Case Study | JumpStarts and the Young Low Tone Pronator

t’s often important to consider not just unusual cases but also the ones that unfold as planned. This case study represents a typical assessment and solution.

Trevor, an 18-month-old with Down syndrome, has a fraternal twin. (His brother Len is considerably bigger than he is.) Trevor had been very slow to show interest in crawling or walking until just a day or two before our initial visit. That’s when his mom zeroed in on his flat feet. Trevor’s mom has him in a play group for children with Down syndrome, and the other parents in the group recommended JumpStart® braces from their personal experiences. Excited about the possibilities that bracing presented for Trevor, his mom had advocated for braces and received a prescription from her doctor.

Given that he was just beginning to ambulate, Trevor was a classic candidate for the JumpStart Leap Frog SMO. This brace can provide stability to his calcaneus and medial-lateral support, and it helps limit forefoot abduction, providing an improved base of support from which to begin exploring ambulation. We measured and tried a size. Overall fit and volume were appropriate. The braces fit well in his existing shoes with the insoles removed. He tolerated the braces well and exhibited very good foot-ankle alignment in assisted standing. Trevor’s mother was quite happy with the immediate improvement in stability.

On the fit visit, the Leap Frogs were donned and final length established. I reduced the medial and lateral forefoot trimlines to the met heads for comfort and to retain a flexible foot plate. Toe length was left quite long, as this size fit into Trevor’s existing shoes. I would ordinarily trim the footplate and encourage a parent to consider buying smaller shoes, but the shoes were very pliable and did not interfere with toe extension, either with or without the brace. Also, Trevor’s feet are currently pudgy and wide; his Leap Frogs accommodated this volume. With any luck, these braces (and shoes) will fit him for a substantial period of time as he’s growing.

I briefed Trevor’s mother on our standard wearing protocol—starting with an hour or two and gradually increasing wear time by two hours per day for six days.

Trevor’s mother wondered whether it would be appropriate to keep him barefoot in the summer months at the beach and so on. I asked her to keep him in the Leap Frogs as much as possible, but to work the braces into his lifestyle, not fit his lifestyle to the braces.

In just the week or so from initial visit to fit assessment, Trevor increased his crawling significantly and was beginning to try to lift himself for standing and walking. The fit and function of these devices were appropriate at this time to provide him with standing stability and encourage ambulation.

During a followup call to Trevor’s mother, she reported that he was doing very well with his Leap Frogs. He began cruising two days after receiving them and was wearing them all day by the tenth day.

—Tim Shride, CPO

Tim received his B.S. in Prosthetics and Orthotics from the University of Washington. During his residency at Connecticut Children’s Medical Center, he worked with a wide variety of pediatric patients and diagnoses. Tim was a clinician for Hanger Prosthetics and Orthotics before coming to Cascade in 2006. In addition to providing adult and pediatric orthotic care, he also provides prosthetic care in our Ferndale and Mt. Vernon, Washington, facilities.

Tim is Board-Certified by the American Board for Certification in Prosthetics and Orthotics and holds a Washington State license as a Prosthetist/Orthotist.

Trevor presents with typical low tone pes plano valgum (flat feet), which is moderate to severe, with significant calcaneal valgum. His feet, very flexible with plenty of range of motion, are correctable to a fully balanced neutral position, free of deformity and otherwise unremarkable. Trevor tries out his new JumpStart Leap Frogs. Tim explains the break-in protocol to patient and parent.