Choosing the Right Footwear

Proper footwear is important for toddlers and children. The foot is soft and pliable, so providing optimal support and protection for their feet ensures healthy development as it will prevent potential damage and problems later in life.

Young children who are not yet walking do not usually need shoes, but you may wish to buy them soft shoes which help to protect the feet if walking or crawling on rough surfaces. Most children walk from around 12-18 months of age. They generally do not need to wear shoes until they have been on their feet on their own for about 6 weeks. Shoes should fit well and allow for growth. Please check regularly to make sure the toes have room to move.

What to Look for when Buying Shoes

Get your child’s feet measured by a professional: If shoes are too tight, they can stop the toes from having enough space and could stop the foot from growing correctly. You should aim to have approximately 1cm space at the end of the toes inside the shoes.

For more information, refer to our flyer. Click here for page 1 and page 2.

A Good News Story

We recently provided a client with a wheelchair equipped with a power assist option. The client expressed a desire to use their upper limbs to propel themselves over shorter distances and to build strength and endurance. She faced limitations when it came to manually propelling herself during family trips to the shopping centre or outings to Crocodylus Park. By adding a power assist feature to her wheelchair, she gained the ability to travel longer distances that would have been challenging for her with a manual wheelchair alone. This allowed her to participate in social outings with her family in a more independent manner. Additionally, it eliminated the need for her to purchase both a manual wheelchair and a larger electric wheelchair. The decision to incorporate the power assist was made during a one-hour meeting involving the equipment supplier Keep Moving, the family, and the therapists. There are various types of power assist options available for manual wheelchairs, and in this case, a groovy handcycle was chosen by the client’s family, giving them choice and control in this important decision-making process.

Postural Care

What is postural care?

Postural care involves evaluating and implementing strategies to maintain optimal body alignment in individuals with physical disabilities. The goal is to prevent postural abnormalities and complications by utilising specialised equipment and promoting correct alignment. Postural care enhances musculoskeletal health, comfort, and overall quality of life. It is integrated into multidisciplinary approaches with healthcare professionals, with a focus on optimizing body alignment for daily activities, well-being, and independence.

How do we determine the appropriate equipment to prescribe?

The first step is to identify the client's positions throughout a 24-hour period. We complete a 24-hour postural chart to determine if the client spends excessive time in one position and to assess the suitability of their current equipment. Prolonged immobility in a single position can lead to various issues, such as contractures, musculoskeletal misalignment, pressure ulcers, respiratory complications, circulation issues, digestive problems, and poor wellbeing outcomes. By implementing postural care strategies that involve regular position changes, proper support systems, and a balanced mix of activities, we can mitigate these risks and promote overall well-being.

What equipment can we prescribe?

We can prescribe various equipment options, including seating systems, standing frames, standing wheelchairs, sleep systems, and positioning beds.

Seating Systems:

Customised seating provides posture support during different activities. When prescribing seating systems, we consider postural needs, mobility, comfort, pressure redistribution, functional activities, growth potential, client input, and collaboration with other professionals.

Standing Frames:

These devices offer upright support, weight-bearing opportunities, and numerous physical benefits for musculoskeletal development.

Sleep Systems:

Specialized sleep systems help maintain neutral spine alignment during rest, optimizing respiratory function and preventing musculoskeletal deformities.

What do we recommend?

We advocate for a collaborative approach when prescribing equipment. It is crucial to involve the client's therapists and equipment specialists in the decision-making process. Our focus is to bring together the family, therapists, and equipment providers to discuss needs, goals, and preferences, and to explore the most suitable equipment options. We organise trials and assist with requests for funding, ensuring a more efficient and tailored outcome for the individual in the long term.

If you represent someone who needs an equipment review or prescription of postural care equipment, head to Make a Referral.

What Can We Learn from the 2022 Australian Physical Activity Report Card?

The 2022 Australian Physical Activity Report Card is a comprehensive research review of physical activity trends in Australia. It contains data, statistics, and insights on physical activity participation rates among Australians of all ages, genders and socioeconomic backgrounds. Here is what the report card has to say about the current state of physical activity in Australia and what parents can do to encourage their children to get active. 

The report found that overall physical activity levels among Australians have been declining since 2005. This decline was particularly noticeable in adolescents aged 12-17 years old, with over half (55%) not meeting the recommended amount of daily exercise (60 minutes per day). Further analysis revealed that this decline was most pronounced amongst boys and young people living in lower income households. The reports also identified key factors which influence whether young people take part in physical activity. These included access to safe places for exercise, parental encouragement, enjoyment of sport/exercise and access to quality sports programs. The report concluded that interventions should focus on targeting these underlying issues to improve participation rates in sport and exercise amongst adolescents.

It offered several suggestions for parents who want to encourage their children to get more active:
• Make sure your child has access to safe places for exercise near home or school;
• Encourage your child’s interest in different sports or activities;
• Be involved in their sports/activities - e.g., attend games/events together;
• Make it fun! Focus on enjoyment rather than competition;
• Provide support when needed - e.g., help them find clubs or teams;
• Provide quality sports programs for your child - e.g., enrolling them into a local club or team;
• Ensure your child has appropriate equipment for their activities.
• Reward effort rather than results - e.g., praise effort even if they don't win; • Support other participants - e.g., applaud good performances by others as well as your own child's efforts;
• Provide feedback that is constructive, helpful and encouraging;
• Set realistic expectations - e.g., don't put too much pressure on them to perform well every time they participate in an activity/sport.

The Australian Physical Activity Report Card provides valuable insight into the state of physical activity amongst Australians today and offers practical advice for parents looking to support their children’s participation levels in sport and exercise activities going forward. By making sure our kids have access to safe places for exercise, providing support when needed and ensuring that our children are taking part in quality sports programs, we can make sure they get the most out of their sporting experiences while staying healthy and happy along the way!

Q+A with orthotist ~ Jarrod Cahir

We are lucky to partner with some incredible industry professionals to offer our clients a quality and holistic service and tailored outcomes. One of those is the very talented Jarrod Cahir from Therapy Tracks, who we often collaborate with to supply Ankle-Foot Orthoses to some of our clients. We sat down with Jarrod recently for a Q+A to get to know him a little better.

What is an orthotist and how do you become one?
An orthotist is a healthcare professional who specialises in the design, fabrication, and fitting of custom-made orthopaedic braces, prosthetic limbs, and other supportive devices. We work closely with patients who have physical disabilities or injuries to help them improve mobility, range of motion, protect their joints and bony structures and increase participation in their daily activities. To become an orthotist in Australia, you complete a university degree in Clinical Orthotics and Prosthetics, which typically takes four years to complete. The degree program covers subjects such as anatomy, physiology, biomechanics, orthotic and prosthetic design, materials science, and patient assessment and management. During this time, Orthotists gain theoretical and hands-on experience in the profession and develop practical skills in designing and fitting orthotic and prosthetic devices.

When and why did you start Therapy Tracks?
I have spent most of my career working in country SA and in the NT at both Alice Springs and Darwin Hospitals, as well as out remote with the NDIS. I’ve been lucky to do some extra studies and meet some incredibly passionate people along the way who wanted to improve health outcomes in regional and remote areas. Therapy Tracks started in 2020, with Emily, an OT in Alice Springs and Oskar an Orthotist in Broome whilst I was working in the UK learning about digital health options in the industry such as 3D scanning and printing, CAD/CAM as well as assisting with research in the field of prosthetics and orthotics. The experience allowed me to trial and gain an insight into some of the technology currently available and brainstorm ideas with colleagues about the huge upside to its use in regional areas, where there were previously very limited options for Orthotic and Prosthetic services.

This digital workflow allows us to take our workshop anywhere and provide a consistent, objective, evidence-based service with our clients in regional and remote parts of Australia. What is a career highlight to date? I’ve been fortunate to have a broad range of experiences to date. Highlights involve working in Indonesia training clinicians at a disability NGO, before going to London Orthotics Consultancy (one of the best Orthotic Clinics in the world), where in both cases I worked alongside enthusiastic people eager to think outside the box and constantly improve outcomes for the end user. I’ve also worked with Paralympians and love the opportunity to travel through the NT and Kimberley – it’s a pretty great job!

How often do you visit Darwin?
We’re currently visiting Darwin once or twice a month throughout the year, working with a number of local providers as part of the multidisciplinary team. Hopefully, as the rate of orthotic referrals continues to grow, we’ll be able to have a more permanent presence later in the year, which is exciting! What is an Ankle Foot Orthosis? An ankle foot orthosis (AFO) is a medical device that is used to support and stabilize the lower limb, ankle and foot. It is worn on the lower leg with various designs wrapping around the tibia and controlling the metatarsal phalangeal joint, to provide additional support and protection for people who have difficulty walking or standing due to conditions such as cerebral palsy, multiple sclerosis, spinal cord injuries, stroke, or other neurological disorders. AFOs can be customized to fit an individual's specific needs by adjusting the shape and design to optimise the position of the ankle, degrees of flexibility, stiffness, alignment and lever arms. They can improve balance, support muscle weakness, promote building strength in the proximal musculature and help people with mobility impairments to move more easily and safely. We take a modern approach, and enjoy working as part of the multidisciplinary team, to utilise AFOs as another rehab tool for the client to work towards their goals.

How do I know if my child needs an AFO?
Some general signs that may indicate that your child needs an Ankle-Foot Orthosis (AFO) include:

1. Difficulty walking or standing without support
2. Frequent falls or trips whilst walking or running
3. Abnormal gait, such as toe-walking or excessive pronation/supination of the feet
4. Muscle weakness or spasticity in the lower limbs
5. Joint instability, hypermobility or contractures
6. Structural abnormalities in the foot/ankle, such as flat feet or high arches

Whilst not an exhaustive list, AFOs can be a useful tool, when designed correctly to assist children to increase strength and improve alignment of their lower limbs to facilitate gross motor function. This complements a lot of the work being done by physiotherapists and has been show to reduce the risk of future surgery, reduce pain into adulthood, sustainably improve function and change a child’s level according to the Gross Motor Function Classification System (GMFCS).

How many patterns do you have for kids to choose from? What is your favourite?
We love making fun devices, that people are proud to wear and show off part of their personality. We have over 100 different patterns to choose from and have recently started further customising AFOs and Prosthetic Limbs with vinyl stickers and incorporating designs like footy teams and colours into the final product. We also have the option for more cosmetic devices if that is preferred.

Why is prescription of a shoe with the AFO so important?
I describe the shoes for your AFO like the tyres for your car - You can have a well-designed 4WD but if it has the slick, city tyres on, the outcomes are suboptimal than the off-road pairing. Similarly, shoes come with a range of different heel heights, stiffnesses and shapes on their sole, that affect the alignment of the lower limbs and trunk. Evidence shows that AFOs must be designed with the shoe in mind to ensure appropriate alignments of the ankle and tibia, that flows on effect to the upper body to increase stability, direct forces and activate muscles around the hips, glutes and quadriceps. We generally modify the sole of the shoes and design the AFO to match the needs of the child at the time, then follow the child’s journey to often reduce the required amount of support as their gait pattern, range of motion, strength and confidence improves.

What is your favourite thing to do in the NT?
I love the outdoor lifestyle, hiking and camping in the national parks, running along the bike paths in Darwin and mountain biking the trails in Alice Springs. Everyone’s always ready to give things a go outside of their comfort zone which which leads to some pretty awesome stories and NT adventures!