Custom foot orthotics on a growing child is a bad idea; here’s why and here is a more cost effective and sensible solution. This past weekend I was the medical staff for a USATFNJ Jr. Olympic track meet. These events are busy for the on site doctor as many young athletes with ongoing problems will visit, asking for ice, or to be stretched or wrapped. One young runner and her dad stopped by to ask for ice for her heel. I always begin by asking questions since many athletes may require some additional care and advice that can help them prevent future problems. This is where my 25+ years of experience can be of great benefit to a young athlete. Initially, her dad said that they had the problem under control and that she was under the care of both the teams chiropractor as well as a podiatrist. After some additional conversation, her dad said that the podiatrist diagnosed a growth plate injury on her right heel and that this was her first event running since her initial injury six weeks ago. I then asked them if they would like me to evaluate her to try to understand why she would have this type of injury. Her father thought it was a good idea to get a free second opinion while I was available and she was in between races. Her father said that the podiatrist had made her custom insoles that were scanned but within the two weeks they arrived, she had already had outgrown them. When I took her shoes off and had her stand up, her hips were uneven and she had low arches in her feet. The foot where the problem occurred had been wrapped underneath with proprioceptive tape by their chiropractor which in theory should have leveled her hips out. I explained to her father that his daughters problem had to do with impact, and that if a stress reaction to a growth was caused by impact, we need to understand why. We also needed to understand why that heel in particular was injured, while the other side remained uninjured. In an injury like this, you cannot understand the problem unless you look at the person first, the point of impact and then understand why their body mechanics in their sport resulted in the injury. Custom vs. off the shelf orthotics; which offers the best fit and most cost effective way to conservatively manage a child’s foot problems? It is quite common for growing children who become patients of ours to have custom foot orthotics recommended by the podiatric community. In theory, this seems appropriate especially if they have severe foot overpronation, meaning that both feet fall in. Foot orthotics reduce asymmetry in gait which will distort the core muscles and result in foot, ankle, knee and back problems. There are two types of foot orthotics; custom and off the shelf. Custom foot orthotic advantages and disadvantages for children Advantages More exact correction than an off the shelf insert. Can be customized to the individual for their specific type of foot. Materials can be varied depending on the type of use. Last longer than off the shelf inserts since they are often more durable. Disadvantages Poor casting technique will yield a poor foot orthotic. Expensive Are not immediately available, since most labs require two to three weeks to fabricate an orthotic. Can be outgrown during a growth spurt, which makes the device ineffective. Some companies are now selling podiatrists custom orthotics systems that the healthcare provider can make in their office. Again, the effectiveness depends on who is making the device and how the device is made. Roadrunner running stores are selling a custom orthotic however, it has been our experience that the devices are not corrective and some of the off the shelf brands they sell for less may actually work better. Off the shelf foot orthotics advantages and disadvantages for growing children. Advantages Much lower cost than custom orthotics. Many prescription off the shelf orthotics are customizable by your doctor. Immediately available. Not subject to casting errors. Easily replaced as a child grows from size to size. Disadvantages Do not last as long as most custom foot orthotics, which can be irrelevant in a growing child. Fit is not as exact as a custom device. Picking the wrong device may result in an ineffective foot correction. Store purchased off the shelf can be effective, however, there are many prescription professionally dispensed brands such as Powersteps and Vionic who manufacture different devices that can be custom chosen for different types of feet or people. Brands such as Bio may be a better choice if a customizable off the shelf is desirable. Powersteps also makes a customizable device. Our office carriers a number of off the shelf options that are custom chosen for the patient to meet their unique needs. Years ago, there were only a couple of off the shelf options for off the shelf orthotics; now there are many. Some brands such as Dr. Scholl’s have a kiosk that allows you to customize your fit. It has been our experience that most of these devices are non corrective or minimally corrective and may be an expensive cushion, instead of being an effective foot orthotic. I personally have never seen a Dr. Scholl’s Kiosk device level the hips on anyone. The problem with growing children and foot orthotics. Growth spurts can cause problems in children who participate in sports. Children with asymmetrical body mechanics combined with inefficient foot mechanics may be more at risk for having problems of impact which can include stress reactions, stress fractures, growth plate injuries, back pain and other mechanically induced overuse type injuries in the feet, legs and pelvis. Foot orthotics can help growing athletes by leveling out their hips which will improve body mechanics. The best type of foot orthotics for growing children should include off the shelf. As mentioned in the story above, outgrowing a custom orthotic means that a growing child cannot be accurately casted for long term use. Custom orthotics are not a cost effective solution in a growing child and are no longer custom if the child outgrows it quickly, leaving you with an expensive and ineffective device to correct your child’s feet. Poor casting or scanning technique may also result in a device that is not corrective or corrective enough, which is more common than people realize. While some insurance companies may cover a custom device, it is also likely they cover a prescription off the shelf device which can easily and inexpensively be replaced. Conclusion An off the shelf orthotic is preferable in a growing child because if they begin to outgrow the orthotic, it can be easily replaced. Off the shelf inserts can be dispensed immediately and usually fit for a full size or a size and a half, depending on the device. The device when properly chosen is going to be your best choice for cost effectiveness and correction ability while your child is actively growing. While it may be tempting to choose a custom device because of the idea that custom is better, the fit, and how it functions is ultimately the most important thing to consider, and in a growing child, an off the shelf orthotic is likely to offer the best fit. You may wish to consider a custom device in a child under the following conditions; 1. The child is now 18 and there is a high level of certainty they are fully grown. 2. Your older child has been that same shoe size for at least a year or more, decreasing the likelihood of further growth..