Case 28: ITW Flashcards
What term is used to describe a gait pattern that is characterized by weight acceptance and weight-bearing on the forefoot throughout the stance phase of gait cycle?
Toe Walking
Idiopathic toe walking is toe walking that persists after ___ years of age without a known neurological or medical diagnosis
past 2 years of age
Do patients with ITW need to strengthen their plantar flexors?
YES in FULL ROM, since they are strong in just one part of ROM
If conservative treatment of ITW doesn’t work, what can you try?
serial casting
NEVER NEEDED TO REFER FOR PERCUTANEOUS TENDON SURGICAL LENGTHENING different from the book!
*if spastic CP, often referred for gastroc lengthening via surgery. But not not not for ITW
What therapeutic intervention approach was developed to address posture and movement disorders? Approach encourages inhibition of atypical or abnormal movement patterns and facilitation of typical movement patterns to promote skill development.
Neurodevelopmental Treatment (NDT)
What is oligohydramnios?
Decreased amount of amniotic fluid during pregnancy.
General physical therapy POC/Goals
- improve active and passive DF ROM
- increased incidence of heel strike at IC during gait
- attain age-appropriate gross motor skills
Physical therapy interventions for patients with ITW
- stretching of tight LE mm groups (esp. ankle plantar flexors)
- gait training
- strengthen weak LE and trunk muscles
- use of orthoses and serial casting
-HEP
Precautions during physical therapy
- pain or spasms related to overstretching plantar flexors (esp. in serial casts)
Complications interfering with PT
- secondary skin complications related to serial casting *HEELS
- skin breakdown from ill-fitting orthoses
- pain in feet/legs
Is ITW a diagnosis of exclusion?
Yes!
Toe walking is also associated with other conditions such as CP, muscular dystrophy, autism spectrum disorder and more, but not ITW.
What developmental delays are associated with toe-walking behaviors?
- language disorders
- sensory processing
T/F: There is a high prevalence of toe-walking behaviors in children with autism.
True!
What tool can be used to differentiate between children who are true idiopathic toe walkers and children who toe walk as a result of a medical or developmental condition?
Toe Walking Tool
Which of the following statements regarding idiopathic toe walking is most accurate?
A. Most elementary-age children will grow out of the behavior independent of management.
B. Children with idiopathic toe walking may have delays in language skills or language disorders.
C. Idiopathic toe walking typically presents as an asymmetrical condition.
D. Idiopathic toe walking is more commonly observed in girls.
B. Children with idiopathic toe walking may have delays in language skills or language disorders.
Which of the following examination findings is most suggestive of a non-idiopathic origin for toe-walking behaviors?
A. The presence of a plantar flexion contracture
B. Toe walking that occurs >75% of the time
C. Presence of spasticity in the gastrocnemius muscle
D. A report of pain in the feet or legs
C. Presence of spasticity in the gastrocnemius muscle
spasticity = probably UMN
A 15-month-old boy is referred for a physical therapy examination due to concerns related to his intermittent toe walking. Other than the occasional toe-walking pattern, the examination does not reveal any significant findings. What is the most appropriate physical therapy recommendation?
A. Refer. The child potentially has cerebral palsy or other underlying medical condition that is resulting in the toe-walking behavior.
B. Keep. Ongoing physical therapy sessions are needed to address the child’s toe walking.
C. Monitor. Toe walking prior to the age of 2 years is a commonly reported gait deviation.
D. Keep and refer. The child requires intervention to address his toe walking and requires medical evaluation and testing to determine if an underlying medical condition is resulting in the toe-walking behavior.
C. Monitor. Toe walking prior to the age of 2 years is a commonly reported gait deviation.
When is heel strike at initial contact observed in typical gait?
around 2 years (book says 18-24 months)
*if patients are walking on toes past 2 years, then look into possible diagnosis
true or false: ITW occurs more frequently in boys than girls
true
true or false: idiopathic toe walking typically presents asymmetrically
false: usually bilateral presentation
*need to check both lower extremities bc sometimes one leg compensates to match the other
