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Orthotics for people with Downs syndrome

Discussion in 'Biomechanics, Sports and Foot orthoses' started by KDucas, Mar 16, 2012.

  1. KDucas

    KDucas Welcome New Poster


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    I have a prospective patient who is a male 23yr old with Downs syndrome who walks with an abductory swing and intoeing. He does not tolerate standard of the shelf arch supports and finds his standard Bar shoes a little tight.
    He is not keen to have orthotist moulded insoles and bespoke othopaedic footwear at his age.
    His pes planus does not correct so I wonder if their is any one out their who has dealt with a similer situation successfully with orthotics and or a particular style of footwear.
     
  2. Boots n all

    Boots n all Well-Known Member

    You have just about ruled out every option, you say he wont tolerate an orthosis, is that because of skin break down or is it psychological?

    If he wont have/tolerate an orthosis or bespoke footwear, then lets modify his favorite shoe, by adding a medial buttress to address the pes planus and this will most likely reduce some of the in-toeing also.

    If this has not reduced the in-toeing in 4-6 weeks time you may need to consider a rocker sole, not rigid, your just changing the tipping point, with the Fulcrum slightly proximal of 1st and and under 5th, you are best to judge that when you see him

    This way you are halfway there, as it is still his favorite shoe after all;)
     
  3. markjohconley

    markjohconley Well-Known Member

    KDucas, first post, good move.
    As for your pt, does he have any complaints?
    mark
     
  4. Admin2

    Admin2 Administrator Staff Member

  5. pnunan

    pnunan Member

    Having worked with Downs Syndrome athletes from all over the world via the Fit Feet program of Special Olympics we have seen thousands from various parts of the world. Those with intellectual disabilities often are very sensative to any type of device especially rigid ones placed in their shoes. We see the same with swimmers and goggles. The first thing to ask, are they symptomatic? Many of the flatfooted/pronated athletes I have seen have more complaints about skin problems rather than orthopaedic/biomechanical issues. If they do have complaints, we have found for the most part, the athletes do better with multi density/EVA orthotic. Again many of the athletes have a heavy gait with increased pressure points as seen on MatScan and RSScan. When we look at shoe therapy, a lot of them have short, wide feet. We have found New Balance shoes offer the best possible fit for a variety of sizes and widths. Again, make sure they really need the orthotics, as many of them have adapted quite well. There are many additional factors you need to look at such as level of activities, muscle contraction, muscle looseness, spine alignment, so they whole kinetic chain.

    Conflict of interests: MatScan (TekScan) and RSScan have supported the Fit Feet program in many different parts of the world. New Balance does not donate shoes or money to Fit Feet or myself. We just find this to be the best shoe due to various widths and sizes.

    Patrick J. Nunan, DPM
    Senior Global Clinical Advisor and Founder
    Fit Feet/Healthy Athletes/Special Olympics.
     
  6. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    What to measure when determining orthotic needs in children with down syndrome: a pilot study.
    Looper J, Benjamin D, Nolan M, Schumm L.
    Pediatr Phys Ther. 2012 Winter;24(4):313-9.
     
  7. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
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