Let ’ s admit it . In most of our pedorthic practices , we are most often treating adult patients facing pathologies and treatments usually developing from the onset of aging , disease or injury . These individuals are the most easiest and plentiful to treat , keep our practices busy and profitable . But too often we tend to overlook or avoid an entire population that has similar , yet different treatment needs .
Children … pediatrics … if you want to be more specific . It ’ s a population that fall in between the ages of newborn to eighteen , and we often forget they have pedorthic needs as much as the adults we treat . For many years , pediatric podiatry has been a hit or miss specialty . In the literature available to individuals practicing pedorthics , many of these cases were not actively pursued , since by the time a child reached adulthood , an estimated half of these cases would correct on their own without treatment . It also doesn ’ t help that insurance companies are also reluctant to cover pediatric cases based on this practice .
There are the obvious cases such as CTEV ( club foot ), hip dysplasia , avascular necrosis of the hip , Legg-Perthes disease and so forth which have always been treated . Rarely would you find doctors prescribing modalities to manage pes planus and pes cavus deformities , mostly because the ossification of the foot is not complete until the early teen years . Historically it was thought that time and resources would be wasted on a foot that may correct itself .
Since then , allied health providers , podiatrists and pedorthists have come to understand that many of the maladies that affect children are hereditary . There may have been hidden problems that never had a chance to manifest themselves as our ancestor ’ s life expectancy was half of what it is now . Flat feet , cavus feet , bunions , hammertoes , all have a genetic predisposition and tend to run in families . We have all seen an abnormally worn lateral heel on a child ’ s shoe and know that overpronation is the likely cause . Similarly , a wickedly twisted shoe or one with an upturned forefoot is indicative of an ankle problem and a shoe width problem respectively .
Speaking from experience , the sainted man who fit my shoes as a child had his work cut out for him . Being blessed with a foot one full size larger , a habit of overpronating , and the choice of a leather sole / rubber heel dress shoe made the task difficult . Thomas heels were a staple of shoes for me , and even those wore out fast . This was in the days before neoprene soling and accommodative uppers . There were shoes with widths , however , nothing like we have today .
Many retailers who carry children ’ s shoes are painfully aware of the needs of children . New mom ’ s and grandma ’ s know that they need “ good shoes ” for their child ’ s feet . That works pretty much until they need to graduate to young adult footwear .
A good example is a situation where a mom brought her second grade son into a store to return the school shoes she had bought him just a few weeks earlier . It was a boat shoe with no counter to speak of . The child had a foot like rubber , very flexible . Though he did not complain of foot pain and difficulty when he was running , it was noted that he fell during recess because the shoe “ slid out from under him .” The problem wasn ’ t the shoe ; it was the foot that was inside it . Foot problems are perhaps the biggest reason for returns in a retail store . Rarely is it the shoe that has the defect .
There are many customers who bring in the “ fatty , fleshy , wide ” toddler for fitting . You do your best because you are still working with a foot laden with cartilage . Children ’ s feet are generally very flexible and they don ’ t complain about minor foot issues the way an adult will .
A serious issue begins when the cartilage ossifies and the many articulations of the feet ossify . There are also issues with tendons and ligaments that are attaining their adult form . There are more than a few who have midtarsal coalitions that are unable to be seen on radiograph until much later , in which case there is surgery in their future .
All of health professionals who have dedicated their careers and practices to helping people with podactic problems , they should not be scared to take on a pediatric patient for any type of pedorthic correction . If anything , it is important to know that in our field of practice , there are many suppliers and manufacturers who specialize in treatments and treatment devices to assist the pedorthists , and shoe fitters with the task of helping “ the little people ” get the most out of corrective devices that focus on their changing physiology and even injury . If not treated correctly this will lead to problems later on as an adult .
Many may not be aware , but the pioneer in pediatric devices for foot , ankle and gait issues is The M . J . Markell Shoe Company . Founded in 1914 as a family shoe store in Brooklyn , NY by Maurice J . Markell , a podiatrist by training , he became the first store to begin specializing in comfort shoes , shoe corrections , and orthopedic prescriptions by 1918 .
Focusing on a population that was in need of its own growing orthopedic market , Maurice Markell was an innovator in development and design . In 1932 and 1933 , he first presented his new and original Tarso Supinator ( inflare shoe ), and Tarso Pronator ( outflare shoe ) at the national conventions of the American Academy of Orthopaedic Surgeons and the American Academy of Pediatrics . Shortly thereafter , he began advertising and wholesaling Tarso Shoes to shoe stores in other cities . These readymade therapeutic shoes for children in that era
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