THE SMALLER THE PATIENT , THE SMALLER THE DEVICE FOR TREATMENT
was a fresh new concept , and their wide acceptance signaled an important advance in the care of children with valgus and varus foot disorders .
In 1953 The Markell Shoe Company relocated to Yonkers and became exclusively a wholesale business . By the 1950 ’ s and in the 1960 ’ s their most important products were still the Tarso Pronators for treatment of children with metatarsus adductus and corrected clubfoot , and Tarso Supiinators for children with hypermobile and symptomatic flatfoot . By the late 1960 ’ s and 1970 ’ s , the use of straight lasted shoes and shoes with arch support features were also developed and offered as a pediatric pedorthic treatment device . It was also at this time that Markell began producing open-toe boots in both straight and reverse lasts for use on night bars , also known as Denis Browne splints .
It is the development of open toe boots and the Denis Browne bars that have emerged as their dominant product line coming into the 21st century . Today the standard of care for the treatment of clubfoot ( talipes equinovarus ) is the Ponseti Method . This method involves a series of long leg casts , followed by a percutaneous tenotomy of the Achilles tendon ( s ), and then bracing for up to 5 years . Open toe boots and some form of abduction bar or Denis Browne bar are integral to the Ponseti Method as a treatment device and in the maintaining of therapeutic correction .
There are many more companies and appliances on the market for children ’ s feet than ever before , especially with new technologies , materials and treatments available for pedorthists to utilize in their treatment programs for pediatric patients . Prefabricated foot orthoses are available in ever increasing numbers while Whitman plates are still on the market and rarely used as a treatment option . The advent of truly customized shells has opened up a new world of possibilities .
Tiny AFO ’ s are manufactured by several vendors , and many labs fabricate custom devices for children . Children have leg length discrepancies and need modifications to shoes . Many doctors still prescribe forefoot wedging , and you need to know how to apply these modalities . Sadly , some pediatricians tell parents of a child with pigeon toes to buy shoes and put them on the wrong feet . A lot of good a canvas shoe on the opposite foot will do to correct the problem , yet it happens .
It you are working a team approach with a pediatrician , the first thing they will tell you they have learned is that a child is not a miniature adult . Children have different needs than adults ; they are not very patient , and squirm a lot . Children with developmental disabilities ( DD ) can make the process even more difficult . Many a shoe fitter has been kicked by a DD child while working with them , and it is even more difficult to make casts for this population .
However , providing good pedorthic care to a child with a foot deformity is a very heartwarming experience . When you take a child who is fairly sedentary , put them into the proper pedorthic modalities , and watch them walk or even run , you will find great instant gratification ; the parents are ecstatic , and you even may see a few tears of joy shed .
Parents will do more for their child than they will do for themselves . For most parents , paying for your services is something they will do even if not covered by insurance . One of our largest problems is convincing doctors that pedorthic treatment can improve function and the child ’ s lifestyle . Most kids won ’ t complain about their feet , they just don ’ t use them as intended . Part of the pedorthic brand is marketing to all the populations that can use our services , children included .
There is hope for a change in the medical community . More and more physicians are taking children ’ s foot issues more seriously than they have in the past . This is a great step forward for the doctor , and especially their pediatric patient . It has long been our position that managing a foot condition from an early stage produces the best outcome for the patient . And isn ’ t a good outcome what we always seek ?
Remember , going forward it will be increasingly important for manufacturers , pedorthists , orthotists , and doctors to work together as a team to treat , fit , educate , and advise parents and their children . Pedorthists have and will always continue to be an invaluable source of knowledge and expertise with respect to the proper footwear , fitting , and modification necessary to help both children and adults .
When you take a child who is fairly sedentary , put them into the proper pedorthic modalities , and watch them walk or even run , you will find great instant gratification ; the parents are ecstatic , and you even may see a few tears of joy shed .
30 Pedorthic Footcare Association www . pedorthics . org