Prefab orthotic with gait plate

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Hi

I'm trying to find a supplier of childrens prefabricated orthotics with an in-built gait plate. So far my searches have only uncovered a brand called Pedifix, but its not cost effective to get singular prefabs posted internationally.

Does anyone know of a good Australian supplier of kids prefab orthotics.

Cheers

Steve

 

I know of NO prefabs that have a gait plate.

Try Algeos for kids prefabs

 

hi Steve,

What is the purpose of the gait plate in the children you are seeing?

Robin

 

Might want to do a search for the threads here. I haven't seen a positive response about gait plates from anyone here (self included) who only work with paed's.

 

Thanks for the advice

The purpose of the gait plate is to help children with in-toeing gait.

I'll take a look at the paed's forum for other more successful treatment options.

Steve

 

The important thing here Steve is to look at why the child has an in toeing gait.

A gait plate simply provides an external pronation moment at the sub talar joint to pronate the foot. The desirable(or not) effect is forefoot abduction which might reduce the appearance of in toeing

If the internal rotation deformity is at the hips, what good is pronating the foot?

So, the important thing is to assess where the internal rotation deformity is arising from. Then assess how this can be reduced(if it can be reduced at all)

As a guide, in 10 years of seeing kids, I have had 1 occasion where the usage of a gait plate was warranted. There is a thread somewhere, that I cannot find, where, either Cylie or Sally posted a fantastic guide to assessing and treating metatarsus adductus. This is worth a read if someone can remember the thread

Happy reading

Robin

 

Thanks Robyn

The last two paediatric patients i have seen had an in-toeing gait caused predominantly by soft tissue tightness internally rotating the hip. The common denominator in both cases was poor sitting posture. I advised the parents on sitting cross legged instead on the feet tucked under their backside. In addition i gave the children exercises to encourage the hips to open up. However after a 3/12 review there was little to no improvement (i do suspect a lack of compliance). My theory of using a gait plate was to further encourage the hips to open up, can you suggest any other treatment options?

Steve

 

I would have to agree with Robin. I think the gait plate's only function is to lessen the parent's anxiety in thinking its going to help their child. I would not want to pronate the foot on purpose with little chance that its going to change the met adductus angle or help stretch out the hip adductors. Sitting crossed legged is a good idea as well as encouraging the child to consciously walk with their feet straighter. Its rare to see in toeing once they are in their teens.

Steven

 

Unusually, I'm going to disagree with you there.

As I understand it The purpose of a GP is not just to create a pronation moment at the STJ. If it was then a lateral wedge would serve the purpose just as well. The purpose of the gait plate is to blockade toeing off 2-5 MPJs (BM low gear). If the foot is adducted at heel lift it is pretty much impossible to come off the High gear axis (1-2) so this is almost always the one being used.

By sticking a rigid plastic extension under the lateral forefoot, you make it very hard to bend your foot off the 2-5 axis. Thus the child has one of two main coping strategies to choose from. One is to simply lift the foot as one, heel lifting and toeing off at the same time. The other is to abduct the leg from the hip. This enables them to roll off the medial edge of the device which should be somewhere near the 1-2 high gear axis.

Its not a million miles away from putting a carbon fibre base plate in a boot to inhibit toe walking. The difference being that it allows the mets to bend, but only if the foot is abducted on the ground. If the foot is adducted, the extension gets in the way.

You have to pick your patients. Can't really go much before 6YO because before then the heel -toe - heel lift - toe off pattern is not very solidly established, and they'll just lift the whole foot. Can't put it in a shoe which only bends one way, or not at all, or which has a built in rocker. Actually flimser sole shoes seem to work better. Can't put it in a shoe which does not hold the foot on to the insole. I wouldn't use it with an adduction which originates below the hips because although that might straighten the foot on the ground, it might externally rotate the hips. Can't use it if the patient is not capable of adapting their gait.

I don't use them often, but I have had some roaring successess with them with more mature in toers when there is no fixed deformity or tightness. I think they have a place.

 

Is this what you are looking for ?

 

As ever Mike, you are a star

 

Steve, I think one of the biggest problems is we just don't know that down the track a child with tight internal hip rotators will have intoe gait. There isn't too many adults I know that can sit in that position as the hips and their position change with growth.

I have used probably 2 sets of gait plates in my career and it was the super last resort with kids that were on a list of derotation surgery. The plates were to stop them from falling. In my opinion the plates are a cosmetic fix while the body just de-rotates itself. We see these kids 12-24 months later and pat ourselves on the back when in fact the other kids that aren't treated would have done the same thing.

With these kids, I make really sure I am confident where the intoe walking is coming from.
- If is it tibia, I make sure it isn't in rickett's territory and reassure, review in 12 months unless mum want's earlier.
- Metadductus - see above post (Thanks Robin!).
- Hips, internal femoral position/rotation/anteversion/antetorsion, however you want to call it or see it, you can't change it, it's the hardest and toughest bone in the body. A piece of plastic won't do a thing.
- If it is soft tissue, I encourage the parents to change floor play to desk play, moving everything to a little desk. Ensure there is a proper booster at the table so they don't pop up and down on the seat, flopping in that position. Use a bean bag for TV time (can't w sit in a bean bag). If they ball sleep, DON'T MESS WITH THE SLEEP. It will stop with time. In other words, change the environment so the child is given less opportunities to sit in that position. Means less work for mums and the child isn't nagged near as much. Sport can help as most W-sitters have terrible postural control and often low tone. Loads of time at the park, games on the fit ball, swimming etc.

Hope that helps.