You have an amazing child with special needs. You are busy. You have a never ending list of appointments to juggle. And now you get referred to an orthotist who will assess your child for an orthotic. You’re unsure what an orthotic is (because you haven’t read my “What is an orthotic anyways?” blog post), how necessary it is, and where it should fall on your list of priorities. Despite all of this you decide to go to the orthotic appointment and see if it will be worthwhile and helpful to your child. This is the mindset most parents visit me with, and it’s completely understandable. This is why I created the family friendly orthotic checklist, so you can keep these points in mind, on your phone, or in your pocket when you’re at your next orthotic appointment.
When considering orthotic treatment it is always important to consider the effect the treatment will have on your child and your family. Orthotists are trained to include a family needs assessment into any orthotic prescription, which will take certain aspects of the client’s life into consideration, but these are usually more related to the activities the client will be performing with the orthotic. The family friendly orthotic checklist dives deeper into a client’s daily routine and effects on family life. Please keep in mind that it may not be possible to incorporate each item on the checklist into the orthotic without compromising its functionality, but it never hurts to ask. Many orthotists I know are very creative and enjoy a new challenge, so maybe you’ll inspire them to create a new solution for you.
Family friendly orthotic solutions will meet the following criteria:
- Easy to get on and off
- Easily fits footwear
- Custom images
-Help access to funding
For most clients and their families being able to get the orthotic on and off easily is crucial to wearing the orthotic. If the orthotic is being put on by a family member or caregiver the orthotic should have some markers which show that it is on in the proper position. Two simple markers I use in my practice is to drill holes in each side the heel plastic, and to mark where the end of the toes should be. As the child grows this mark won’t be as accurate, but it will help for a few months. At this time most of the straps being used in orthotics are Velcro. It is the most easy to use and functional type of strapping. Unfortunately it is not the most durable. If durability and ease is required having a stronger material backing the Velcro is a good solution.
Being able to put the orthotics on and off independently is an important milestone and life skill for some kids, so it is important to ask what hand the client will use so the straps can be placed on the side that will make it easiest to do up. For children who are using above ankle orthotics (SMO’s) typically you will need to do the straps on the orthotic then put it in the shoe. However, I have designed an above ankle orthotic which can be left in the shoe (In-Shoe SMO) and only requires an ankle strap. This takes less time because it’s two less things to do when getting the orthotics on and off. Making this easier can be the difference between a child doing their orthotics and shoes independently or not. Which is an especially important consideration for kids in school, as teachers and education assistants well know.
For children who wear orthotics which go from the foot to the knee (AFO’s) most designs require them to put the orthotic on before putting it into a shoe. Recently, I have designed a new style of AFO which allows the client to keep their orthotic in their shoe for ease of sliding in and out. This AFO has the joint at the back of the brace instead of the sides, and I call it the PJO (Posterior Joint Orthotic). Along with increased independence this can definitely reduce the time it takes to get out the door and helps to make transitions quicker in school so your child can get more play time with their friends. Please contact me if you would like more info about the PJO.
For some kids it is very important to prevent them from getting their orthotics off. In these cases there are a few options which can help. The easiest is to roll a sock over the top strap of the orthotic, and if it’s long enough, roll it down over the heel so the sock is locked in place by the shoe. If this doesn’t work the other thing I have done is add a leather buckle closure to the end of the Velcro strap. This is very effective but it makes the process of getting the orthotics on and off significantly longer.
Fitting orthotics into footwear is the biggest challenge I face as an orthotist. It would make my job very easy if I could just give my clients a big clunky shoe to fit their big clunky orthotic. The problem is nobody wants to wear a big clunky shoe. Kids with special needs are still kids, and kids usually want the same things as other kids. So getting to have a shoe like their friends can mean a lot. That’s why I do whatever I can to help fit an orthotic into “cool” or “pretty” shoes. The most common alterations include grinding the plastic and making sure the strap placement is high and out of the shoe. These sound like simple solutions but it sometimes takes hours to get orthotics to fit properly into nice shoes.
The second most common issue regarding footwear is getting boots to fit over orthotics. In the past I have recommended to not spend too much time looking for boots because most will not fit over orthotics. I am always on the hunt for good quality boots at affordable prices. Please let me know if you find some!
The final footwear issue is using sandals with orthotics. For some kids having footwear which is light and breathable is very important. In most cases Crocs can work well to fit over orthotics. They are not the most durable but will usually last a summer. I have seen kids wearing other styles of sandals but no brand has had a consistent style which works. If you want a sandal which is made specifically for orthotics you can check out the Keeping Pace website and ask your orthotist to order them for you, as they will not ship to Canada. Unfortunately, the styles are limited and not really “cool” or “pretty”, and they are quite expensive, but they are very durable. Otherwise, for most kids I recommend just wearing a sandal that fits the foot for limited use (as long as they are safe to do this) and don’t worry about using the orthotic, sometimes it’s nice to have a break.
Orthotics have come along way since the days when all orthotics were made of metal and leather. These were very heavy and cumbersome. Now orthotics are most commonly made form different types of plastics which have reduced the bulk and weight significantly. However, in certain situations even these relatively lightweight orthotics can be too heavy for the kids to move with so we need to be able to offer options. At this time there are two main ways to reduce the weight of an orthotic. The first is to remove unnecessary plastic from the orthotic. The second is to use materials which are lighter than plastic. Lightweight materials which orthotics can be made from are carbon fiber and fabrics. These lightweight orthotics are not typically custom made and they may not provide the strength or stability of a custom made plastic orthotic. Therefore it is very important to consult with your orthotist, therapist, and/or physician when considering these options.
The comfort of an orthotic is something that obviously needs to be right for anyone wearing these devices. I make sure to include padding or flexibility at potential problem areas. Two things I commonly do in these situations is to add foam or gel, and remove plastic or hard material from the affected area. The benefits of anticipating problem areas by incorporating these extra comfort options in the original design of the orthotic is to reduce the number of extra appointments the family would have to make for adjustments due to skin issues, and to help ensure that the initial fitting is relatively quick (20-30 minutes).
Another way to reduce the number of extra appointments is to ensure that the orthotic is durable. If your child is very active or if the orthotic needs to be extra strong for any number of reasons, it is usually a good idea to mention this to your orthotist so we can include the extra reinforcements into the manufacturing process. In situations where extra reinforcements are required I will typically increase the thickness of the plastic and/or use a stronger foam, fabric or leather for strapping or liners.
It may come as a surprise to you, but orthotics can also be multifunctional. As well as for use during walking, the same orthotic can be used as a stretching aid, a trial for a different style of orthotic, or they can have removable sections for specific activities. The most common multifunctional components I have used are ankle stretching straps, removable knee and foot sections, and when appropriate we will sometimes cut down the orthotics to a lower level of support for the client to try before deciding to make a new device.
The next item on the checklist is the option to have a custom image printed on the plastic. For many years orthotists have been able to offer standard designs that everyone could choose from. While this made the orthotics more kid friendly it didn’t always match what the child was really interested in. Now it’s possible to make an image that matches anyone’s interests, and the client and their family can even design it themselves! Sometimes our clients like to get help from their parents, siblings and even grandparents when making their choice, which really makes the orthotic experience feel like a family affair. Toronto Orthopedic has been offering this service for a number of years now and it has really helped the kids and their families take a more active interest in the orthotics. Everyone is excited to see the finished product at the delivery day “reveal” and the kids look forward to showing off their new orthotics to their family and friends.
Finally the moment you’ve been waiting for and probably the most important item on the checklist . . . cost. There are many expenses for families of children with special needs and orthotics can be expensive. The good news is that the Government of Ontario covers 75% of the cost of the custom orthotics (as long as they go above the ankle) and if your family is receiving assistance from other government programs (such as Ontario Works, Ontario Disability Support Program, Assistance for Children with Severe Disabilities, etc.) then 100% of the cost is covered. Other third party payers such as health insurance, or other charitable organizations (such as Easter Seals, Jennifer Ashleigh Foundation, Lions Clubs, Rotary Clubs, etc.) may cover the remaining 25%. Getting in touch with these charities can feel like an overwhelming task, especially if you don’t have a social worker. I understand how difficult this can be so the friendly and knowledgeable office staff at Toronto Orthopedic can help your family figure out their way through these systems so you can get the funding you need. I will caution you to be patient, because dealing with these organizations can take time, but hopefully it will be worth the wait.
I hope you have found this information valuable. Please leave a comment, or contact me if you have any questions. Thanks!