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.