I will generally consider family history, but do not treat if their is no
family history of note.
Akbal
----- Original Message -----
From: "Gareth Milne" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, April 20, 2004 10:15 AM
Subject: Prescribing Orthoses to Children who aren't in any Pain
> Mailbase,
>
> I have seen quite a few younger patients who have
> booked in by their parents because of their "flat
> feet".
>
> Their expectation seems to be for me to fit an
> orthotic into their shoes to stop some their
> "flat-footedness".
>
> What is the general rule that people use to decide on
> whether a child needs and orthosis that comes in with
>
> 1. no previous or current foot/ankle/knee hip pain
> 2. excessive pronation (ranging from mild to pes
> planus)
>
> One analogy (although quite generalised) that has been
> presented to me is in regards to foot posture and
> relating this to going to see a back specialist about
> back posture. If you were to go to a back specialist
> with a very hunched over and no pain asking if you
> posture could contribute to future back pain there is
> a fair chance that they may say yes (stand to be
> corrected). Giving you a back strengthening programme
> could help improve you posture and decrease the chance
> of injury occuring.
>
> Using this analogy I can see the use of orthotics as
> being similar and more of preventative medicine rather
> than waiting for the foot to be injured and then
> continue to be injured due to the continual strain
> from the excessively pronated foot type.
>
> What I have tried to do is find any pain in the usual
> areas on the foot from a excessively pronated foot
>
> -medial calc, planter fascia, achillles, post tib,
> flex hallucis longus, calc epiphyseal plate and
> navicular
>
> and if I find no pain then have been describing to the
> parent that it's up to them what they would like do as
> I have no evidence to suggest that preventive medicine
> in the use of orthoses with help reduce injury in the
> future especially if the child is very active already
> and in no pain.
>
> The same could be said for an adult who has flat feet
> for whatever biomechanical reason who asks if they
> need an orthoses if not in any discomfort.
>
> Your comments would be greatly appreciated.
>
> regards,
>
>
>
> =====
> Gareth Milne
>
> Sportsmed
> 156 Bealey Avenue
> Christchurch
> New Zealand
>
> +64 3 366 0620
> +64 21 136 1244
>
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>
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