Children’s Orthotics and Supramalleolar Orthoses


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Article by Dr. Misako McLeod, DPM

Children sometimes have flatfeet and parent are often told by their pediatricians that they will “grow out of it.” This is an erroneous and antiquated assumption. Children should be properly evaluated by a foot and ankle specialist, not a pediatrician with minimal foot and ankle biomechanics training.

I have seen patient with metadductus  (C-shaped foot), clubfoot deformities, equinus, and severe pes valgus (flatfoot) which were seriously misdiagnosed and given incorrect treatment plans.

Although many young children do outgrow mild flatfoot, some do not and this will affect their activity level later in life. Often children with flatfoot tend to be less active, overweight, and more sedentary.

I strongly recommend that all children with questionable foot issues be evaluated by a foot and ankle specialist. Orthotic therapy should be considered in children of 3 years and older to assist in the musculoskeletal development of their foot structure and alignment if their flatfoot has not resolved. Early correction of alignment issues will prevent future potential foot and ankle issues as an adult.


Supramalleolar Orthoses (SMOs) used for severe pes valgus in children.


Some children might require a simple orthotic, which can be changed out about every 6 months, depending upon the growth rate of the child.

Dr. McLeod has an “Children’s Orthotic Outgrow Program” which replaces the orthotics as the child outgrows them in a 2 year period. This saves on costs and replaces the orthotics as need for a 2 year period.

Some children, however, have more severe deformity and require a custom-made supramalleolar orthoses (see above picture)  which supports the ankle and the foot. Rarely, is surgery indicated for simple flexible flatfoot problems.


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When surgery is necessary, subtalar arthroresis is the common procedure of choice once other pathology such as tarsal coalition and other more complex issues are ruled out.

When evaluating your child. Dr. McLeod will perform a through neurologic and musculoskeletal examination,  followed by x-ray examination, and gait examination. She will make recommendations based upon the child’s orthopedic needs and projected development. All the above treatment options are available.

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