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3 yo presented with total foot collapse. rear foot, medfoot pronation--bulging med mid foot, everted heel etc. He is unable to toe walk without assisitance. Difficult for him to stand on tippy toes without assisitance. Mum says family history but he complains of very sore feet after most acitivity. He rubs along the plantar midfoot to show where it gets sore. He has reached normal milestones, is an active happy bright child. Does not appear to trip more than normaly?? What sort of exercises?? would you out there recommend? Just in standing it would appear that any sort of soft device is simply going to bottom out with the force of his collapse. Are rigid devices an option at this age?? As you can tell I don"t see many Paeds this young or this severe?? I would appreciate expertise. Thanks hj

Rigid orthoses may be made for children as young as 3 years to improve their symptoms and hopefully prevent progression of their pes valgus deformity. You could also add varus heel and arch wedges with adhesive felt or some other suitable material to get a similar effect if the parent can't afford a custom foot orthoses. Also some labs make "kiddy orthotics" that are premade so that you can modify them to work quite well also. High top shoes help greatly with this age group. If you have access to a medical library, the chapter I did with Don Green 14 years ago on this subject gives an excellent review of the biomechanics of pediatric flatfoot deformity and its treatment (Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992). This book is out of print unfortunately. However, I do have the chapter as a 3 MB pdf file if your e-mail server will allow this large of a file to be uploaded.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Kevin thanks for your continued expertise on this forum. Great to get your opinion on this case. Yes I should be able to recieve your file. would be grateful if you can send it. thanks hj

If you want the chapter sent via e-mail, I will need your e-mail address.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Dr. Kirby, would it be possible for you to send the chapter to me as well? I am the Podiatrist from Greece- Lefteris. I would be greatful. My email is: vogias21@otenet.gr
Thank you very much

Hi hj---ray
Are you planning to use other Rx modalities for this case?
You mentioned he is very weak in the plantar flexors and invertors making it difficult for him to toe walk and heel raise. Do you think it is caused by soft tissue issues i.e. weakness or could their be a bone structural issue or even both. Were you able to reduce his deformity?

It sounds like he needs the devices described by Kevin as well as appropriate footwear, but I would also be looking at exercises to improve the musculature within the foot and the leg. The trick is how do you get a 3 year old to do exercises without it becoming a chore and driving the parents crazy?
The types of exercises I get all of my paediatric patients are -
1. when cleaning the teeth stand on the toes for 20 seconds or one side of the mouth.
2. Dancing on the balls of the feet.
3. picking up items i.e. clothes, pencils with their toes.

etc...

You could even refer them onto to a good physio if you are not comfortable giving exercises. The orthotics will only work when they are wearing them the exercises are a vital part of any child's treatment.

cheers

mark

Dr. Kirby I sincerely thank you.You were so motivated on sending this chapter, that i received it 14 times!! :)
(I supose it was a wird internet-error)
Thanks again

Looks like I need another e-mail program....it says there was an error in sending the e-mail and stays in my outbox, even though it is apparently sent successfully. I haven't had problems with Outlook Express before....any suggestions?

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Thanks for your input mark,, I will be adding the excercises, the appropriate ftwr and the deformity was able to be reduced. Young lad is yet to return. Podomania recieved your email 14 times Kevin but I guess my provider will not let me recieve it?? I have not had noticication not computer literate enough to know how it works, sorry, cheers hj

HJ-Ray:

As I stated earlier, you need to provide me with an e-mail address before I can send anything to you via e-mail. E-mail is no different than snail mail, people can't send you anything unless they know your address! :)

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Hi Kevin, I had asked Administrator C.P. to forward address, he had replied that he had done so, sorry I thought you had it. First--ray@hotmail.com
regards hj

Kevin recieved your email, thanks heaps for your patience and expertise, regards hj

Hello Kevin,
I have a similar case:a 9 yo boy has flatfoot and scoliosis. It would be great if you can also sent the Chapter that you mentioned to me. I really appreciate your help :) . My email address is mabelqiu@yahoo.com.
Mabel

Esteemed Dr. Kirby,

I have tried to obtain this chapter without success (Kirby KA, Green DR: Evaluation and Nonoperative Management of Pes Valgus, pp. 295-327, in DeValentine, S.(ed), Foot and Ankle Disorders in Children. Churchill-Livingstone, New York, 1992) for what it be be to him very grateful if it could order it him to my also for e-mail.

My e-mail is: jgarcia@umh.es

Thank you very much,

Jonatan

Hi Kevin,

I'd be grateful for a copy as well if you don't mind. My e-mail is:

podiatry@aspringinyourstep.co.uk

Many thanks,


Tim