PODOPEDIATRICS.

BY DAVID E. KRIZBS


The foot has been largely neglected in traditional orthotic devices. Although optimum orthotic control emphasizes the role of the shoe and its attachment to the proximal portions of the orthosis, today relatively few orthoses contain footplates which provide corrective forces to the disabled foot. It is clear that equally little activity in the area of foot correction is occurring in children's orthotic clinics. Herman Tax, a podiatrist, has attempted to fill the void of information available on children's foot corrections with this publication. The dearth of scientific studies relating to the efficacy of podiatric intervention, however, is conspicuous in this skilled clinician's attempts to be comprehensive.

The topics covered range from evolution and phylogeny, through embryology, growth and development, and other more orthodox subjects usually included in encyclopedic volumes ofmedical treatment. Tax emphasizes foot phylogeny, a tenuously related subject at best (which may prompt the advice that, whenever showing exercises to children, ‘Telling a child some familiar animal [also] walks this way, will make the exercise interesting to the child."), and brings in other superfluous information on childhood infections, immunizations, and the use of vitamins.

Most chapters are profusely illustrated and referenced, often containing bibliographies of over 100 references at a chapter's end. Reference lists are considerably shorter in the podiatric chapters, presumably reflecting the lack of scientific substantiation of many of their podiatric tenets.

Perhaps the greatest contribution that the book makes to orthotic practice is the inclusion of diagrams and detailed instructions on the fabrication and use of foot orthoses. Indications and contraindications for the devices, however, are incomplete and occasionally inaccurate. For example, cable twisters are listed as the second most useful treatment of rotatory deformities of the lower extremity (after the Denis Browne splint). Their deforming forces on intervening joints are nowhere mentioned, nor are the facts which were presented in his well-written growth-and-development chapter, that rotatory deformities tend to correct spontaneously until age 6, ever again mentioned, Lastly, it would aid the reader's understanding if statements such as "[Excessive pronation] must be neutralized as early as possible because it sets the stage for future disability," were substantiated by reference to clinical studies, logic, or at least by anecdote.

Tax provides a good historical background of shoes and their therapeutic utility in chapter 17. Chapter 18 lists some of the problems associated with ballet, giving the reader an introduction to some of the benefits and hazards which may accrue to children with selectedrotational deformities of the lower limb. The concluding three chapters can be safely ignored, since an understanding of their topics (Dermatology, Childhood infections and Immunizations, and Brief Outline of Diseases of Interest) is of peripheral interest to the clinician dealing with foot orthoses and can be better obtained through the more accurate and more comprehensive works noted in the bibliography.

Podopediatrics is recommended to health professionals interested in growth and development of the foot, its childhood pathology and podiatric treatment methods. Keeping in mind the caveats mentioned above, the book should serve to stimulate any clinic team member to investigate further the advantages which podiatric correction methods may offer the juvenile orthosis-wearer.

DAVID F. KREBS, M.A., Assistant Research Scientist, Prosthetics and Orthotics, New York University Post-Graduate Medical School.