Hey James!!  I'm Beth the token OT on the list, ok, there may be some
lurking here quietly.  I'm not an expert on foot orthotics but, from talking
to some great PT's who say the newer wisdom is to be very conservative with
the application of orthotics.  If she's able to walk fine, the joint is
stable, etc, usually only a good pair of shoes for long distances with lots
of play without shoes helps.  Toe walking needs to be watched and needs to
be evaluated as to why she is toe walking, sensory, visual, motor problems
can be causes.   Your doc should also have you go get your daughters vision
checked as this is sometimes a cause of toe walking.  
It is confusing because, a lot of it depends on what philosophy your
practitioner utilizes.

Beth t the OT 

> -----Original Message-----
> From: Cerebral Palsy List [mailto:[log in to unmask]] 
> On Behalf Of James Ward
> Sent: Sunday, August 27, 2006 9:46 AM
> To: [log in to unmask]
> Subject: orthotics
> 
> Hi,
> 
> I am new to the list and have a question about orthotics.
> 
> I will try to offer a quick summary
> My daughter just turned three recently and only at her most 
> recent visit did her developmental pediatrician admit that 
> she "warranted a diagnosis of cp."  She shows gross, fine 
> motor, and speech delay. Prior to the cp diagnosis, she was 
> described as hypotonic. She started in afos at about
> 18 months. She did not walk until around the age of two. Her 
> balance and coordination are poor. As became more active, and 
> her fine motor skills improved, it became more and more 
> difficult to keep the afos on her (she would loosen them or 
> take them off herself).
> 
> We had her reevaluated at about two and a half. At this point 
> she could walk with or without afos. Several physicians, an 
> ortotist, and a physical therapist have evaluated her. The 
> ortotist recommends afos, an orthopedic doc recommended 
> orthopedic shoes, a pediatric orthopedic doc recommended 
> smos, her developmental pediatrician is not sure that she 
> even needs orthopedic shoes as long as her shoes have arch support.
> There is general agreement that she pronates and has a 
> tendency to toe walk. Her tone is now described as mixed, 
> though she is still fairly hypotonic. I am not sure where the 
> physical therapist stands at the moment, but suspect she 
> would lean toward afos.
> 
> Any information, or suggestions, on how to navigate this 
> world of orthotics would be helpful.
> Thanks.
> 
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