Kids Alignment and Gait Correction

Does your child need orthotics?

There is currently considerable debate about what the best shoe and orthotic combination is for growing and adult feet. EastWest Physiotherapy uses the common-sense approach.

Firstly, it is quite normal for very young children to have flat feet (low arches) and bowed legs.

This stage spans from one to seven years. It is very uncommon for children to need orthotic intervention at this age. We encourage spending lots of time barefoot, and when choosing shoes, the more flexible, the better.

As children increase their participation in sport, more stress is placed on the muscles, ligaments, bones and fascia. This is a fantastic input to the growing nervous system, and the more time outside away from the computer, the healthier the child becomes. Clinically, between 7 and 12 years, children begin to adopt their adult postures, and their motor patterns are being developed. Some children may encounter issues relating to posture and may complain of overly tired legs, specific ankle or knee pain or may have coordination problems.

From twelve to sixteen, children are rapidly growing, hopefully participating in loads of physical activity, and we believe they are in a very critical stage of postural development. Walking and running patterns are being grooved in the nervous system for life.

This is an excellent time for an assessment at EastWest Physiotherapy. In-toed or out-toed patterns can be easily measured and corrected using orthotics (this is similar to braces for oral alignment and best fixed when the bones are growing). This can influence spinal health and alignment.

As kids become more active and heavier, a host of lower limb conditions can occur, including arch pain, Achilles tendonitis/severs, shin splints, aching legs, patellofemoral pain, low back pain, Osgood-Schlatter’s disease, and general growing pains. Generally, these conditions get worse with:

Faulty biomechanics
Excessive tissue loading
Rapid growth spurts.

Faulty biomechanics need to be assessed by our movement professionals, as overpronation/supination are poor postural positions. Some common methodologies used include gait analysis, muscle testing, digital postural analysis and palpation of tissue stress.

Some common correctable physical findings may include:

Muscle imbalance
Leg length difference
Pelvic misalignment
Excessive ankle pronation/supination
Instability/hyper mobility.

We take pride in our innovative and logical approach to postural biomechanics at EastWest Physiotherapy. Book your free 10-minute consultation and find out how we can help your child stay fit, happy, and active.

Kids' conditions treated

Explore all the conditions specifically in kids that can be treated by Foot Alignment & Orthotic Therapy.

In-toeing often begins with the way the lower leg develops. Some children have a tibia that twists inwards more than usual. This alters the way the feet and knees align, even when the hips are attempting to maintain a neutral position.

Kids with in-toeing usually rotate their thigh and knee outward to compensate. Over time, this can overload the back of the hip, leading to tight hamstrings, tired legs, or an awkward walking pattern. Some children improve as they grow, but many continue into adulthood with the same torsional pattern and ongoing hip issues.

Orthotic therapy works well for in-toeing. We commonly see steady improvements in tibial rotation, approximately one degree per month. Hands-on myofascial release and simple home exercises support the process, helping to restore natural movement. All of these are available at EastWest Physiotherapy.

Out-toeing usually develops for a different reason. Instead of the tibia rotating inward, the leg may turn outward more than ideal. This shifts how the knees and hips line up, often placing the kneecap slightly off-track during movement.

Children with out-toeing tend to rotate the knee inward to compensate. You might notice the knees drifting together, the feet pointing outward, or the pelvis tilting forward. While some children outgrow it, many continue to experience knee discomfort or reduced efficiency in their walking pattern into adulthood.

Orthotic therapy is also effective for out-toeing, although improvements tend to occur a little more slowly — roughly one degree every couple of months. Myofascial release, stretching, and strengthening help reduce strain and support long-term correction.

The condition typically occurs in children between the ages of 8 and 14 years. Sever’s Disease is characterised by activity-related pain that occurs on the back of the heel, where the Achilles tendon attaches to the heel bone, which is alleviated when the child walks on their toes. The child may experience swelling in the affected area and tenderness upon touch.

Sports that require a lot of running, jumping, and other high-impact activities are particularly associated with Sever’s disease. Children who are prone to Sever’s disease are usually very active, experiencing a growth spurt, have tight calf muscles, may be in-toed or out-toed, and may be pronators. Treatment starts with load management, anti-inflammatory modalities (e.g., ice, cold laser), biomechanical analysis, myofascial release and possibly orthotic therapy when indicated.

During your child’s adolescent growth spurt (typically between 9 and 16), his or her bones grow rapidly. If your child is involved in a lot of running and jumping activities during this time, he or she is at risk of developing Osgood-Schlatter Disease (tibial tuberosity apophysitis), an overuse syndrome that causes pain, swelling and tenderness just below the kneecap where the patella tendon inserts onto the tibia.

Short term rest, anti-inflammatory modalities, and orthotics to minimise biomechanical stress are prescribed. We find a high proportion of kids with Osgood-Schlatter Disease are also in-toed; a condition easily managed with orthotics, much like the work of orthodontists with teeth alignment.

Sinding-Larsen-Johansson (SLJ) syndrome is pain at the bottom of the kneecap (patella) where it attaches to the patella tendon. It is caused by swelling and irritation of the growth plate. A growth plate is a layer of cartilage near the end of a bone where most of the bone’s growth happens. It is weaker and more susceptible to injury than the rest of the bone.

Children are at risk of SLJ when they participate in high-impact sports (such as running and jumping), experience rapid growth, increase their physical activity levels quickly, and have underlying biomechanical faults. Treatment includes load management, local anti-inflammatory modalities, a biomechanical assessment of gait and posture, and identification of tight or weak muscles/nerves. Commonly, out-toeing affects the forces at the patellofemoral joint. If this is present, orthotics with a gait plate are indicated to remodel the tibial torsion.

Kids complain of growing pains regularly. It is worth getting an assessment if the condition is persisting and is preventing your child from being active. Typically, the child is undergoing a growth spurt in the long bones, and the myofascia is struggling to keep up with the elongation.

My advice is to try hot Epsom salt baths and stretching exercises. If this approach is not effective, there may be an underlying postural issue that requires specialised management. Treatment often involves custom orthotics to align the feet and legs in the most efficient posture, as well as myofascial massage, acupuncture, dietary therapy, and stretching exercises.