July 2007

Posture development and pediatric orthotics

by Dr. Terry A. Rondberg

In recent years, the link between poor posture and health issues has been proven beyond a doubt. As the Mayo Clinic put it, "bad posture doesn't just make you look dumpy, it can also lead to serious health problems."

To combat this "epidemic" of posture‑related health problems, we need to concentrate on children. Not only does today's lifestyle ‑‑ with hours spent at the computer or lugging heavy backpacks ‑‑ contribute to the posture crisis, but the incidence of pedal imbalance is escalating as well.

This is why almost all pediatric chiropractic experts recommend that children between the ages of six and twelve should be screened for pedal imbalance and postural problems.

According to Mark N. Charrette, DC, a recognized authority on extremity adjusting, biomechanics, and spinal adjusting techniques, "a child just learning to stand totters and sways because the foot's weight bearing abilities are minimal. Measurements of foot loading in young children find relatively high values in the midfoot region with metatarsal loading about equal. As the child grows, midfoot loading decreases and the third and fifth metatarsals begin to bear more weight."

In an article for The Chiropractic Journal, Dr. Charrette examined the four phases of pedal development:

a) By six‑months, a child exhibits bowed legs and the feet point inward.

b) By age two, the child is walking and the lower extremities seem to straighten out.

c) In another year or so, when skeletal growth accelerates, knock knees and in‑toeing may appear.

d) When growth rates stabilize, usually at age six or seven, healthy alignment of the feet and legs should be observed.

This is the stage of musculoskeletal development when a child should begin to be examined for pedal stability and integrity, Charrette advises.

Because it's difficult for parents to recognize pedal imbalance, they need to have this examination done by a competent doctor of chiropractic. This is particularly important since foot imbalance is usually not a painful condition.

But, like vertebral subluxations themselves, the absence of pain or other symptoms doesn't mean all is well. The imbalance can affect the structural integrity of the body and may cause or exacerbate vertebral subluxations.

Charrette gave the following specific and practical "how to" information for chiropractors: "A simple visual exam will indicate the need for further testing for pedal imbalance in children. Watch the gait for signs of foot flare and toeing out. If the child is wearing everyday shoes, check the heels for signs of excessive lateral wear, another sign of imbalance. When the patient is standing barefoot, look for three other important clues to pedal instability: low medial arches; Achilles tendon bowing; and patellar displacement."

Fortunately, chiropractors are in a position to help their young patients by recommending custom orthotics. "When it has been clinically determined that a young patient can benefit from orthotics, the first step is to determine the most appropriate level of support required. Weightbearing casts, with the foot in the position of function, provide the most accurate documentation of pedal instability and its impact on integrated spinal biomechanics," Charrette stressed.

While many chiropractors appear reluctant to address foot problems in their young patients, many practitioners say compliance is higher than most would expect. An article in Podiatry Today, reported that Russell Volpe, DPM, "experienced few problems with compliance or tolerance. He says kids usually have good toleration to orthotics that are prescribed to control motion in high motion, flexible feet. When a carefully prescribed device is made by a quality lab from a well‑executed negative impression, Dr. Volpe says there are usually few problems."

Charrette agrees. "Custom‑made, flexible orthotics allow the developing foot to perform controlled movements without disrupting complex structural interrelationships. By limiting pronation through greater arch support, orthotics reduce plastic deformation of pedal tissues," he noted.

If chiropractors want to make a lasting contribution to the health of the next generations, they need to do everything possible to decrease the incidence of vertebral subluxation in their young patients today. For many, that means looking not only at the spine itself, but at the child's posture and, by extension, the child's feet.

More information on pediatric orthotics can be obtained from Footlevelers.com. Specific information on children and orthotics is available at footlevelers.com/conditions/child_posture.php.

(Dr. Terry Rondberg is president of the World Chiropractic Alliance and publisher of The Chiropractic Journal and the Journal of Vertebral Subluxation Research. A popular speaker at chiropractic conferences and seminars, Dr. Rondberg is also a frequent guest on TV and radio shows. He has written numerous articles on chiropractic for the profession and the public, as well as several best‑selling books, including "Chiropractic First," "Under the Influence of Modern Medicine," and, with Timothy J. Feuling, the "CBS Malpractice Prevention Program," and "Chiropractic: Compassion and Expectation.")