Toe walker (Full Version)

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PTupdate.com -> Toe walker (January 4, 2004 4:25:00 PM)

Members, (especially Drewfus),

Looking for all your best treatment tips for treating a toe walking 4 year-old with no other apparent developmental or neurological abnormalities. His two other siblings did the same thing, but integrated quicker.

Duffy [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]



tlhpedspt -> Re: Toe walker (April 3, 2004 5:48:00 PM)

I recommend coming up with a variety of play and balance activities that place the child in position with increased dorsiflexion (I have a firm foam wedge and a wooden wedge/incline) that work nicely. Make a game about "heel walking", active dorsiflexion. In catalog for $13 there are a pair of foot items that "beep" that can be used. I do not currently have any but other therapists have found them successfull. Also, look into any sensitivty/sensory integration things that may need to be addressed. Check range of motion--provide stretching if needed. If significant decrease in range of motion, sometimes botox and serial casting are used.



tc -> Re: Toe walker (April 11, 2004 5:13:00 PM)

You can teach parents calf ROM exercises if there is limitation or do dorsiflexion exercises if child is old enough. For tx ideas: lots of squatting activities (both sustained squat in play and squat to stand), going up and down stairs, walking up inclines, walking on uneven surfaces, single limb activities (kicking).
I also agree with the above post to follow up on sensory issues- they may need some desensitization on the heels. Common with premies due to all the heel sticks.
Good luck.



Andrew M. Ball PT PhD -> Re: Toe walker (April 29, 2004 5:20:00 PM)

Sorry Duffy,

Didn't notice the question. In my experience, most "idiopathic" toe walking isn't idiopathic at all. It's usually related to either prone deprivation in the early months, or having been put into a walker or exersaucer in early months --- which kick off posterior balance reactions.

Look to the core, strengthen the rectus, the TA, and the obliques. Usually, "idiopathic" toe walking results from a poor core compenstated by retracted scaps, which throw off the kids' center of mass. Once the core is coordinated, work the serratus anterior --- usually that "idiopathic" to walking will go away.

Drewfus



tlhpedspt -> Re: Toe walker (April 3, 2004 5:48:00 PM)

I recommend coming up with a variety of play and balance activities that place the child in position with increased dorsiflexion (I have a firm foam wedge and a wooden wedge/incline) that work nicely. Make a game about "heel walking", active dorsiflexion. In catalog for $13 there are a pair of foot items that "beep" that can be used. I do not currently have any but other therapists have found them successfull. Also, look into any sensitivty/sensory integration things that may need to be addressed. Check range of motion--provide stretching if needed. If significant decrease in range of motion, sometimes botox and serial casting are used.



tc -> Re: Toe walker (April 11, 2004 5:13:00 PM)

You can teach parents calf ROM exercises if there is limitation or do dorsiflexion exercises if child is old enough. For tx ideas: lots of squatting activities (both sustained squat in play and squat to stand), going up and down stairs, walking up inclines, walking on uneven surfaces, single limb activities (kicking).
I also agree with the above post to follow up on sensory issues- they may need some desensitization on the heels. Common with premies due to all the heel sticks.
Good luck.



Andrew M. Ball PT PhD -> Re: Toe walker (April 29, 2004 5:20:00 PM)

Sorry Duffy,

Didn't notice the question. In my experience, most "idiopathic" toe walking isn't idiopathic at all. It's usually related to either prone deprivation in the early months, or having been put into a walker or exersaucer in early months --- which kick off posterior balance reactions.

Look to the core, strengthen the rectus, the TA, and the obliques. Usually, "idiopathic" toe walking results from a poor core compenstated by retracted scaps, which throw off the kids' center of mass. Once the core is coordinated, work the serratus anterior --- usually that "idiopathic" to walking will go away.

Drewfus



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