August 29, 2008

Ideopathic toe walking - gait abnormality or bad habit

According to Ms Blackburn, each of these treatments has drawbacks.

"The first option, which involves surgery, certainly increases the range of movement, but in the longer term it may well lead to even shorter muscle fibres," she says. "The second option, splinting via plaster casts, is invasive, expensive and leads to wasting of the muscle. The third, botulinum toxin, has limited effectiveness as it lasts only three to six months and acts by weakening, rather than directly lengthening, the calf muscle. We wanted a strategy for management that was less invasive."

{youtube}uG9s0DEz-GE{/youtube} The way a person walks is a product of messages the brain sends to the muscles of the lower limbs, Ms Blackburn says.

"For children who toe-walk, the brain is sending mistimed messages, so the walking pattern is changed. We need an intervention, such as the calf-raise exercises, of two to three years to keep calf muscles long while we retrain the brain to achieve walking with a normal, stable gait."

To date, the results of the study have indicated that the children have longer calf muscles, are able to place their heels on the floor, and walk with a normal heel strike, Dr Percival says.

"Although the results might take a few months - or even years - to show up, we are confident these children will continue walking with a normal heel strike."
Action

For further information, contact Dr Paul Percival on +61 3 9905 3488, email paul.percival@eng.monash.edu.au or visit www.ecse.monash.edu.au/centres/mucbe/.

(<a href="http://www.monash.edu.au/pubs/monmag/issue11-2003/research/toes.html" target="_blank">Keeping kids off their toes</a>)

------------------------
Toe Walking
http://www.articlesonbabys.com/articles/149/1/Those-toe-walking-Angels/Page1.html
Those toe-walking Angels
 Toddlers find it amusing to walk on their toes and may walk quite a distance if not reprimanded by adults. In some cases, the toddler may outgrow this habit. A firm high cut shoe that does not bend in the middle can help the toddler overcome this habit. In case the efforts may not yield the desired changes, visit a doctor or take medical guidance at the earliest. &lt;a href=" http://www.greatdad.com/tertiary/36/1540/those-toe-walking-angels.html"&gt; Toe walking&lt;/a&gt; is also a health condition suffered by a large percentage of toddlers. In the absence of medical guidance:

    * They will be unable to walk in the correct manner for a long time.
    * It may lead to chronic problems like pain in the hip and backache later in life.


Steps for this simple exercise are:
Step One: Stand your toddler up on an inclined plane.
Step Two: Let the child walk up the plane on toes.
Step Three: Now its time to turn back and walk down using the calf muscles.

------------------------
Gait Abnormalities:

http://www.childrenshospital.org/az/Site932/mainpageS932P0.html

Toe-walking
Toe-walking is one of the least common gait abnormalities. If your child walks on his or her toes, and it under 3 years old, the problem can be normal, but after age 3, if the problem persists, it requires careful evaluation by your child's physician. Most cases of persistant toe-walking are familial or are simply secondary to tight muscles. Treatment may involve observation, physical therapy, casting or surgery. Toe-walking may indicate a neuromuscular disorder such as cerebral palsy or it could denote developmental dysplasia of the hip or leg length discrepancy (if it involves one foot only). For more information on how these conditions are diagnosed and treated, see entries for these topics.
-------------------------

Idiopathic Toe Walking:
http://www.mmidocs.com/pdfs/idiopathictoewalking.pdf
Idiopathic Toe Walking
Most children toe walk occasionally when there bare feet are on a cold floor, or
when they are first learning to walk cruising along furniture. Some kids do it on and off
for fun when role playing or doing ballet moves. But if your child is older then 3 years
and consistently walking on his/her toes, a pediatrician, and/or an orthopedist should
evaluate the child.
What Causes Toe Walking?
Toe walking has a spectrum of different etiologies. At the end of this spectrum is
a condition called idiopathic or “habitual” toe walking. With this diagnosis ultimately the
cause is unknown. A diagnosis of idiopathic toe walking is made after evaluating the
child to rule out any neuromuscular or orthopedic problems. Such as, cerebral palsy
(brain injury at birth), injury to the spinal cord, or paralytic muscle disease including
muscular dystrophy. Once these diagnoses are ruled out a diagnosis of Idiopathic toe
walking may be made. Idiopathic toe walking first appears when the child is a toddler and
walking begins. Often the child can walk flatfooted when prompted to do so. But when
the child is unaware he/she is being observed their preferred position is to walk on his/her
toes.
A child with idiopathic toe walking may walk on his or her toes due to hyper or
hyposensitivity. The child may not like the feeling of different surfaces on their bare feet
causing them to riser up on their toes to decrease the surface of their foot in contact with
the floor. In this case you may notice the child dislikes tight clothing, stepping in the
sand, and/or on the grass, dislike certain textured foods, and/or dislike vestibular input
such as, swinging, jumping, etc. Many times idiopathic toe walking is associated with
language delays, and with certain forms of autism. So, it is important to make sure that
your child is not having any delays with communication or social skills. In this case, a
developmental assessment may be appropriate.
What is the Treatment for Idiopathic Toe Walking?
This habit of toe walking can result in loss of range of motion of the ankle, and
ultimately lead to a shortened Achilles tendon. This may need further intervention such as
daytime and nighttime bracing. This bracing would include a removable ankle foot
orthosis, which is a lightweight plastic brace that goes up the back of the calf and
maintains the foot at a 90 degree angle. In more extreme cases serial casting, and/or
surgery to lengthen the achilles tendon may be appropriate. Like any habit, the longer you
continue to do it, the harder it is to break. That is why it is important to have your child
evaluated and started in to a physical therapy program as soon as possible.
In physical therapy your child will be started on a stretching and strengthening
program, will complete gait training, balance, and postural exercises, and if necessary
will be started on a sensory integration program. The physical therapist may also use
neuromuscular electrical stimulation. This gives the child sensory feedback of when to
use the appropriate leg muscles to allow for a more normal heel-toe gait pattern. The
Page 2
physical therapist will also give the parents and child a home exercise program including
exercises and activities to decrease toe walking.
General Physical Therapy Activities for Toe Walkers:
1) Abdominal and trunk strengthening:
• Sit-ups with feet held
2) Proprioceptive and Balance Activities:
• Start off by placing 10 marbles and a little bucket/Tupperware container on the
floor. While standing pick up one marble with your toes and place the marble in
the bucket on the floor. Continue to do this until all 10 marbles are in the bucket,
and repeat using the opposite foot.
• Have child stand on a pillow to do activities at the table, such as playing a board
game, cards, puzzle, play dough etc.
3) Stretching Exercises:
• Stand on bottom step holding on to railing. Move one foot back so that your heel
is off the edge of the step. Using your body weight press heel down towards the
floor. You should feel a stretch in your calf. Hold 30 seconds and switch feet.
------------------------

http://en.allexperts.com/q/Physical-Rehabilitation-Medicine-981/2ND-PART-TOE-WALKING.htm

Expert: Ken Stack
Date: 4/13/2006
Subject: 2ND PART TO TOE WALKING QUESTION

Question
YOU ANSWERED A QUESTION I HAD REGARDING MY 8 YEAR OLD SON TOE WALKING AND ASKED IF WE FELT IT WAS A HABITUAL ACT. MY HUSBAND AND I BELIEVE IT IS BECAUSE MY 5 YEAR OLD SON HAS BEEN DOING IT AND I WAS A TOE WALKER AS A KID. (MAYBE A WEIRD HEREDITARY TRAIT?) WHEN WE TELL THEM TO STOP WALKING ON THEIR TOES THEY WILL FOR A SHORT TIME AND THEN GO BACK TO IT AFTER AWHILE. YOU SAID YOU HAD SOME EXERCISES WE COULD TRY TO HELP HIM BREAK THE HABIT. WE WOULD LOVE TO TRY THEM OUT ON BOTH BOYS.
P.S. THEIR PEDIATRICIAN HAS ALWAYS GIVEN THEM A CLEAN BILL OF HEALTH AND DOESN'T BELIEVE THEY HAVE A MEDICAL PROBLEM CONTRIBUTING TO THIS.
THANK YOU.

Answer
FYI: It will likely take 1000-3000 repetitions of exercise and several weeks to break the habit and form a new one.

EXERCISES POTENTIALLY TO END TOE WALKING:

1)  Calf Stretching - only if the achilles tendon is short(as previously explained in the last message)  calf stretching every day 3 minutes total time holding each stretch 20-30 seconds.

2) Standing Reach - Stand on one leg keeping foot flat on ground.  Instruct him to reach down to touch the floor at a point to the left of his foot 3-12" then return up without loosing balance and also 3-12" in front of his foot then to the right of his foot.  Goal is 30 reaches total with no balance loss.  Repeat on the other foot.  Increase the difficulty by closing one eye or both.

3) Tree Huggers - (cute names help with kids)Opposite of a heel raise with balance needed again.  Instruct him to stand with arms out in front of him as if he was hugging a tree (this brings his bodyweight forward a bit to help with balance).  Next instruct him to lift his toes and the front of his feet up so he is on his heels.  He will lean backwards a bit but do not let him bend at the waist and lean forward otherwise the exercise is a waist of time.  Goal is 50x without balance loss.

Exercises can be done daily combined with reminders on making an effort to change the habit - stop walking on his toes.

That's good to start with.  I'd always recommend a 1x consultation with a physical therapist or other trusted professional that can identify other contributing factors.

0 comments: