Studies Indicate Shoe Inserts Make a Difference

Effect of Dynamic Foot Orthotics on the Motor Skills of Children with Developmental Disabilities

Physical Therapist Valerie Wondra in collaboration with Dr. Ken Pitetti, a professor at Wichita State University, conducted a study to test the impact of shoe inserts on locomotor development with children at the not-for-profit early childhood center where she works in Wichita, Kansas. In providing physical therapy treatment for the children at her center she noticed that some of the children with shoe inserts appeared to be making greater improvements than those who did not have inserts. In order to test her assumptions she conducted a study, gathering data over a 12-month period using the PattiBob^TM insert from Cascade Dafo®.

Wondra chose children for her study based on their difficulty with locomotor skills, rather than how their feet presented. She used a student pool of 50 children, many of whom have differing levels of developmental disabilities. She tested the locomotor skills of the children using the Peabody Test, which included activities such as walking up and down stairs, jumping forward, jumping down, and walking across a balance beam. The children were tested after wearing the inserts for one week, two months and four month intervals.

In the early results, there were already noticeable improvements after just one week of wearing the Pattibob inserts. One little girl gained locomotor skills of six months after wearing the PattiBob inserts during this time period, compared to three-to-four month improvement gained over the entire previous year.

In Wondra’s study results, the group of children who experienced the greatest improvement in locomotor skill development were those who did not initially present as if they needed shoe inserts. Her theory is that the better support and stronger lever for push-off provided by the PattiBob inserts increased the children’s proprioception and gave them greater sensory feedback. The increased feedback provided benefits greater than not wearing the inserts.

After the children wore the shoe inserts every day for two months, Wondra tested them with the inserts both in and out of the shoes. The children maintained most of the functional locomotor skill improvements when the inserts were removed. This indicates that the body maintained skills that were developed by the increased sensory awareness, provided by the inserts.

Wondra presented her initial results at the American Orthotic and Prosthetic Association (AOPA) conference in September 2004, and will present the complete 12 months of data at the American Physical Therapy Association (APTA) Conference in New Orleans later this year. An article on her study was published in the January 2005 issue of Journal of Prosthetics and Orthotics.

Physical Therapy Intervention for Children with Hypotonia and Flat-feet
A second study conducted by physical therapist, Dr. Charmayne Ross, for her dissertation at Loma Linda University in California, focused on the value of physical therapy intervention for children with hypotonia and flat-foot dysfunction. In her training she had worked with many children with low muscle tone and flat feet and had observed improvements in balance and adjustment for those children wearing foot othoses. Like other physical therapists working with this population, she intuitively sensed that stabilizing the children’s feet would improve gross motor function. She had experienced this positive impact in her work, but wanted to conduct the research to gather more objective data.

Dr. Ross used the HotDog^TM insert from Cascade Dafo with posting and arch fill in order to address the mechanical alignment she was researching. Dr. Ross’s study examined the effectiveness of a physical therapy intervention for six months using the HotDog insert and an exercise program for children with atypical development.

She found that children with developmental delays and hypotonia who received specific intervention (orthoses wear and orthoses wear combined with exercise) for their flat-foot dysfunction, showed improvements in their arch development and gait parameters when compared to the control group. All groups showed improvements in the gait parameters of velocity, step length, single limb support time, and cadence, but those in the intervention groups revealed stronger improvements.

Dr. Ross was particularly interested in conducting and publishing this research to bring awareness to the preventive benefit of physical therapy intervention. She found the use of soft foot orthoses, in the identified population, prevented many undesirable effects including hesitancy, and falls. The inserts further allowed children to move more freely and play with more confidence. Rather than waiting to see if normal maturation would correct the flat-foot condition, Dr. Ross’s study set out to investigate if the inserts and specific exercises could indeed improve the current condition and serve as a preventative intervention.

At the end of Dr. Ross’s study many of the parents of the children who participated, reported a decrease in concerns regarding the chance of their children falling and potentially hurting themselves. Hence, allowing parents to be more at ease because their children demonstrated greater balance, less hesitancy and were able to move with more freedom.

Dr. Ross presented her initial results at the American Orthotic and Prosthetic Association (AOPA) conference in Florida, September 2004. She presented her poster presentation at the American Physical Therapy Association (APTA) Conference in Anaheim, October 2004, and will present her poster at the American Physical Therapy Association (APTA) Conference in New Orleans, February 2005. An article summarizing her study and thoughts regarding foot orthoses was published in the December 2004 issue of Advance for Directors. Her study is still being reviewed for possible publication in a major peer review journal.

For further information on Dr. Charmayne Ross’s study please feel free to contact her at Char_therapy@sbcglobal.net or Cross@dynamic-therapies.com.