The authors summarized the information well (1). However, I think they omitted a very important aspect of possibly congenital incorrect posture including the examination: tibial torsion defects.Most commonly in a tibial torsion defect is an external rotation of the foot and the malleoli relative to the knee and the neutral plane. Those affected often compensate the externally rotated feet ("Charlie Chaplin"-like gait) by inward rotation of the entire leg, with subsequent internal rotation of the knee (differential diagnosis in knee pain) and retrotorsion of the hip joint, which may lead to hip pain.I therefore recommend always checking for tibial torsion defects on examination, in addition to the comparison between right-side and left-side internal rotation in supine and in prone positions as mentioned on p 73 of the article.

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Prevention of habitual or shoe-induced foot and toe deformities in children and treatment of congenital or developing malformations require a change of view towards functional aspects and the use of modern technical possibilities based on our traditional knowledge.Statics, functional anatomy, biomechanics, neuromotor and psychomotor activity, and developmental physiology have to be considered as well as the broad variety of physiological interindividual differences. Modern materials and fabrication techniques make it easier to produce anatomically and functionally correct and appealing shoes, inserts, and orthoses. New means of invasive treatment improve the preconditions for orthotic management. Cultural and cosmetic expectations and the real extent of disability, impairment, and handicap have to be carefully differentiated for the sake of every single child.

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