Q: What is your feeling about the effectiveness of splinting to manage foot deformities once children become early ambulators?
A: With reference to most early foot deformities, I am a big believer in controlling the calcaneus because, until the age of six, the calcaneus plays a huge role in creating forces on the rest of the foot. Therefore, in a patient with juvenile HAV/hammertoe, controlling the heel in varus in a very early ambulator will prove effective at slowing down whatever deformity may be there or waiting to worsen. In other words, I splint with a deep heel cup. I don’t think that taping joints to change angulations is particularly successful. I would, however, never discourage parents from keeping certain joints splinted in improved positions. As long as the biomechanics are not being compromised through splintage, allowing the ligaments and joint capsule to set t le in a more corrected position during maturity can only help the situation.
In cases of metatarsus adductus, in particular, I am a frequent user of the Wheaton brace. I find that splinting the foot nightly in a more corrective position helps to reshape and/or hold the midtarsal ligamentous structure.
Note:
Louis DeCaro, DPM specializes in pediatrics with a special interest in sports medicine and biomechanics for both adults and pediatrics. He is vice-president of the American College of Foot & Ankle Pediatrics (ACFAP). He is currently in private practice with an office in West Hatfield, MA. He is a member of the surgical & medical staff at Franklin Medical Center and Holyoke hospital. Dr. DeCaro is the founder/director of an adult & pediatric biomechanics gait lab, which takes place biweekly at his office.