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Corrective shoes and inserts as treatment for flexible flatfoot in infants and children
NM Sheffler, GK Driggs, BF Kitchen, AW Fowler, M Hack, C Riecken and N Gould J Bone Joint Surg Am. 1990;72:470-473.

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Copyrighi

1990

by The Journal

of Bone

and Joint

Surgery,

Incorporated

Correspondence
A Letter and and double one-half to the spaced typed period including to the editorial will no letter Editor (including pages after the to a recent the reply process, be printed must in length. Journal articles of the be signed references), To article author by all authors, and must must not for All be considered publication. or authors, possible the final typewritten, exceed publication, within correbe subof the running study To the Editor: as Treatment 810, July First, tional niques, applied foot authors that they For as achieve did A more the child could structure

symptomatic. one can perform I have 1 . Not into of a Thomas children 2. Children was the office to take

If I wear any made task. other

a shoe

with

a Thomas

heel

and

a long

counter,

observations: a fourteen he or she long have counter flexible athletic office a long response able another much has to eighteen-month-old not started feet are Because whether would while make that the foot wearing or while subjective; have a Thomas physiological Guy to walk. will often usually noted of this wearing to the flatfoot skills. to observe counter indicated type scrutiny. of shoes that My heel and that a long the foot M.D. Bishop 75208 observations suggest of shoe child The is brought application enable these in a that The better he or study

a letter spondence, jected However,

referring

be received such will approval

infrequently, because heel off who and

a reasonable

including without

abridgment.

running. to be slow observation, a shoe

correspondents. Kudos Flexible for a gallant I do, concerned shoe-inserts well as a good undersurface neutral not address have were document I have with told the feet probably that was method important will foot not years would to walk better years Now, and factor hallux the cuboid a decrease Other study. themselves. be next parents or inserts interesting forty that is not to continue or fifty prophylactic beneficial. Neil 2300 Garrison Baltimore, To the Editor: et al. Infants it tells My counter tired Thomas and has and I am Shoes story. to a shoe a resident, end counter. good years. at the feel that had day. that the next a Thomas time my feet able duties. shoe, If I wore I was days heel were a shoe This and that a long had all day situation are a I was rest still a long at which of the I found during If I wear extremely in complete and Inserts 800-810, (71-A: agreement as Treatment July 1989), with M. Garwyn Scheffler, Medical Maryland the article for Flexible D.P.M. Center Suite 105 21216 years. this Only support study then and would to follow with these for the I be comfortable shoe-modithe in the and there treatment this position these concern symptoms any to Wenger Flatfoot attempt however, about require laboratory, of the during issues support the et al. (Corrective in Infants have skilled and a few measurement to ensure of the mid-stance assume

or in performing instituted heel subjective child was wearing support that not the in this and

Shoes
,

and 71-A:

Inserts 800(pun Functechthat are of the The

had and she was and

a Thomas that was not could the while published not should better

a difference. did perform the shoe not than The

for 1989) I am controversy.

Children this concerns. plastic and that hind the phase that

overwhelming

at answering

long-standing insert. casting posts part of gait.

to do more it was entirely

intended)

barefoot. it was

the custom-molded

because use

scientific

orthotic to the

I believe counter functions

or fore

be condemned. it is supported

when

in a more

position. K. Driggs,

in the article.

is that the authors in adult long-term life between

it is unlikely in the because foot. and are enable patients the were in both of the of for To for Flexible by Wenger was said. The heel protection terior tibial The makes shoes are the Editor: Flatfoot et al. authors shifted I found in Infants

1001 North Dallas, Corrective and Children for child The as much when the Shoes what was and (71-A: was asked Inserts 800-810, not said Texas

because

alterations and to the shoes which position, enable orthoses had

of the

not appreciable concerned not correct in a more do not correct enable a controversy of treatment communities. problems. secondary lateral first the first of the them

the groups benefit corrective correct orthoses Orthoses, that

structural parents anything. structurally eyes;

as Treatment July as for 1989), what

many

shoe-inserts a patient analogous to walk For value patellae. podiatric tributing acquired the under creates develops. additional manifest groups fications peroneus

interesting that a yarns should

to eyeglasses

noted into

to stand is that would

on tiptoe, the passive and posprescribe

eyeglasses

to see better. as to whether who chondromalacia is a confulcrum

position.

inference such has that

of an insert

be augmented program. in a knee that Now that with peer

.

by a gastrocnemius as one ligamentous to well wear molds apply. who has by patient a step are under might flexible tarsal who without constructed that laxity.

of pronation

in runners

muscle-strengthening authors also

. . .

is widely Similarly, I believe to the aspect metatarsal. metatarsal, such problems

accepted pronation that foot loss and take loss of the The of the

for quadriceps-strengthening noted along this early bouts has rigid there treatment available, leather, from who

orthopaedic to other valgus is often tendon in stability long-term into

pressure sneaker no longer of patients child and not

sneakers are well cast;

structural on the

the etiology as it courses of the fulcrum hallux many valgus

impractical observation are three the that treatment: of spastic flatfoot region from the

jogging made have the

lightweight should types older was flatfoot

longus

of pressed benefited and recruit arthritis, arthritis arch they of

to insert

In my opinion, intermittent

who needs caused take

flatfoot coalition, has some wearing but

effects

of pronation, all of these

as metatarsalgia,

need years to

a protective

Unfortunately,

or a neurological in the mid-tarsal

abnormality;

and the older

It would in assuring

and can barely my long short

supports. Admittedly, are While no more Subjective that examples so than Impressions. I commend Furthermore, carriers doctors will in the the authors I predict use this opinion, for a scientific farther that article and many approach farther third-party down away claims to this problem, from health the art of providers for orthoses M.D. Center Street 77030 as TreatJuly we are growing experience discussion anecdotal, authors the heading

of flatfoot

Boulevard,

I am uneasy medicine. and insurance which,

to turn

by Wenger Flatfoot in that

are necessary. B. F. Kitchen, Department Kelsey-Seybold Clinic Houston, 7000 Doctors Fannin Texas Inserts of Orthopedics

Corrective and Children all of the first came heel

but I do not think

introduction when and and

needed

to work

To the Editor: ment 1989) for Flexible

Wenger Flatfoot

et al.

Corrective and efforts

Shoes

and 71-A:

all night persisted

in Infants on their

Children,

800-810,

for forty

a moccasin-type

my feet

are to be congratulated

to demonstrate

that corrective

470

THE JOURNAL

OF BONE

AND JOINT

SURGERY

CORRESPONDENCE shoes pronated my own only the deformation of replacing there and effective Here in children: for all patients as strong and inserts foot, problem of the prejudices, do not but, shoe. parents shoes well fitting, for a length of preventing the are often than Helfet-type deformation managment is a problem, for skipping A. W. High Bridgend, Mid more the concerned deformity heel-cups with the expense foot, and with of the affect children. surprisingly, of the the natural history that not the of flexible they have flatfoot, addressed problem of or with certified These They position. children far more to have would foot shoes or any well seem support childs To the 1989), 810, trials dulum by Hugh the many nicians. Wenger In seeking by achieved improvement Is relative to correct to deteriorate. as a tool astigmatism? practically I have function Thomas lasting alleviation similar The barking and heel Cowell of the I have observed comfort observed and my et al. ignored to the determine use of height this in gait, arch sight Does a fundamental how various and comfort, for seventy imply much types of consideration absolute posture. as function? however, corrective they been has fail lenses a failure I have my eyes should to reverse of worn have eyeglasses continued myopia correction, had improved with may and with were D.P.M. Road 48076 a and but be discarded anatomical they footwear, (as have failed others). is to note To Treatment July 1989), the Editor: for Flexible Wenger On et al. page Flatfoot state 803 In of

471
pedorthist orthopaedic designed demonstrated appropriate worn provide The or soft tennis a much flexible are for

the shoes

control the not

group calcaneus

is actually basic and put

a form the foot that have service

of treatment. footwear. in a neutral this seemed store. wear

in young

Their

conclusions it appears foot and

are in agreement related

are the most a surprise group

of all prescription

to support

of deformity

It is consequently

to me to find It would in a self group. should

group or perhaps

of

improvement for the control shoes more shoes children was negate fitted realistic such
,

as well. by parents comparison that as

to be This no to be study report would to of the the

In my experience, trodden-over that method is my if deformation prescribe reassurance. is no doubt

to either

be barefooted

are an inexpensive of the

of the shoe. of pronation prescribe a heel-cup; as well F.R.C.S. Rise Britain 799, 71-A: therapeutic of the laid procedure involving are typical of cliof trained pendown to July 800CF3 I 1QJ Great

concluding for most

recommendation

children supported and of the

either this the

prescription

sneakers

as these

seem

of the shoe

satisfactory other. While

is not really out authors our determine form, diligently the bias

by either carefully, control

of rope

on the toes, Fowler,

the and our this

study

carried analyzed, the and

written While foot,

carefully Association to also study

group continues to resolve

View, Glamorgan Wales,

Litchard

to significantly efforts

conclusions. Research does Foundation optimal not seem management

scientifically study,

in its current

Editor: for 1989), support than the

In the Flexible Cohen the fifty

Editorial by Wenger Flatfoot and years, adherence through the Cowell

Corrective et al. in Infants questioned observed advocacy non-invasive

(

Shoes Corrective and Children whether the of the and

(71-A: Shoes
,

covering July
. . .

the study

and Inserts

issue. It would clusions of this majority wear gested by simple studies. for the the

seem that the are significantly will flatfoot, but We and

support of your editorial for premature. I would assume continue those may to consider children potentially cost controlled and who containment, well supportive child have benefit for the symptomatic

the conthat the footas sugmore sci-

as Treatment

of ethical flexible

practitioners also also

the

primarily for

conclusions. I have swinging that Kidner procedures Diveley were to the principles

authors, and

significant from appropriate

For

more from Owen

hyper-flexibility than entific prescription

in theirjudgement applaud well

rigorous Thomas the

observation. writing,

encourage

analyzed

more

modulated of which being

attempts teachings anecdotal,

at the based

footwear,

of Dickson on the

studies,

observations

Carl Prescription 9861

Riecken,

C.Ped. President

Footwear Broken

Association Land Parkway 21046 Inserts 800-8 (thirtyas 10,

correction

Columbia, Corrective and Shoes

Maryland and (71-A: controls

as important years; that there able because to function. of cases

in Infants Group

Children

I, twenty-one

ophthalmologist been

nine feet) wore standard-last leather shoes that is, so-called shoes that had no corrective features built in. The shoes in contour this statement. has not a long have shoe may inch) today provided control (not straight-last) counter, a heel side; foot. shoes, did heel, inversion and have and a solid wedge shoe I have that the a long at the with that is a shoe been shoes all ofthese had shank, a steel parlance, and measures that led that straight-last fore part and of the there with the of shod the to continue the aging has were and 0.32 been worn a steel (almost shank. the a Thomas

orthopaedic were normal confused orthopaedic and it may Of course, to adapt who in the if not The all shoes steel increasing or (one-eighth by

Anatomically, thousands

I am heel, features.

In shoe-manufacturers

so-called

in which be relieved
,

patients

as a result

of the use pain wedge can

of footwear. dramatically there slight literature The Morton 26221 correction is replete participants Hack, Southfield Michigan even found
.

centimeters custom-treated by the by the shank, right

this

foot heel

on the medial an orthopaedic the group a slight of footwear Therefore,

are arch-supportive to believe,

a medial and

though

be no

anatomical of pain findings. study up the

improvement. improvement et a!.

Bordelon in gait is indeed

to an abnormal

individuals children some or left). with

The

counter

of Wenger wrong tree.

flawed.

had a Thomas have shank sizes child. is gradually

and all were strengthened

all straight-last

to denote increasing authors

to be supportive weight not

of the growing Were results inserts their they that for controls no a

Lathrup

Village,

1 . BORDELON, R. L. : Correction of Hypermobile Flatfoot in Children by Molded Insert. Foot and Ankle, 1: 143-150, 1980. 2. COWELL, H. R. : Shoes and Shoe Corrections. Pediat. Clin. North America, 24: 791-797, 1977.

are the conclusions four should different have been types that

flawed? footwear? in the or

not comparing conclusion were and obtained not that

of arch-supportive is no difference type corrective history with individuals probably

so, their measure

by the use of any prevailing intensive does controls. the advice must comments treatment not alter period natural

of arch-supportive shoes
,

(Editors Editorfor was not

nole.

It is the polk-v

of The

Journal

to edit letter the

all letters by Mr. official

to the Riecken opinion

three-year were shoes

since

grammar and style: however, edited, at his request, because Footwear Association.)

thefollowing it represents

not really Furthermore, or wearing since Therefore, report.

authors

regard

to wearing personal part been Gould, were

of the Prescription To rective Children This on steel study information shank shoes,

sneakers no such such

be considered or unshod should

to be off-the-cuff not have Nathaniel

philosophy, the Editor: I take significant Shoes and Inserts as Treatment by Wenger is seriously obtained even et al. which flawed from without and the issue with the article for Flexible Flatfoot in the July are leather, professionally To use issue not

of this included M.D.

entitled Corin Infants and ofthe entirely fitted Journal. based by a

project. in the

appeared study. modifications,

the conclusions

orthopaedic
.

Department University
.

of Orthopaedics and Rehabilitation of Vermont College of Medicine Burlington, Vermont 05405

VOL.

72-A,

NO.

3. MARCH

1990