Saturday, May 22, 2010


A couple months ago I asked our physical therapist if there was anything we could do to help improve Peanut's ability to walk. Her immediate reply, "orthotics". I was a little hesitant, simply because of the preconceived idea I have about orthotics (braces). I imaged large, clunky, uncomfortable devices that limit movement and were destined to make Peanut feel miserable. Yes, I envisioned Forrest Gump and being unable to run with the other kids until one day he broke free from his awkward restraints, never to look back again. But I figured the PT knew what she was talking about so we started down the long winding path to get an approval for orthotics. It did take FOREVER because of our unwilling insurance company, but as of Friday morning, we left our local orthotics office with Peanut's orthotics fit neatly to her little toddler feet.

Peanut needs orthotics because of her low muscle tone known as hypotonia which is a common characteristic in individuals with Down Syndrome. When Peanut bears weight on her legs she has a tendency to roll her ankles inwards, or foot pronation. Since Peanut is not walking just yet, she will primarily wear these orthotics during therapy and on an off throughout the day.

The orthotics will increase her stability when bearing weight and when she begins walking. When using the orthotics, her body will "learn" the correct way to stand. "The use of orthotics will help her to build and reinforce her gait muscle strategies and movement patterns." Essentially the orthotics are training her legs into a pattern of movement. We were given 2 options: Cascades and Sure-Step. We chose Sure-step which uses a method that "compresses the foot into alignment".

The Pros of Sure Step: First, to cast for Sure Step they only needed to take measurements for Peanut's feet compared to Cascades that require an actual cast to be made as in making a cast for a broken leg or arm. So there was no yucky cast material or trying to force a 19 month old to sit still. Second, Sure Step is a shorter orthotic for SMOs Superior Malleolar Orthosis both at the ankle and at the bottom near the toes versus Cascades. This is important because she still has free range of movement in her ankles and she is able to bend her toes which will allow her to develop more typical pattern of movement when bearing weight, pulling to stand, walking, and eventually running. Third, both Cascades and Sure Step are designed to be worn with a pair of socks and underneath a pair of shoes. The socks are to limit friction between the skin and the plastic material of the orthotic. However, it's impossible to over-tighten a Sure Step orthotic, their pamphlet stated several times, "tightness is essential for proper fit!!! Snug is not enough!!!" which "hopefully" means that we will be able to continue using Peanut's regular shoes versus moving her up in size and width, which is common for the Cascades brand. There are some limitations to the shoes that can be worn with these orthotics: we are to look for lace up sneakers and a round toe box and to AVOID shoes with tread coming up over the front of the toes and any fashion shoes. Can't say I'm said to report that high heels aren't in Peanut's future anytime soon. ;-) And lastly

I stated previously that these orthotics should be worn with shoes, but we are a barefoot sorta family when sitting around the house. So, I attempted to have Peanut wear the orthotics with a pair of socks around the house to break them in. That turned out to be a big no-go in the kitchen. Peanut has steadily been bear crawling here and there throughout the house. Since the orthotics have no traction on the bottom of them (and why would they as they are meant to be worn in shoes?), instead of bear crawling Peanut has been sliding this way and that across the kitchen floor. She sadly resembles Bambi trying to walk across the ice.

Here's Peanut sportin' her new orthotics, barely visible, huh? (Sorry for the dazed and confused look, I was interrupting Signing Time to snap these photos.)

Sure Steps are conveniently labeled so we don't put them on the wrong foot.

Sure Steps come in a variety of colors and styles. We chose Blossom.

No orthotics are required when swinging.

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Rochelle said...

Thanks for the great post. We are holding out a little longer on them for Alayna but, we might have to go that route too. She looks super cute! Hope to see her up and walking soon.

Menconi Family said...

We never looked into getting Claudia orthotics because she walked so early and never had any PT issues, really. At age 10, I finally had her evaluated because she started complaining about foot pain. Boy, do I wish we'd done it years earlier! She HATES wearing them. I think she'd have adjusted more easily to them if we'd started much younger.

Cathy said...

Thanks for the info. I think we'll be going that route soon too.

Cate said...

ooh, I'm not sure she should do the Bambi routine. we were told not to ever wear them without shoes. They're so slippery they're hazardous.

But we were also told barefoot time is also important, to give some time to let the ankles work on their own.

stephanie said...

Boy those have come along way over the years. Seriously, can't even see them. Bet they make a huge difference for Peanut. Glad you were able to get them. love the swing picture. What is it with little ones on a swing. Always cute.

To Love Endlessly said...

haha Cate, it's a learning experience for us too. The sure steps were quickly removed after the first topple to the kitchen floor. Thankfully, she didn't slid far so there were no tears, just a shocked and confused lil' red head. haha

Bulldogma said...

LOL! We have the exact same ones for The Skink! The only difference is that I ordered them with the white Velcro as opposed to the pink.

The Sure-Step orthotics also help our little ones' knees develop properly because the ankle is aligned. YAY orthotics!

Kelli said...

Great info. I think we will be going that route soon with Lindsey. Would Stride Rite have the shoes that would work with orthotics? Cute design. The swing picture is adorable.

Sweet Pea's Mommy said...

Thank you so much for posting this! Our OT brought up orthotics on Wed and wanted us to talk to our PT. We won't see her until this Wed so I've been nervous about it as well. I've spoken to a few people and there really are a lot of options out there so we will see what happens. Thank you for such an informative post!!!!

Ruby's Mom said...

Ruby has these too.We have the Busy Bee pattern with pink straps.I have found that Robeez shoe's fit perfectly over the suresteps.I bought several pair and they are all that Ruby wears right now. Dragonfly-- lilac-Robeez-baby-shoes/product.aspx?ProductID=1035&deptid=288&PriceCat=2&Lang=EN-US

Courtney said...

Lucy has had her SMOs for almost a year. I was soooooo resistant, for many of the same reasons you stated. I had visions of something big and bulky, and glaringly "SPECIAL NEEDS". Hers are cute. They look a lot like Peanut's but we did have them casted for a perfect fit. I pick up cheap-ish sneakers and pull the soles out, and then they fit over the SMOs wonderfully. (My faves are the Converse One-Stars at Target!)

We are a barefoot house, too. Lucy's PT has made peace with the fact that Lucy'll wear her orthotics all winter long, but probably not as consistently in summer! Ha! I hate how much Lucy's feet sweat in them in the summer time. Plus, I haven't found a cute strappy sandal that wears well with the orthotics yet! Tee hee hee!

I did hate them at first, but we've all grown used to them. The difference in her gait is amazing, and that makes it all worth it!

The Hapa Girl said...

I saw the Suresteps at the Conference in Sacramento so I knew what we were getting into. Lillian just got hers about a month ago and has been doing GREAT in them! Our biggest issue were finding new shoes!

LOL...yeah, she doesn't do good wearing them without shoes on either. Her poor chin ate the kitchen floor too many times!

And I like the fact we can pick and choose designs!

Amy said...

These are the exact orthotics my kiddos have! It is fun all the choices you have to pick from. Irina has cute pink bumble bees, and the boys have dinosaurs and construction vehicles. We got shoes to fit at Stride Rite because several of my little ones have wide feet without the orthotics and so we needed the double wide shoes. She is so adorable!