4Kids

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A medially posted orthotic to protect the paediatric plano-valgus foot

The Problem All toddlers have flat feet because of a low angle of calcaneal inclination, by five to six years this angle has increased, and in most cases, a medial longitudinal arch becomes apparent. Inclination of the calcaneus is vital to the foot, as if there is a reduced or negative calcaneal inclination the plantar aponeurosis will be lengthened, the windlass mechanism will not occur, and the foot will not achieve supination at the propulsive phase of gait. The most significant feature of paediatric pes planovalgus (pathological flat foot) is medial bulging in the area of the talo-navicular joint. The medial longitudinal arch is usually low, but not always completely absent. A collapse of the mid-tarsal joint indicates that the calcaneus has been forced to rotate postero-laterally under the talus. The talus will assume a more medial and vertical position as the sustentaculum tali loses its supporting position beneath the neck of the talus. These changes render the foot ineffectual at withstanding the forces of ground reaction, which are highest at the propulsive phase of gait.		The Concept Early treatment is vital, for if a child continues to walk on this foot type, the condition rapidly becomes irretrievable. Control of the child’s foot needs to be achieved quickly and comfortably by utilising a triplanar wedge directed against the talo-navicular bulge and medial arch, which will increase the calcaneal inclination angle. As the calcaneus is dorsiflexed it will also adduct, restoring talo-calcaneal congruency. Restoring alignment in this way helps to maintain the stability of the foot. Support of the foot also controls the internal leg rotation associated with sub-talar joint pronation and thereby reduces other symptoms such as knee pain (e.g. Osgood-Sclatters disease). Prevention of the collapse of the medial arch will reduce the strain on supportive ligaments and other soft tissues, thereby allowing the patient to enjoy running and walking whilst remaining symptom free.

The Solution

Conditions treatable with 4kids orthotics include:

• Tired and aching feet.
• Plantar Fasciitis.
• Plantar Heel Pain.
• Posterior Heel Pain and Achilles Tendonitis.
• Ankle pain.
• Shin and calf pain.
• Knee pain (Osgood-Schlatters disease).

FAQ’s

Can 4kids be customised? Heat modification can be used on the underside of the shell to gently shape the device for an optimal fit but care should be taken not to damage the anti-bacterial top-cover. What wearing in period is required? A wearing in period must always be allowed in order to give the patient time to get used to the orthotic, however, it is not unusual to notice an immediate beneficial effect. It is important to review each child on a regular basis, particularly after periods of rapid growth to ensure correct sizing of the orthotic. How long will they last? The length of time the 4kids orthotic lasts will vary between patients and this depends upon a number of factors including patient weight and activity level. However, around 4-5 months is the average, provided that the child does not outgrow them. The products life will be maximised if they are cared for properly.

Can 4kids be used in different shoes? Talar Made 4kids orthotics are only available in a standard length and therefore accommodation within all children’s shoe styles is not usually a problem. It is important for children to use shoes that have adjustable fastening, provide good heel stability and have a flexible sole at the forefoot. Can they be cleaned? 4kids orthotics should be cleaned regularly in order to prolong the product life expectancy. The best way to clean the devices is to gently sponge them with warm, soapy water and dry with a paper towel. Do not soak the product for long periods of time or dry artificially. What should be done if the pain continues? In resistant cases it may take some time for patients to derive the full benefit from a foot orthotic. Patients and parents/guardians alike should be advised that if symptoms deteriorate they should return to discuss the problem with their original prescriber.

What sizes are 4kids available in?

	Kids 1	Kids 2	Kids 3	Kids 4
UK	8 – 10	10½ – 11½	12 – 1	11½ – 2½
EURO	25 – 27	28 – 29	30 – 32½	33 – 34½
US (Child)	9 – 11	11½– 12½	13 – 2	2½ – 3½