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Excessive shoe heel wear in adolescent girls

Discussion in 'Pediatrics' started by Nina Davies, Nov 8, 2008.

  1. Nina Davies

    Nina Davies Member


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    Hi,

    Are orthotics the answer??

    It is not uncommon for girls 11-14 to get excessive posterior plantar medial heel wear without shoewear anywhere else. They are asymptomatic; however, the concerns are raised about their gait becuase they are wearing their shoes out so quickly.

    On examination they will have some degree of 'excessive' femoral neck anteversion, developmental genu valgum and tight hamstrings (no specific formula but they happen together).

    From what I have found, orthotics do no work at reducing the heel wear (or is this the prescription?).

    I'm under the impression it wouldn't...as heel strike occurs quickly and is mainly influenced by swinging limb striking the ground at the angle caused by the developmental changes/ soft tissue position.

    So...can an orthotic have an influence on posterior, plantar, medial heel wear?

    Should you interfere with the asymptomatic, developing limb just because of heel wear?

    Should the cobbler place a seg on the heel to protect the shoe while this wear is occuring...instead of the podiatrist?

    Look forward to your comments...

    Thank-you

    Nina :)
     
  2. Heather J Bassett

    Heather J Bassett Well-Known Member

    Hi Nina, how common is medial heel wear?
    Must admit I have not noticed this personally?
    Do you have a reference for this, I am interested in reading further.
    I look forward to the further discussion.
    Orthotics affect feet once w/bearing?
    Not sure how they can change heel stirke?
    Cheers
     
  3. markjohconley

    markjohconley Well-Known Member

    Nina, admin2 will be along shortly, I expect, to give some references to threads that discuss medial heel wear of footwear, I think Kevin Kirby offered some excellent posts.
    hj--ray, hi, here in canberra there's lots'n'lots, nearly all females.
    Sunday arvo, "champing at the bit" work tomorrow, yesssss
     
  4. Admin2

    Admin2 Administrator Staff Member

  5. Heather J Bassett

    Heather J Bassett Well-Known Member

    :eek: sleeping at the wheel not good for one!!:bang:

    Cheers
     
  6. Heather J Bassett

    Heather J Bassett Well-Known Member

    Mark do you see this clinically or observing? general public.
    Iteresting now having read further threads,
    I have not seen this a lot clinically.
    I have a 14 year old daughter and as I sit and watch/wait for her after school over the last years there are many disasters of feet that I see but med heel wear is not something that stands out in my memory as being common.
    Again just personal sightings.
    Our local school insists that footwear is very imoportant. It must be BLACK!! At least 90% plus of the young girls wear the ballet slippers.
    Majority of the boys wear unlaced skate shoes.
    We thought we were going to be busy with the ageing population?
    I guess these kids are growing?
    Can not say I'm champing at the bit for Mon morn but there again I am passionate once I get there.;)

    Cheers
     
  7. Nina Davies

    Nina Davies Member

    Thank-you for the trhreads etc will get cracking on the reading!

    And sorry... to clarify...when I say common it's because I work mostly with the kids!

    This will happen in the adolescent girls, with the 'formula' of knock knee, anteversion and tight hams.The wear is so spectacular it goes through the sole to the waffle..mind you shoes are not made too well these days!

    As knocked knees are not a developmental trait in boys and I don't see it in them/ it's not common...however if they have weak gluteals and G. Vg then is will occur.

    I only ask because I don't think insoles are the answer. I have taken over a caseload where others have provided them...and to be quite honest, I can't see it's made a difference! I have consequently removed/ not replaced them an that's when the debate starts!

    Thank-you for your posts

    Nina :)
     
  8. Nina Davies

    Nina Davies Member

    Hi,

    Me again.

    Have read the threads and this is what there is so far..

    Medial heel wear will occur with in-toeing
    Shear force causes heel wear
    Sitting positions should be advised on to reduce intoeing
    Supinating a foot will induce intoeing
    The density of the heel material will affect the foot's NEXT movement
    Exercises that encourage external rotation will help discourage intoeing.
    Gait plates have been discussed (but where is the research to support them apart from cosmesis!?)

    All of which I agree so...

    As there is no mention of orthotics...I'll take that as a no, they will not reduce heel wear!
    As we can't yet assess shear in-shoe, we can't link this to orthotics.
    If an orthotic would increase the supination moment then this would increase intoeing...so again not an arguement for orthotics.
    As the problems are steming from above the ankle - it's these that you should be addressing. In the interim - change the material at the heel.

    I think it does highlight an interesting point in that we can prescribe insoles without considering the effect that it is having on the treatment aim...or the consequences of treating an asymptomatic patient.

    I still haven't found an article to support the use of orthotics for reducing heel wear.

    Nina :)
     
  9. markjohconley

    markjohconley Well-Known Member

    Heather, clinically. Black, makes all the difference, and "ballet slippers" just what developing bodies need to wear on concrete, excellent, i'll take your word for their use as I would get into a wee bit of bother if I sat and watched 14 yr old girls! Haveagoodday, mark c
     
  10. Steve The Footman

    Steve The Footman Active Member

    One significant factor with outsole wear is that it only occurs when there is movement between the outsole and the ground. It does not always reflect the forces or pathomechanics that are in play. There is usually some movement at strike and terminal propulsion causing wear - but there can also be wear during abnormal motion compensating for some functional deficit.

    Medial heel wear is not a common problem that I have seen. If the foot is in valgus at strike then the first contact and wear will be medial. In severe intoeing the foot will strike the medial heel first in order to have the pivoting action that is required to deflect force.

    Probably the most common problem that I have seen leading to medial heel wear is shoes that do not fit properly. The result is a sliding or shearing of the foot in the shoe. From looking at the shoe it looks like severe pronation is occurring. In fact it is just the shoe pronating as the heel is rammed onto the medial heel counter. The foot itself may be in significant varus inside the shoe. This can be easier to identify by looking at the wear inside the medial heel counter rather than by a gait assessment.
     
  11. Bug

    Bug Well-Known Member

    I've also seen it quite a big Nina and think you have hit the nail on the head. What are you treating and how does an orthotic influence those positions that are devlopmental?

    I have had some success with a stretch/strengthen program working on the hams, hip flexors, adductors and abductors. Cheap and relatively easy for everyone. That and good shoe education. I have had a few kids actually that I have also got the local boot maker to whack on a thomas heel with great effect.

    Keep up the dialogue!
     
  12. Heather J Bassett

    Heather J Bassett Well-Known Member

    Hi cylie, thanks for your constant input.
    do you have a paediatric resource for your stretching resume?
    Is it one that you have developed?
    does anyone have a good resource specific to paeds?
    THANKS

    Cheers
     
  13. Bug

    Bug Well-Known Member

    Thanks Heather.

    I just a computer program called Physiotools - there is a musc/skel pead version. There is also a box of exercises that you can purchase call: VHI Peadiatric Functional Exercises. There are a stack of kits in general adult stretch/strengthing that can also be modified.

    I like both of these as I have one ready to go or I can grab the cards with the exercises that are more suitable to that age group. They are either a drag and drop on the computer or little cards that you pop onto the photocopier

    These are copyrighted to so sorry, can't share them. But easily purchasable.
     
  14. Hi Nina,
    I have seen this clinically with the trend of lacing the shoes loosely and tucking the laces underneath the tongue of the shoe. They also tend to soften the heel counter by standing on it or crushing it whilst removing the shoes. Consequently whilst in swing phase the shoes slide off the heel and drag on the ground.
    New shoes laced up correctly has remedied the medial wear (in the absence of a valgus rearfoot or other major biomechanical issues). Perhaps this is just a crazy Brisbane trend??
    I hope I'm not over-simplifying it.
    All the best.
     
  15. Ella Hurrell

    Ella Hurrell Active Member

    Hi All

    I have also seen heavy medial heel wear in kids, particularly hypermobile teenaged girls. In my experience, it seems to be those that wear ballet slipper-type shoes and Ugg-style boots (usually soft suede wellington-style boots) that seem to be very popular in this country at the moment. :bang:
    I suspect the lack of 'substance' of these types of footwear is a lot to do with it as well, but pursuading a teenaged girl to wear anything more supportive is a tough one!

    I completely agree with Stuart about the laces on some shoes - this is something I have seen also.

    Ella
     
    Last edited: Dec 3, 2008
  16. Boots n all

    Boots n all Well-Known Member

    About 2 years ago a private girls school in Melbourne banned the wearing of T'Bar's due to the fact that it was "trend" not to do the buckles up at all.
    Which resulted in heavy wear on the shoes as the young "ladies" slopped around in the loose shoe, one of the areas that was showing the most wear was the heel.
    Stuart is quite right about the lace "tuck" and every child that comes through our place gets told how to take off a shoe correctly..."with your hands":bang:
     
  17. Adrian Misseri

    Adrian Misseri Active Member

    G'Day Nina,

    Like others, I quite often see medial heel wear, and have tried a myriad of things to stop it. One thing to note, is that some degree of femoral anteversion if often residual in teenage girls as the hip widens and the internal rotateors do not stretch enough initially. This usually resolves during puberty, however is more frequent in post puberty girls than boys.
    With the lateral heel wear, I've (annecodtally) found that it occurs moreso at heel strike where the calcaneus/heel of shoe is in valgus. I've tried putting a LATERAL heel wedge in peoples shoes which makes the heel of the shoe more parallel to the ground, thus less uneven wear on the medial side of the heel. This can be useful in teh intoeing gait, as this will provide a pronatory moment to the rear foot which is already subjected to supinatory forces form the internally rotated lower limb.
    Cheers!
     
  18. Nina Davies

    Nina Davies Member

    Hey! Thanks for all the responses since, I was unaware that this thread was still going as I couldn't find it (now I know how to!)

    So, I guess the next step is to tackle the shoe manufacturers...anyone offering?!!

    Nina :)
     
  19. Boots n all

    Boots n all Well-Known Member

    Why would you tackle the shoe manufacture?
     
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