Curly or Hammer Toes in Infants and Toddlers

Parents are often concerned about infants and toddlers having curly toes or toes that are already hammered. This is a very common chief complaint. They worry that their children will have pain and misshapen toes/deformities/hammertoes later in life. They want to do everything for these children (rightfully so). Common “reverse deformity stretching” aka stretching in the opposite direction of the deformity, is sometimes not enough and there can be deforming forces working against these daily stretches. These deforming forces are seen in kids with flexible flatfeet (which most kids have at this age). Surgery is highly discouraged for this condition.

 This child is an 11-month-old who presented as a new patient initially at 6 months with a “curly” lesser digit on one of his feet. At that initial evaluation parents were given stretching exercises for the toe to try and help straighten the deformity. Today he presents at 11 months and is starting to cruise (hold onto objects to walk). 

Bottom line: the patient was dispensed littlesteps foot orthotics today (for reasons below) and will do phenomenal.

Picture #1 – Curly Toe Deformity

This patient illustrates many pediatric ideas :

1 – Flexor stabilization of the lesser digits (by the FDL) is a powerful deforming force of the lesser digits. Kids with pre-existing digital deformities will worsen without intervention.

2 – Flexible flatfeet causes overuse/overfiring of the FDL. Whether it is severe or typical flexible flatfoot in these kids the stabilization forces are still seen.

3 – Littlesteps stabilize the heel valgus/eversion/flexible flatfoot and thus significantly decreases the instability of the child and thus decreases the unnecessary “firing” of the flexors/FDL,   allowing manual stretching to achieve better results by straightening toes that are more curly than desired.

This is a classic case of a patient with flexible flatfoot who, as they begin to walk, has significant “firing” and overuse of the flexor tendons of the feet for stabilization. This issue, in this patient’s case and with many digital deformities, is that the contracture will often not allow the “curling” of the toe to straighten out over time and in many cases will make the issue worse. The patient is an almost 1 year old who is now beginning to cruise. The patient’s father has noticed that when he gets up and holds onto something that he will almost be able to stand for a brief time, however he sees a significant amount of toe contracture of the lesser toes of both feet. The patient’s Dad especially sees the affected toe (3rd digit,) which is adductovarus and plantarflexed, flex even more to the point in which it curls under the foot. The patient will then  turn his ankle and fall. Dad is concerned about this ankle collapse as well as concerned that the toe stretching exercises he does with him nightly will not work as well. Dad is “reverse stretching” the toe when he can so that to give the toe as much opportunity to straighten. Dad is aware that the curly toe may not fully “uncurl” but wants to do everything possible to help it while the child is flexible.

Picture #2 – Flexible Flatfoot stance

The child is dispensed littlesteps to stabilize the rearfoot (calcaneal valgus) so that the stabilizing lesser toe tendons do not have to over fire and increase/preserve the curly toe. Standing on the littlesteps there is noticeably less flexion contraction and a total removal of ankle instability. Videos and pictures are taken.  littlesteps have a deep 30mm UCBL heel cup (to stabilize heel valgus) with a medial skive (to stabilize the sustentaculum tali/STH0, medial and lateral longitudinal arch support and a lateral flange to cut down on abduction of the foot . 

Picture #3 – Curly Toe with active flexor contracture/stabilization

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Advancing Comfort and Support: The Popularity of Prefabricated Foot Orthotics

In the pursuit of enhanced comfort, improved foot alignment, and efficient injury prevention, foot orthotics have become an indispensable tool. These inserts, designed to support the feet and correct biomechanical issues, have traditionally been custom-made to fit the unique contours of an individual’s feet. However, with the advent of prefabricated foot orthotics, a new era has dawned, revolutionizing the accessibility and affordability of this invaluable technology. In this blog post, we will explore the world of prefabricated foot orthotics, discussing their benefits, limitations, and their impact on foot health.

Understanding Foot Orthotics

Foot orthotics, also known as shoe inserts or insoles, are specially designed devices that are placed inside shoes to provide support, correct structural abnormalities, and alleviate pain. They are primarily used to address foot-related issues such as overpronation (excessive inward rolling of the foot), flat feet, high arches, plantar fasciitis, and other conditions affecting foot alignment.

Traditionally, custom-made orthotics have been the gold standard for addressing specific foot issues. These are created by taking impressions of the patient’s feet and tailoring the orthotic to their unique requirements. However, this process can be time-consuming and costly, often requiring visits to healthcare professionals, such as podiatrists or orthotists.

Enter Prefabricated Foot Orthotics

Prefabricated foot orthotics are a relatively recent development that offers a standardized solution to common foot problems. These orthotics are manufactured in various sizes and shapes, designed to fit a range of foot sizes and arch types. They are readily available, allowing individuals to purchase and use them without the need for a professional fitting.

Benefits of Prefabricated Foot Orthotics

  1. Affordability: One of the primary advantages of prefabricated foot orthotics is their cost-effectiveness. Custom orthotics can be quite expensive due to the involved process in designing and manufacturing. Prefabricated options provide an affordable alternative, making foot orthotics more accessible to a wider population.
  2. Accessibility: Prefabricated orthotics are readily available from various retailers, eliminating the need for specialized appointments and long waiting times. This accessibility ensures that individuals can find relief for their foot issues promptly.
  3. Convenience: With prefabricated foot orthotics, individuals can purchase and use them immediately without having to wait for the custom-made versions to be produced. They can be easily transferred between different pairs of shoes, enabling users to enjoy their benefits across various activities and footwear choices.
  4. Versatility: Prefabricated orthotics often come in a range of sizes, arch heights, and designs to accommodate different foot shapes and conditions. They can address common issues such as arch support, cushioning, and alignment, providing a versatile solution for a wide range of foot-related problems.

Limitations of Most Prefabricated Foot Orthotics

  1. Lack of Customization: The main drawback of prefabricated foot orthotics is their inability to address individual foot irregularities with the same precision as custom orthotics. While they offer a range of options, they may not provide the exact level of support or correction needed for more complex foot conditions.
  2. Specificity: Prefabricated orthotics are designed to address common foot problems and provide general support. However, certain individuals with more severe or specific conditions may require custom-made orthotics to ensure optimal results and comfort.
  3. Trial and Error: Finding the right prefabricated orthotics may involve some trial and error. Individuals may need to try different brands, sizes, or designs before finding the one that suits their feet best. This experimentation can be time-consuming and frustrating for those seeking immediate relief.

The Quadrastep Prefabricated Orthotic System is often considered a top choice in prefabricated foot orthotics for several reasons:

Customization: The Quadrastep system offers a high degree of customization, even within a prefabricated format. It takes into account the individual’s specific foot type, arch height, and alignment to provide a more tailored solution compared to generic prefabricated orthotics. This customization helps improve comfort, support, and overall effectiveness.

Evidence-based design: The Quadrastep system is based on years of research and clinical experience. It incorporates the principles of the Root biomechanical theory, which is widely recognized and respected in the field of podiatry. The design aims to address common foot problems and improve biomechanical alignment, thereby promoting optimal foot function and reducing pain.

Versatility: The Quadrastep system offers a range of orthotic options to accommodate different foot types and conditions. It categorizes feet into six different types (Q1-Q6) based on their specific alignment characteristics and provides corresponding orthotics for each type. This versatility allows for a more precise fit and targeted treatment for various foot pathologies.

Ease of use: Being prefabricated, the Quadrastep orthotics are ready to use without the need for complex measurements or molds. This convenience saves time and effort, making them more accessible for both patients and practitioners. They can be easily fitted into different types of footwear, promoting patient compliance.

Professional endorsement: The Quadrastep system has gained recognition and endorsement from many podiatrists and healthcare professionals. Their positive experiences with the system’s effectiveness in managing foot problems contribute to its reputation as a top choice in the field.

Prefabricated foot orthotics have brought about a significant shift in the world of foot health. While they may not provide the same level of customization as their custom-made counterparts, they offer a cost-effective, accessible, and convenient solution for many common foot conditions. For individuals with mild to moderate foot issues, prefabricated orthotics can provide the necessary support, alignment correction, and pain relief. However, it is essential to consult a healthcare professional, such as a podiatrist or orthotist, to ensure the best possible outcome for more severe or complex foot conditions. With advancements in materials and manufacturing techniques, prefabricated foot orthotics are likely to continue evolving, enhancing foot health for a broader range of individuals in the years to come.

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QUADRASTEP Efficacy in the Workplace

A quality improvement study into the effectiveness of the semi-custom, prefabricated shoe insert program (Quadrastep System) at reducing complaints of discomfort in an industrial setting.
Jeffrey Dow, RPT, CEASIII, Premise Health System
Pauline Lewis, MS, CPE, Michelin

A common source of reduced productivity and lost work time in the industrial setting is musculoskeletal discomfort in the feet, knees, hips, and low back. Even when working identical job posts, these symptoms can vary widely between employees, and could potentially be caused by intrinsic foot biomechanics coupled with long-term standing activities. Therefore, to prevent injury and reduce daily discomfort, one size-fits-all approaches such as anti-fatigue mats or off-the-shelf shoe insoles may be less effective than treating each employee’s specific biomechanical traits. The Quadrastep System is a prefabricated, semicustom shoe insert system that bridges the gap between more expensive, fully customized orthotics and off the- shelf options. We studied the effectiveness of the system in a large manufacturing plant by assessing and providing Quadrastep inserts to 28 volunteers. After 2 months of daily wear, 94% of these volunteers said they received some benefit from the inserts, while 52% reported full resolution of daily symptoms.

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