Have you ever seen the show Family Feud? A team member answers a question, getting the most points for the most obvious answer (as voted by the audience). Let’s try one… What word first comes to mind when I say “podiatrist”? My guess is that the majority of you are going to say “orthotics” and if you did, well you just scored yourself a whole lot of points!
It makes sense that podiatrists and orthotics should go hand in hand. After all, as podiatrists, we treat all conditions of the foot and ankle (and lower limb to be precise). Rightly or wrongly, podiatrists are often seen to be prescribing a whole lot of orthotics. Let’s be blunt about it. Orthotics are a great way of revenue raising for any business. But, as health professionals it is our duty of care to ensure that we only ever recommend a course of treatment that is justifiable and necessary. I’m careful to tread lightly here, because I have faith in our industry, and I do believe that of the podiatrists I know of out there are all prescribing orthotics for the right reasons.
So as a parent, we’re commonly asked if the child needs orthotics. There’s no simple answer to this. But what I can tell you is that often times, there are far more cost-effective evidence-based treatment options to orthotics, that will deliver appropriate results. Many children who visit our clinic present due to parental concern over foot position (flat feet, mild in-toeing etc). A lot of times, particularly with growth-related presentations, no treatment at all is warranted (other than some parent education as to what to be mindful of and when to bring the child back). Parent education goes a long, long way in these instances. Once you undertake a thorough assessment, and discuss the physiology of exactly what’s taking place, you can quite often allay all of those parental concerns, and perhaps all that is needed is some a simple stretching regime and some good footwear.
Whilst so much of what we see in paediatric podiatry is growth-related, and does tend to self-resolve, there are also plenty of instances that do require intervention. Typically, I tell parents that if something is painful, or unilateral (one-sided), or has come about rather acutely, then you’re best getting it assessed. There are children who in-toe and have flat feet for much more sinister reasons that just growth. There are children with underlying neurological and rheumatological conditions that certainly warrant some fairly firm podiatric intervention. And whilst many of these patients might end up in orthotics, many may also get away with some more cost effective in-shoe modifications. In a nutshell, it all depends on the level of control we need to achieve. If we can get the child into some really great supportive footwear, then perhaps lesser intervention is required. But there are always exceptions to the rule… there are children who, with even the most supportive of footwear, will still need this coupled with a full-blown set of customised orthotics.
So, my advice to you? Find yourself a podiatrist who can really explain and justify the presentation at hand. Find someone who can make a thorough assessment and is willing to answer your questions. Make sure you ask, ask and ask! It’s absolutely your right to ask as many questions as you feel necessary in order to make an informed decision. Whilst the podiatrist should recommend or guide you toward the most appropriate treatment option, it is your child, your money, and ultimately your call. Unless you have a very acute and rapid onset of pain/symptomology, or a more sinister underlying presentation, then in most instances it is ok to trial the more “conservative” options before moving to the most expensive treatment option out there. Ask your podiatrist if you’re doing your child a disservice by selecting a more cost-effective treatment. Ask your podiatrist if footwear alone might be an appropriate starting point. Ask your podiatrist to justify why orthotics are necessary. And if you’ve got yourself a great podiatrist, they will be more than willing to tackle these questions openly and honestly with you.