Q&A with Roberta Nole, MA, PT, CPed

Q: How do I know if a toe-out gait plate is appropriate?

A: I have had a lot of concerns about the misappropriate use of Toe out plates for kids, so I am glad you are asking.

Yes, we have Toe Out Gait plates.  They are used for kids with true toe out gait. With that in mind, if a child (or adult) is walking toe out, they likely have external tibial or femoral torsion and a supinated foot.  See below…

 This is from an article by Volpe:

“A gait plate to induce in-toe is rarely used. The biomechanical concept is the same with the distal angulation in the reverse direction. It is most appropriate for a child with an external femoral or tibial torsion without pronation of the foot. However, using an orthosis to control motion of the foot in a child with compensatory pronation will sufficiently reduce abduction and out-toe in most case.”


feet   feet2

So my concern is that practitioners not confuse an abducted forefoot (associated with foot pronation), with a truly toe out gait from external torsion.  See the images above:  The first picture shows a pronated foot, with flat arches causing an abducted forefoot (ie NOT TRULY TOE OUT).  The toe out picture on the right show a true toe out (in this picture would look like external tibial torsion).  If the tibia or femor has external torsion, that would supinate the foot and raise the arch.

I hope that helps you understand when it is appropriate to use a toe-out git plate.

Q & A with Robert Nole, M.A., P.T., C.Ped


Roberta, Do you recommend any products to help post up the orthotic for a true leg length discrepancy of about an inch?


The most lift I would attach to a heel of an orthotic is 1/4″.

You can get extended 1/2″ lifts that are not attached to the orthotic. They require a very very deep shoe like a deep sneaker or boot. 

I have rarely been able to make a lift any larger than 1/2″ that will fit it inside a shoe. We can make whatever you want, but I couldn’t guarantee shoe fit. And I have never found prefab lifts of this size.

Most of my patients using lifts larger than 1/2″ usually have them put onto the external shoe. That’s the ideal solution.