Tri-plane wedging and kinetic in-shoe modifications
Tri-planar wedging and kinetic interior shoe modifications are a first line treatment modality commonly utilised at LBF. They allow for the foot and lower limb position to be controlled in many common paediatric podiatry pathologies, however, do not provide the same degree of control and support that is given by customised orthotic devices.
This treatment type is often considered adequate for many children with mild to moderate presentations. Some examples of instances when it may be applied include, but are not limited to:
- In-toeing
- Limb length discrepancy
- Uncomplicated pes planus
- Mild hypermobility
- Athletic overuse syndromes
- Osteochondroses (Sever's, Os Good Schlatter's Disease)
Wedging and kinetic modifications are incredibly cost-effective and have a relatively quick turn-around time. On occasion they may be made in LBF’s on-site laboratory during the time of consultation. This form of treatment is applied to the interior of the shoe and is intended to last the life of the shoe, and later is discarded when the child outgrows the footwear.
Given that children may outgrow treatment devices relatively quickly, this form of cost-effective treatment is frequently utilised when it is considered sufficient to control the presenting paediatric foot pathology.
Exterior shoe modifications
At LBF we have an onsite laboratory where we manufacture a range of treatment devices as well as facilitating extrinsic shoe modifications. Modifications to the exterior (midsole or outsole) of a shoe, are typically performed when the degree of correction or control is too severe to be incorporated solely into an orthotic device. An example of this may be when a child has a limb length difference exceeding the norm or in instances of insufficient ankle dorsiflexion as seen in a variety of different neurological conditions. In the instance of a limb length discrepancy, the appropriate shoe would be cut through the midsole and the discrepancy would be accommodated for by way of a raise being inserted into the midsole. Additionally, a degree of posting to correct the foot position may also be incorporated.
Midsole modifications are a great option for children to allow them to continue to wear off-the-shelf footwear, or if they are transitioning out of custom-made orthopaedic footwear.
