Idiopathic Toe Walking "ITW" Flashcards
Break down “Ideopathic Toe Walking”
- Idiopathic→ Not sure why, unknown cause
Toe Walking
In General
May be seen fleetingly when infants first begin to walk as they develop balance rxns and postural control
ITW
Defined:
Toe walking that persists, becomes more predominant, impacts balance/gait mechanics w/ unknown etiology.
ITW
Differential Dx:
- Mild CP, unDx’d MD, Tethered Cord Syndrome, ASD related
A note about premies and tip-toeing
Premies tend to take longer to move out of normal tip-toe stage when first learning to walk***
Potential Causes of ITW
4 Listed:
- Achilles mm shortening→ gastroc/soleus
- Mm weakness of DFs and/or core→ abs, glutes
- *HypOtonia→ Toe walk more as a compensation for weakness→ fixing for stability/balance
- Sensory processing deficits→ seekers vs avoiders
- Rise onto toes to localize all input to toes== SEEKING
- Rise onto toes to avoid input to entire foot==AVOIDING
Potential Causes of Toe Walking
Diff to decipher
True muscular toe walking vs walking that began as sensory deficit resulting in tightening of mm’s
1.Achilles Tightness
*NOTE: PF assocd w/ knee hyperEXT (“PE class”)
- Tightness of mm structures
- may be able to get foot flat→ pronate/hyperEXT to compensate
- no “penguin walk”
- palpable fibrosis @ Achilles
- measure using R1/R2→ clonus/tone may indicate more serious cause
2.Muscle Weakness
- Decd strength DFs OR PF/DF imbalance=toe walk
- Decd abs/glutes→ shifts COM forward= falling foward=toe walk for balance
-
*HypOtonia→ Fixing thru LEs (knee EXT+PF), becomes habitual=tightness
- poor foot align/midfoot PROnation
3.Sensory Dysfunction in ITW
Seekers vs. Avoiders
-
Sensory Seeking→
- LESS tight and ABLE to load heels w/ tactile input
- Onto toes when excited or new environment→ verbal cues corrects this**
- Do better shoes off (like how floor feels)
-
Sensory Avoiding→
- Hard to decipher, shy away from tactile input
- Do better shoes ON (do NOT like floor)
ITW video
slide 7***
Tx of ITW
Tightness
-
MUST address underlying cause!
- in add. to primary impairs
-
Tightness→ stretch!
- Static→ not as effective vs prolonged pos’ing
- Night pos. AFOs→ prolonged 6hrs+ = best
- NADA
- Wedge stand/active stretch= best
- serial casting→ severe→ 6-8wks
Tx of ITW
Weakness
“a foot, belly, and butt”
- “A foot, a belly, and a butt”
- foot alignment, core, glutes
- Strats:
- prox strengthening
- flippers
- therabands
- animal walks→ penguin, duck, bear
- K-taping- O→I for facilitation
- gait training
ITW Tx
Sensory
- Brushing protocol (w/ OT)
-
Diff textures, surfaces, inputs to bottom feets
- vibration*, deep pressure, jt compress, feet in sand/grass, pebble walk (in socks too), spio/compress vest
-
ankle wts→ proprio and body awareness*
- YOU’VE SEEN THIS!!!!
Posterior Wt Line Training aka
Getting wt. back over heels
