On average, Down syndrome (DS) occurs once in every 700 live births and results in life-long
disability and increased risk for comorbidities.1 Individuals with DS are also susceptible to
secondary physical impairments and limitations as a result of complications associated with
joint hypermobility, hypotonicity, and increased ligamentous laxity. Secondary impairments
such as pes planus (flat feet), weakened muscles, bony abnormalities and arthritis may lead
to painful joints and feet. Additionally, children with DS often manifest deviations in gait
as a result of physical limitations imposed by orthopedic and muscular deficiencies that may
lead to decreased postural stability. These secondary losses in function, which exacerbate
disabilities, may be preventable with the use of appropriate early interventions aimed at
correcting abnormal joint alignment. Research exploring effective physical therapy
interventions for adults and children with DS is currently very limited. However, the use of
orthotic devices to support lax ligaments and hypotonic muscles, which are common
manifestations of DS, is one accepted method of intervention for children within this
population. Orthoses are variable in structure and the degree of support provided to the foot
and ankle also differ between foot orthoses (FOs) and supramalleolar orthoses (SMOs).
Previous studies have supported the effectiveness of orthoses on improving ankle and foot
alignment, as well as gait parameters. However, disagreement currently exists concerning
which type of orthotic device is most beneficial for the population of children with DS.
Children with DS express variable degrees of joint laxity and hypotonicity, as well as
differences in the severity of specific alignment abnormalities such as excessive pronation
or calcaneal eversion.6 Current literature is insufficient for explaining differences in the
benefits provided by FOs and SMOs and the specific indications for their use in children with
DS is unclear.
Study Aims This study will demonstrate the differences in structural outcomes provided by FOs
and SMOs and develop specific criterion for matching individuals of differing orthopedic
impairments with the most beneficial orthotic device.