As a paediatric physiotherapist, I often have parents bring their children to see me with concerns about the way their child is walking. The parental concerns vary from “My child walks funny and falls over a lot!” to “My child has flat feet and knock knees” and the children concerned vary from typically developing children to those who have been diagnosed with Cerebral Palsy or undiagnosed developmental delay. The children’s ages vary from early walkers at 9 months old to school age children at 7-10 years old.

When I see these families, I start with an assessment of the child’s gross motor skills, their bone structure, and analysis of their walking patterns. Every child is individual and therapy is tailored specifically to suit each child’s needs. However, I find that parents often have similar concerns and I often get asked some common questions. So I thought it would be helpful to discuss the top 3 Frequently Asked Questions today.

FAQ 1: People say that it is best to let children walk bare feet. Is that true?
Bare feet walking for children has its benefits, such as the sensory input of feeling the different textures of the ground they walk on, challenging their balance and improving proprioception (the sense of knowing where their joint/body is in relation to each other). The issues to be aware of with bare feet walking would be to ensure that the environment is safe and free of unknown sharp objects which may cut their feet as well as ensuring that the ground temperature is not too hot or too cold to prevent burning of the child’s soles.

More importantly though, from my point of view, is being able to ensure that a child’s ankles are stable and in the optimal position for ideal bone development and growth. If a child’s joints are too lax, and the ankles roll in, causing changes to the alignment of the knees and hips then I would actually recommend children have suitable shoes to support their ankle and allow the child to walk with increased stability, foot bones to grow correctly and ankle ligaments and muscles to strengthen in the correct alignment. Once ankle bones develop incorrectly, we cannot change that easily. So I believe in proactively ensuring optimal bone development in the feet.

FAQ 2: Should I get orthotics for my child?
Studies have shown that orthotics are not effective in young children who do not complain of foot pain, and may be effective for school age children who complain of foot pain. Surveys have shown that 50%of podiatrists you see will recommend your child who does not complain of foot pain to get orthotics and 50% of podiatrists will recommend that you do not.

In my experience, the typically developing young children under 6 years old often do not comply with the use of orthotics in their shoes, as they find it uncomfortable. I often recommend getting good shoes for typically developing children and this is often sufficient to provide the ankle support and flexibility young children need when walking. We would also implement suitable and age appropriate activities to strengthen the hip, knee, ankle and foot muscles to correct the child’s walking pattern.

For children with lax joints and various conditions such as Cerebral Palsy, then orthotics would be appropriate and necessary at times. However, not all children with Cerebral Palsy require orthotics. At times, I find that the orthotics hinders the child from functioning at their best, and they find it hard too. This is especially true for the children with very mild Cerebral Palsy and is very high functioning and active.

FAQ 3: My child has Cerebral Palsy, should we have fixed or dynamic Ankle-Foot-Orthoses (AFOs)?
Children with Cerebral Palsy would often be seen in various Cerebral Palsy Clinics and be assessed by a Rehab team consisting of a Rehab Specialist, Physiotherapist, Speech Therapist, Occupational Therapist and Orthotist. The decision for AFOs and what type is often decided in consultation with the family and the Rehab team.

In my experience, families can sometimes still be confused with why they got the AFOs that they got and what is the purpose of it. There are many types of AFOs and they can be fixed at the ankle or dynamic. Depending on the child’s, parents’ and Rehab team’s concerns, AFOs are customized to suit the child’s needs and functions. I often find that the simplest way to understand what type of AFOs a child needs is to decide what is the most important priority for the child’s development and the parents most important concern. From then on, we can determine the best type of AFOs a child should get. Bearing in mind, as a child grows up their needs changes and so would their AFOs.

As you can see there is no standard answer to fit every child, and what suits one child may not suit another. So if you have any concerns about your child’s walking or how their feet and ankle bones are developing, and you would like your child assessed, contact our Paediatric Physiotherapist on 9557 8521 for an appointment today.