Determining whether an adult patient would benefit from an orthotic device can sometimes be tricky. Considerations such as the extent of the injury or condition, the patient's weight, pain intensity, level of mobility needed, and other goals can complicate physicians' treatment plans.

The difficulty level notches up even more when developing a treatment strategy for children. The factors referenced above are necessary, but doctors must also consider that a child's body is constantly changing and growing. Any orthosis part of the recovery process should be designed and prescribed with these variables in mind.

In many cases, selecting orthoses for your young patients is not just as simple as taking an adult size off the shelf and sizing it down to meet a young patient's needs. That's why it's often crucial that pediatricians partner with a pediatric orthotist and device manufacturers who have expertise in designing orthoses that can be used to help children meet their recovery goals.

A pediatric orthotist specializes in treating children's conditions, like Blount's Disease, Rickets, Bow Leg, Scoliosis, and other neuromuscular and skeletal disorders. These orthotists have expert experience in evaluating children, scanning or casting children's limbs or other body parts, fabricating and modifying molds and braces, and custom-fitting orthoses for the child. 

As importantly, they understand a child's growth and development and how their treatment may need to be adjusted - sometimes often - to take those developmental changes into account. 

Before we dive further into who designs and provides pediatric orthoses, the characteristics of the devices, and some specific treatment options ACI offers you and your young patients, let's establish some of the reasons children may need an orthotic in the first place.

Why Would a Child Need an Orthosis?

Pediatric orthotics range from shoe inserts to knee-high braces and are used to help children with flat feet, toe walking, weakness, poor balance, frequent tripping, leg length discrepancies, and other conditions or injury recovery. The orthotics are designed to improve a child's walking pattern and aid in physical development, making it as comfortable for them as possible. They are also helpful for pain management, increasing mobility, and aiding recovery.

Some other conditions that might require a child to receive orthotic treatment include:  

• Foot pronation 
• Foot supination 
• Leg and foot spasticity 
• Hip dysplasia 
• Foot or ankle mal-alignment 

• Severe metatarsus adductus 
• Tibial torsion 
• Clubfoot 

As mentioned earlier, there are plenty of variables to consider when determining if an orthosis would be a helpful – and realistic - part of the patient's recovery plan. Special considerations you may encounter in managing the treatment of your pediatric patients include:

• Custom vs. off-shelf. While some devices are primarily prefabricated components, pediatric orthoses tend to be custom-made because tolerance for error is lessened.
• Growth. The tendency of a child's bones and muscles to grow non-synchronously challenges orthotists to consider design features that will sustain productive orthotic forces over time while maintaining range of motion.
• Developmental age. Each child presents a unique combination of motor development, cognitive and adaptive function, and learning ability.
• Communication. Very young children often cannot verbalize pain or describe problems with how an orthosis fits or feels. Young patients cannot be expected to understand application details, schedules, or care instructions.
• Weight. Plastics and other synthetic materials are typically preferred over metal and heavier choices to make the orthosis as lightweight as possible. Minimizing weight while incorporating sufficient durability to withstand the stresses imposed by an active child adds to the challenge.
• Finishing enhancements. Colorful finishing, such as cartoon or action figures, can make orthosis wear significantly more acceptable to a younger child. Other techniques - designing braces to be worn under clothing or to fit into normal-appearing shoes – enhance body image and acceptance among older, appearance-conscious teens.

Pediatric Orthosis Design and Characteristics

Board-certified orthotists with formal education in biomechanics and material sciences are qualified to design custom devices for children. 

If the physical therapist measures the child, the orthoses are usually fabricated and returned to the physical therapist for custom fitting and delivery. In some cases, families can even purchase supports and braces at pharmacies and sports stores. 

Lower extremity orthoses are designed for a child's specific functional needs and ambulatory status, with considerations of 3-point force systems and ground reaction forces to control alignment in all three planes. 

Transverse rotation control of the lower extremities (hips, knees, tibial torsion) requires children to wear torsion cables or metal uprights with a hip/waistband/belt or elastic twister straps and waist belt. Lower extremity devices should control movement and provide stability without resisting the desired range of motion for activities or causing complications. 

Pediatric Orthotic Treatment Options 

We offer a variety of orthoses in pediatric sizes to specifically address the needs of children and young adults experiencing motor impairment due to lower extremity conditions. Our clinical experts manufacture each product intending to correct abnormalities and enhance patient mobility. Select products are also available in infant sizes. 

Below, we highlight two specific orthoses physicians commonly use as non-surgical treatment options for conditions like Blount's Disease, Rickets, and Bow Leg. 

Pediatric KAFO Brace

This orthosis is uniquely custom fabricated for the youngest patients who require treatment for Blount's Disease, Rickets, Bow Leg, Knocked Kneed, and other skeletal malalignments of the lower extremity. The dynamic V-VAS™ joint system allows for sequential correction of the deformity and accommodation of growth. 

It is the only system that creates a bending moment that maintains the four-point correction throughout the full range of knee motion. The Pediatric KAFO brace design is adaptable to incorporate a medial or lateral Step lock or Drop lock joint opposite of the V-VAS™ joint to simplify straightening adjustment and increase knee stability if needed. 

This orthosis is commonly used for the treatment of: 

• Blounts, Rickets, Bow leg, knocked knee, and other bowing deformities 
• Non-surgical treatment for Blount's disease  
• Treatment of the tibia vara and genu varum (bowleg) in infant and juvenile patients  
• Treatment of Infant and Late Onset Blount's Disease  
• Physiologic Bowing  
• Genu valgum  
• Rickets  
• Joint laxity  
• Post osteotomy or hemiepiphysiodesis  

Pediatric PRAFO® AFO System 

Our flagship product is the PRAFO® Orthosis,  a fully adjustable, custom-fitted AFO that can help manage many ankle/foot anomalies that pediatric patients experience. 

We offer several variations of this product line that consists of different sizes (bariatric, adult, and pediatric) and liner options (Kodel®, Fleece, Terry Cloth, Polyurethane Foam, or Pad & Strap) with various color choices. This line also includes optional accessories that help complement secondary needs. 

We help guide physicians and their patients in choosing the most appropriate AFO system based on patient etiologies, cost, and applications. 

The PRAFO® Orthosis offers many adjustable features beneficial for ambulatory and non-ambulatory pediatric patients. Its custom-contoured aluminum heel connector bar helps to control dorsi-plantar flexion by allowing infinite, measurable adjustments. Its ergonomically designed foot plate allows its liners to be replaced or cleaned easily without tools. 

Product features include: 

• Clinically proven for effective ambulation 
• Controls dorsi-plantar flexion  
• Infinite measurable adjustments  
• Custom-contoured, malleable aluminum heel connector  
• Malleable aluminum anti-rotation bar  
• Compatible with all liner variations that we offer if applicable  
• Proven superior integrity of the superstructure  
• Specific options to enhance alignment and support of the ankle and foot (e.g., VCA™, Plastic stabilizing shell)

Contact us for more information about our pediatric orthosis options for your younger patients.