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

Find local movie times and trailers on Yahoo! Movies.
http://au.movies.yahoo.com

-----------------------------------------------------------------
This message was distributed by the Podiatry JISCmail list server

All opinions and assertions contained in this message are those of
the original author. The listowner(s) and the JISCmail service take
no responsibility for the content.

to leave the Podiatry email list send a message containing the text
leave podiatry
to [log in to unmask]

Please visit http://www.jiscmail.ac.uk for any further information
-----------------------------------------------------------------