By Susan Glairon
Children with low tone need early orthotic intervention to prevent gait problems down the road. When Ting Cusick arrived in the United States in 1998, the newly adopted one-year-old had nonfunctioning lax hips and feet. But despite these early setbacks, Ting began walking at 14 months, four months earlier than the average Chinese infant, according to her mother, Beverly Cusick, MS, PT, BOC COF.
Ting is now 13 years old and excels in soccer, skiing, gymnastics, and cheerleading. Her mother, a pediatric physical therapist, attributes some of her daughter's athletic success to wearing heel seats in canvas shoes with laces, flat soles, and deep heel boxes, beginning when she was 12 months old.
Although many pediatricians and orthopedic surgeons won't recommend foot orthotics for pronated feet in patients younger than five—saying that children undergo significant developmental changes during their first five years—many orthotists and physical therapists, such as Cusick, argue that it's important to intervene much earlier. These practitioners recommend intervening anywhere from 18 months to two years of age; however, some recommend orthotic intervention as early as when a child begins to stand, and for some infants born prematurely intervention can occur before the child's due date.
"The physician's ‘party line' on pronated feet seems to be, ‘Don't worry, she'll outgrow it,'" Cusick says, adding that only pronation occurring in a "sound pediatric foot" corrects without intervention. According to Cusick, "children with feet that will not improve over time are dismissed, and they will load their pronated feet two-million times per foot per year in pathomechanical alignment that communicates up the leg to the torso." Muscle fatigue while walking and increasingly stiff leg muscles are common complaints in children, adolescents, and adults who have retained persistent foot pronation, she says.
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