Childrens insoles

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I wanted advice on anti pronatory insoles that can be accommodated in Clarks girls school shoes. Pre fabricated insoles such as Vasyli are too deep to be accommodated in the rather shallow girls shoe. Any advice would be appreciated.
Thank you
Bonnie

 

Hi Bonnie

Where are you based, where you are I hguess depends whats available in the market for pre- manufactured , are you able to make your own ??

 

Hi Bonnie
Never like to use Pre Fab insoles such as Vasylis in childrens shoes.Getting good results with low profile Eva with MHW and arch support in combination.

Mark walbank

 

I am based in the NHS, and we order in insoles from commerical firms
Bonnie

 

Bonnie, the problem may well be the style of the clarks shoe?

Maybe they can replace the shoe for a more accommodative style?

The prices look very cheap http://www.clarks.co.uk/c/kids-school-shoes

 

wrong button, sorry admin

 

Hello Bonni
I think the problem is risovibile using a shoe designed with a removable footbed, with a strong rear greater than that of clark. This is to improve the stability of the heel and foot orthosis afford to do a job properly. if the foot is too long, simply looping it and then mark it on the tip, eifilare with the scissors.
Ciao
Giovanni

 

kiddythotics from Algeos

 

Can you enlighten me on
1. the good reason to make a orthoses to a child.
2. How many % of this population need orthoses.
3. Is there evidence supporting the use of orthotics.

 

There is as more evidence for foot orthotics in painful flatfoot in kids than there is for minimalism in kids to treat it. See the Cochrane review and most recent systematic reviews. The evidence is weak (due to flawed nature of most of the studies), but it is stronger than evidence for minimalism, which I can see no Cochrane reviews on. Should not a clinician do what the evidence tells them to do? I go where the evidence takes me.

I have a case at the moment of a 6 yr old with an FPI of 9 (ie flat); can't walk more than a few hundred meters without "pain" in the foot. She does heaps of minimalism - barefoot around home most of the time; gymnastics and ballet 2 x a week (so the msucles are really strong)- how is minimalism supposed to help? Foot orthotics are going to give an instant relief for that pain. Are you saying I should not use foot orthotics?

 

I am entirely sure you are correct. It is the use of orthoses in asymptomatics that concerns me - but you knew that.

 

I will be very carfull to draw conclusion from this flimsy evidence and transfer to general population some specific finding
So if we agree there is flimsy evidence that orthotics works for painful flat foot in kids.
2. This population represent how many % kids ?
3. how long... what the science tell about that. (don't tell me all "the entire live" because is working on some month of follow-up... if it's the case I will refer to the "Rehabilitation for ankle fractures in adults" Cochrane review

From Cochrane (Just for the info of those that never read well the articles):
Three trials involving 305 children were included in this review. Due to clinical heterogeneity, data were not pooled. All trials had potential for bias.
- Data from one trial (40 children with juvenile arthritis and foot pain) indicated that use of custom-made orthoses compared with supportive shoes alone resulted in significantly greater reduction in pain intensity (mean difference (MD) -1.5 points on a 10-point visual analogue scale (VAS), 95% CI -2.8 to -0.2; number need to treat to benefit (NNTB) 3, 95% CI 2 to 23), and reduction in disability (measured using the disability subscale of the Foot Function Index on a 100mm scale (MD -18.65mm, 95% CI -34.42 to -2.68mm).
- The second trial of seven to 11 year old children with bilateral flat feet (n = 178) found no difference in the number of participants with foot pain between custom-made orthoses, prefabricated orthoses and the control group who received no treatment.
- A third trial of one to five year olds with bilateral flat feet (n=129) did not report pain at baseline but reported the subjective impression of pain reduction after wearing shoes. No adverse effects were reported in the three trials.
Authors' conclusions:

The evidence from randomised controlled trials is currently too limited to draw definitive conclusions about the use of non-surgical interventions for paediatric pes planus. Future high quality trials are warranted in this field. Only limited interventions commonly used in practice have been studied and there is much debate over the treatment of symptomatic and asymptomatic pes planus

 

Exactly what I said ... limited evidence! (and that Cochrane review is 3yrs old now; more recent systematic reviews have more data included)

Still substantially more evidence than minimalism! Why are you demanding evidence for foot orthotics, but not demanding the same evidence for minimalism from those that promote it?

How do you think I should treat that 6yr old girl mentioned?

 

I treat foot problem with orthotics also!
I ask for evidence because we do an intervention (using a device)... I don't ask you evidence for not using orthotics! ... same thing for the shoes... same thing for medication...

Hope you don't prescribe orthotics to every flat foot... for prevention... for long term...

I have an interesting cas : a 12yo girl with orthotics and BBS that consult me for recurrent foot pain. I take off all this interference gradually and she is now more active, less pain, and more barefoot and minimalist.

 

Blaise, do you think that the orthoses prescribed to this pt might have been inappropriate? Unfortunately foot orthoses aren't always made/prescribed by clinicians knowledgeable enough to prescribe. I think the saying is 'you shouldn't throw out the baby with the bathwater', mark

 

My opinion: any prescription of orthotics on long term for kids with no foot pain (especially in prevention or to correct a 'supposed' abnormal biomechanics) is inappropriate !! Even by one of my friend, colleague, .....

 

And again where is your evidence that barefoot/minimalism is a valid treatment for ANY foot condition?

Where is your evidence that barefoot/minimalsim treats or PREVENTS any flatfoot condition?

Blaise welcome back, these boards wouldn't be the same without your straw man arguments promoting a dying FAD! Your N=1 case is laughable.

I agree with the idea of finding a more supportive shoe and working from there.

 

I'm sorry, where did you state that this was the case with your 12 y/o pt? confused

 

My 12 yo girl had a orthotic since 9 yo because flat foot and pain initially (she come from Australia)... it was helpful but since 2 years pain came back gradually and now it's worse than before... and she has orthotics... so we have the choice to change it (renew with better one, make by a podiatrist)... and to increase the support... and to tell her that she needs bigger shoes... and you know what? For each new interventions she is better for some weeks. Now the shoes are so big and the orthotics so corrective that we cannot go further... Hummmm

 

The main objective whether adult or children is to find out the genesis of the tissue stress. Solving this may mean an orthosis or may not. Precluding an orthosis as a tool for treatment due to bias is asinine. Treating with an orthosis without knowing the genesis of the tissue stress is equally asinine.

 

agree,
I will add :
... we need to considered the tissue adaptation in the equation...

 

I think, insoles should not be prescribed for children for at least eight years old!

 

Fereshteh

Can you please explain your rationale here?

Regards

Scott

 

what if the patient under 8 years old is in pain and orthoses would help?

 

I think you don't know what you are talking about!!

 

Do YOU know what you taking about !!!

 

Yes, Blaise, I do know what I am talking about.

I have treated children with foot orthoses for 29 years now, from using felt padding in early walkers to modified over-the-counter (OTC) orthoses to custom foot orthoses from the ages of 3 and upwards. I've never seen any problems with foot orthoses in children under the age of 8. During the last 29 years, I have probably treated about 1,000 children in that age group either with in-shoe padding, modified OTC foot orthoses and/or custom foot orthoses.

In addition, my residency director, Ronald Valmassy, DPM, who trained me during my student years and during my Biomechanics Fellowship on pediatric foot biomechanics and pathologies, and who has even more experience in treating children than I do (and is recognized as one of the leading authorities in treating chlldren's foot and lower extremity problems) had no problems either in treating children under the age of 8 with custom foot orthoses. In addition, both Drs. Merton Root and John Weed, both professors of mine, routinely prescribed custom foot orthoses for children under the age of 8 and never reported problems with custom foot orthosis use in this age group.

Now, Blaise, let's talk about you. How many children under the age of 8 have you made custom foot orthoses for? Let's see how your vast experience in treating these children, and following them up for years until adulthood, stacks up to my experience and the experience of my professors who wrote the books on foot and lower extremity biomechanics and foot orthosis therapy.

I know the answer, Blaise, I've already heard your tired little song over and over again. You have little to no clinical experience in treating these young people with foot orthoses but just think that all foot orthoses are evil, should only be used short term and that foot orthoses somehow weaken the feet. You will say that these children with painful symptoms due to excessive subtalar joint pronation moments simply only need to wear a minimalist shoe and all their problems will be solved. What a joke.

Blaise, please read this book chapter that I wrote over two decades ago with Dr. Don Green (yet another podiatrist considered an expert in pediatric flatfoot surgery and the treatment of children's foot problems), that describes the conservative treatment of pediatric pes valgus deformity (Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992).

Time to get educated, Blaise.

 

Nice to hear from you again
I will be very quick: show me the evidence!!!!
Time to have a little more rigourous

 

Show me the evidence that using foot orthoses in children under 8 years old does any harm, Blaise.

Time to be a little more rigorous than just playing the same old "Big Bulky Shoes Are Bad-Orthotics Make the Foot Weak-Minimalist Shoes Cure Everything" song again.

 

Saw a "new" Simpsons where minimalist trainers got a mention , not sure if Homer's disapproval of them is a good thing it was a kind of skit on urban cool in the States, not sure if such things have spread to the UK or if they have they have passed me by

 

Researching the need/effectiveness/outcomes of orthoses in assymptomatic kids as Robb Kidd is concerned about delves into subjects like prevention, performance enhancement and quality of life upgrading that are more difficult to prove than factors like pain or a presenting complaint which themselves remain unproven at highly applicable and valid levels.

One either senses that Wellness and getting feet "better" have a biomechanical place or not. However, there is no evidence verifying that improving overall biomechanical health along with treating complaints is a waste of time.

Can The Arena come down to earth and admit that the evidence related to orthotics is poor quality, low level and not convincing enough to draw mandates, dictum's and unwavering practice paradigms on either side of many of our debate subjects.

Personal opinions and experiences, strong numbers of followers and childish bullying and personal attacks will not make either sides debate right or wrong. Consider the correct debate position of those scientists who believed the earth to be round and how they were treated by the wrong majority in futile debate that delayed growth and change.

These pages confirm that low level evidence reflecting a different opinion to the faithful are forcefully vilified as useless and worthy of extinction while low level additions to the literature that are favorable to TS, subtalar joint axis theory and metatarsal length rather than pressure patterns, etc. are praised beyond merit. This is especially dangerous to students or to those undecided about their biomechanics.

As a scientist and clinician, I am quite comfortable in using Sackett's EBM principles to state that following poorly conceived evidence that merely points a finger in one direction does not validate application into practice as strongly as PA promotes.

No evidence compared to weak, low level and biased evidence sit on a relatively equal plane for me and other free thinkers, until proven otherwise.

My position for Robb Kidd to consider experiencing, with wellness in mind is that certain foot types that are destined to develop collapsed feet and postures should be diagnosed and treated aggressively with custom foot beds/ORF's and MERF's in order to reduce/prevent or reverse their inherited biomechanical fate, until proven otherwise.

If you can't prove me wrong (or please do), I'm not sure why you wouldn't consider visiting prevention in cases of youthful feet that are genetically destined for a lifetime of suffering.

Pardon my use of sarcasm but do you have something better to do while waiting for their pain and suffering to present to your clinics or for the high level evidence that you hint exists to actually surface?

Dennis

 

Show me the evidence that assess the side effect and potential harmful effect of the orthotics for children on long term...

So with your lack of rigour and reflexion, I suppose you agree to give an antibiotic for treating hypercholesterol because there is no evidence showing is bad... or casting a hand for biceps hypertrophy because no evidence show is no good... or... ... ...

 

Blaise, you are so predictable.

Blaise, since you seem to think you are such an expert on the matter, answer these two questions:

1. How many children under the age of eight have you treated with custom foot orthoses for their painful pathologies?

2. How many children that you have treated with custom foot orthoses for their painful pathologies have you followed long term into adulthood?

I won't hold my breath waiting for your answer, Blaise, since I believe I already know the answers: 0, 0.......

 

How many people I gave antibiotics for hyper cholesterolemia? : 0
... And I can say with confidence that it's a bad treatment

So can you give me ONE piece of evidence about side effect one long term?
I realize that your practice seems flimsy, not evidence based and based on your own experience... and if it's OK for yourself, fine... but try to convince the world that you are the only one right...

so... I was asking you for EVIDENCE

 

Jesus H why do we have to continually put up with Blaise's snot-nose brat "I know you are but what am I?" drivel. He hasn't added anything of value (nor any evidence that is factual) to this academic board since day 1. Call me out if you disagree but please provide the thread where he substantiates ANY of his claims and doesn't just play Devil's advocate for profit.

Last I recall Blaise you had your keester handed to you on another thread and abruptly departed. you should have stayed gone, your career in BS has peaked early. Clean out your dogmatically biased mind and read the volumes of current research shooting large holes in the BS you and your "natural buddies" are vomiting all over cyberspace.

I predict a really bad year for barefoot/minimalism based on what I have read thus far.

Goodbye Blaise; 'click' :empathy:

 

Let's try again, Blaise:

1. How many children under the age of eight have you treated with custom foot orthoses for their painful pathologies?

2. How many children that you have treated with custom foot orthoses for their painful pathologies have you followed long term into adulthood?

Imagining things in your own mind is very different than having 29 years of clinical experience of seeing, first hand, the excellent clinical results of correctly made foot orthoses on painful pediatric foot and lower extremity pathologies. I thought even you would know that.

 

No evidence?

 

No clinical experience in treating children with foot orthoses, no training in foot orthosis therapy, no clinical experience in following children long term into adulthood with foot orthosis therapy? However, you seem very full of confidence that you are right and all podiatrists are wrong about their positive clinical experiences with foot orthoses for children?

Do you actually have something you can teach us, or is it all about you trying to elevate your status relative to podiatrists by criticizing them, when you have no clinical experience in what they do?

Like David said, Blaise, when will you finally add something of value to Podiatry Arena?

 

What I find really annoying is Bonnie initially asked for practical advice on foot orthoses & footwear & the discussion got hijacked YET AGAIN, by Blaise. Blaise please go & argue somewhere else. I have also practiced for many years, have seen many children (not as many as others on this site) & followed them & their subsequent children, & I have not seen problems as a result of my treatment. N=1 yes, but there are a lot of us N=1 that seem to be having similar success & satisfied patients.

 

I couldn't agree more.

I have a fairly large paediatric caseload, approx 20% of a full time MSK caseload. Reflecting on that caseload, I couldn't live with myself as a clinician if I had blindly accepted the approach of 'wait and see' what happens with other peoples children who were complaining of symptoms due to pathomechanical foot functon, and in 9 years, i have never had a child/parent report adverse reactions to orthotic therapy that wasn't immediately correctible/repairable.

SorryBlaise, I don't know you from Adam, but i think your suggestions are dangerous to paediatric practitioners who may be more gullible than others.