This time of year brings about the back to school rituals as well as the autumn sports seasons. It is a great time to remind ourselves of the often neglected biomechanical issues that may be lurking undetected amongst our children. It has been widely acknowledged for many years that children often do not complain of pain when experiencing the effects of overpronation or other common maladies of the lower extremities. Oftentimes recognition and subsequent treatment of these conditions is delayed until late adolescence or adulthood, once symptoms have already occurred. I would advocate for a more proactive approach in addressing this situation, if nothing more than alerting and educating parents or other responsible adults such as teachers and coaches who interact with children regularly. Discussing foot and leg issues with local pediatricians will often expose the concept of “they will grow out of it” mentality is still popular, despite the evidence to the contrary within the adult population. Great controversies exist about how to treat kids with foot issues, some advocate for bare feet to strengthen the muscles and help with balance and proprioception, while others advocate for supportive shoes and possible arch supports to protect vulnerable feet and prevent future disability and deformity. These controversies will probably never be settled, and no matter where you are in this spectrum of philosophy, we are all in a position where we should be working to improve the chances of our children to grow up with a more healthy and physically active lifestyle.
There are numerous ways an experienced and knowledgeable biomechanics practitioner can help parents and their children avoid the pitfalls of future pain and deformity. Returning to school is a common time for the purchase of new shoes, and it generally leads to a welcome response when you offer advice on proper shoe selection and fitting for children. You can familiarize yourself with the various shoes that are currently popular amongst the kids, and counsel the parents on the pros and cons of these shoes. You can also discuss with them the appropriate shoes for various sports such as soccer and basketball. You can inform parents about growth plate issues such as Calcaneal Apophysitis, and how certain shoes may be a causative or preventative factor.
Parents may sometimes be skeptical about these issues in their children due to the lack of direct complaints of pain. Does the child have sleep issues or want to stop and rest frequently when walking or standing for periods of time such as shopping trips? Do they want to avoid physical activities? Do they trip and fall more than other kids their age? Do they have unusual wear to their shoes? Do mechanical foot and leg issues run in the family? Oftentimes problems like these in children are subtle and difficult to evaluate. Sometimes parents are unwilling to admit or acknowledge their children may have a problem or are unwilling to invest in a solution. Oftentimes children are not willing to participate in particular exercise regimens prescribed for them, or wear the type of shoes that best address their conditions.
Knowing what is "normal" at various stages of childhood is important in the proper management of pediatric biomechanics. Did the child reach their benchmarks in normal development, such as crawling, sitting up, and walking? Many very young walkers tend to look very flat footed, and appear to waddle as they walk. A relatively quick examination and assessment can determine if there is significant pathology present or not. Parents often worry when their toddler “toe walks”, a quick check of ankle range of motion can quickly dispel this fear.
The use of custom foot orthotics in children is also very controversial. It is difficult to recommend a potentially costly investment in a device that may only be effective for a few months or at most, a year during a growth spurt. A trial of an over the counter support, coupled with the appropriate shoe is rarely bad advice in this scenario, particularly in children under the age of eight. The goal in treating these younger, less propulsive patients should be maintaining verticality of the heel relative to the floor. These feet are generally more flexible and pliable, and the use of deep heel cups such as UCBL devices may prevent midfoot and forefoot deformities which occur secondary to excessive Calcaneal Valgus. Once a child reaches age 8 they are more susceptible to growth plate injuries and muscle imbalances due to growth spurts. Many kids also participate in year round sports activities, which may lead to overuse injuries. Depending on the child’s lifestyle, a custom foot orthotic in the presence of biomechanical deficiencies in this age group may be indicated. Parents will sometimes spend small fortunes equipping their future star athletes with the latest and greatest sports gear, yet neglect their child’s medical needs. Again, this might be a good time to discuss these issues with teachers and coaches involved in children's sports, they may be in the best position to offer sound advice on the performance of the young athlete.
As the child progresses into their adolescence and teenage years they may start to exhibit noticeable symptoms that were absent when they were younger. They may also communicate their symptoms more readily such as fatigue or pain at night. I would generally consider a child with most, if not all of their growth plates closed, the same as an adult, in terms of biomechanical based treatment. Compliance can sometimes be an issue, particularly in this age group, so consider what the teenager likes to wear and what activities they participate in when prescribing custom foot orthotics for them.
Education is most important in the raising of our children. Not only the children themselves, but the parents and other adults in their lives, including the podiatrist, orthopedist, physical therapist, chiropractor or other medical professional entrusted with helping children move better.
