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My 5 year old has been in orthotics since 18 months, so I"m happy to answer any questions I can. He has them for low muscle tone, pronated ankles, and arch development. He started walking at 19 months.
- I think they've really helped a lot. First, because he started walking soon after getting them. But now because I can see that even though he still needs them, the bones in his feet are developing properly.
- He will still need them for another year. Our PT and orthotics person (and others have heard the same thing) said that because the bones in kids feet aren't fully formed or hardened until about age 6, kids typically wear them until then. After that he can get shoe inserts.
- We've had almost no trouble getting him to wear them. I think it took a day or two at the beginning, but now it's fine. The only issue is as he starts growing out of a pair or needs them adjusted, they can hurt to wear. We've had short periods where he didn't wear them while we waited for an appointment and then there's another few days of adjusting back to wearing them.
- The best shoes I've found are XXWide from Stride Rite. The velcro strap is long enough to fit across the top of the shoes. I size up about a whole size.

Just a few other thoughts:
- The main thing I would ask about is how much time she should spend in them versus barefoot. We've gotten some different opinions over the years from PTs. He does spend time barefoot at home, especially on the weekends.
- Now that he's older, I worried about teasing, but there's been almost no comments from other kids, other than curiosity.
- If your DD is in daycare, make sure that everyone understands how to put them on, including floaters. Or that there is a plan in place to pass on the info if teachers are out. We had a few issues at our old school where they weren't put on at all or improperly after nap.

Let me know if you have any other questions!

@psw27: Our son was in EI starting around 13 months with PT (among other things), so the first recommendation, as I recall, was from his PT. But his pediatrician also noticed at an appointment and gave us the referral. For him, it's that his ankles roll in as he walks or stands. It's especially noticeable from behind if he squats down from standing.

I’m a practitioner who does gait analysis, orthotics evaluation and biomechanical assessment. I will say in 10 years of doing this, I have never put a child under age 9 or 10 in orthotics, but that could be because our clientele tend to be active kids who are injured temporarily not from congenital issues or disorders. It’s a little controversial and you’ll hear differing opinions from different practitioners. It’s hard to know what’s normal at that age up until about 7 or 8 because developmentally, flat feet, knock knees, rotation in hips, etc are all considered normal. However, worsening alignment, difficulty with walking/running and pain are a different story that usually needs to be treated.

The main concern is reliance on the device and weakening muscles. An orthotic is a brace so just like any other brace it will keep your child in good alignment, but if proper strength and mobility doesn’t develop then they will have to continue wearing it indefinitely and get more and more aggressive with the support. I would make sure whoever is evaluating your child specializes in Pediatric bracing/orthotics and has a good plan for muscle development in tandem with the orthotic and a good plan to eventually stop using them.

@Chuckles: sounds like you have a great plan and good physio! And yes, like I said, I do deal with mostly developmentally average kids with typical sports injury type problems. Only occasionally do I get a true congenital deformity...though we field a lot of questions from worried parents! I even catch myself analyzing my 3 year old. I only say to the OP to make sure she sees a specialist in Pediatrics as I know in my own profession and allied profession there are MANY practitioners who can make the case for orthotics and bracing for literally anyone that walks into their office. It can be a money grab industry with a lot of dishonesty about what orthotics do and don’t do, what they can and cannot prevent or treat. I won’t get into details here, but like anything, do your research and get second opinions if something doesn’t seem right.