes (rigid, more than 10mm drop, high stack, TRC rating of 50) : It is TOTALY unethical to give this type of shoes to asymptomatic children!!!!!!!!!!!"

Okay we will start by letting you know that that is a Mens X-Trainner size 10, by Vasyli, its not a child shoe, assume nothing Blaise.

l will also tell you it is a very light weight Pylon sole,

l will also tell you that heel drop is an incorrect term applied by the uneducated, we are talking about footwear, it is heel pitch, a term given about 200 yeas ago, it doesnt need a new name.[/QUOTE]
Can you give me the indication for that type of shoe?

 

I just had another pediatric flatfoot patient come into my office yesterday who I first saw for painful feet and legs at the age of 7, and now, 9 years later, he is taking college prep courses (says he is pre-Medicine) as a junior in high school. He was being evaluated and casted for his fourth pair of orthoses from me yesterday and, when I asked him how he liked them, he said: "I love my orthotics. When I wear them I can run, walk and stand with no pain. It is nice to have no pain because, when I don't wear them, I do have pain."

Should I have waited until he was 8 or 9 or 10 years old to treat him? Of course not. The parents wish they could have had me see him sooner, before he was 7, since he was having symptoms since the age of 4 related to his pediatric pes valgus deformity.

Those who don't treat children with symptomatic flatfeet and haven't directly seen what correctly made foot orthoses can do for a child's life have no business telling us, who do have this wonderful clinical experience, that we shouldn't be treating these children with foot orthoses.

It simply amazes me how some people who are so ignorant have so much to say to those of us who heal these children's pain day after day with foot orthoses and, to top it all off, then have the arrogance to preach to us about how we are doing things so wrong. Amazing!

 

Hi Kevin,
I'm not sure if you think I have an agenda, (which I don't) I was just trying to explain my thoughts on this sometimes divisive issue. I greatly respect your experience and the success you have no doubt had with many cases. I have a general practice but see many children, so whether to treat or not is always at the forefront of my mind.
Regards,
Matt

 

Matt:

I do not think that you are the one on this thread that has an agenda. I thought all of your comments were very reasonable.

Treat the children in your practice like they are your own children. That has been my treatment guidance principle for children in my practice for the past 28 years.