Toe Walking-can physiotherapy help?

You may never have noticed, but some children tend to walk up on their toes, rather than keeping their heels down. This is referred to as “toe walking”. But why do they adopt this position?

 
In many cases, the reasons are never known why a child may start to walk on their tip toes. Some walk like that from very early on-as soon as they are on their feet. Others develop their walk in this position as they get older. Many children choose to walk on their toes for some of the time, as a game or to avoid a cold floor for example. But toe walking refers to children who walk up on tip toes for most of the time and often struggle to correct their position by keeping their heels down.

A child in a toe walking position.

A child in a toe walking position.

Toe walking can be very common and many toddlers grow out of it. However it can be associated with other conditions, such as cerebral palsy (CP). Children with CP may have tight Achilles Tendons due to spasticity (rigidity) in their muscles and this causes them to have to walk up on their toes. Some children who seek sensory feedback (for example children on the Autistic Spectrum) may adopt a toe walking position as a sensory strategy.

 
But for many there can be no definite reason for toe walking-this is known as idiopathic toe walking. Most children who are idiopathic toe walkers end up with some degree of tightness in their Achilles Tendon and calf. This is because the calf does not get a full stretch when in a pointed position, as it is when toe walking. But part of toe walking can also be attributed to habit…and this is often the hardest part to rectify. Therefore early intervention can be extremely beneficial.

 
For children who toe walk there are several methods of physiotherapy treatment that may help. Firstly a full physiotherapy assessment would be carried out. The Therapist would look at muscle length, particularly around the calf and Achilles Tendon. They would also assess muscle strength, especially the muscles of the lower limb and core (back, hips and abdominals). They would then provide an exercise programme that targets muscle lengthening and strengthening. For younger children this may involve parents being shown how to stretch certain muscle groups and encourage activities that help to strengthen particular muscles. For older children, it may be more appropriate for them to be taught how to stretch and strengthen themselves. They may also use a stretching wedge to specifically stretch the calf muscles.

 
Regular, daily stretching is important in order to gain some length in the muscles and therefore allow your child to be able to put their heels down more easily. However, for some children, stretching alone may not be enough. These children may require further intervention that can include serial casting (regular plaster casts being applied to the ankles over a period of 4-6 weeks to gain a consistent stretch), splints (made of plastic, they hold the ankle in a certain position, therefore preventing toe walking) or in very severe cases surgery.

 
If you have any concerns about your child toe walking or would like some advice, please contact Therapy Stars on info@therapystars.co.uk or 07813 764938.

 

Hypermobility and your child

Having recently been asked to assess and advise parents regarding their child with hypermobility, I thought it may be useful to look at hypermobility in general. Many parents are told that their child is hypermobile…but what does this mean for your child? Hypermobility is the term used when you have more than normal range of movement at some or all of your joints. Is if often referred to as being “double-jointed”. It is relatively common, particularly in children, as we get less mobile as we grow older. Like many conditions it encompasses a wide spectrum from mild to more severe symptoms.

A mild case of elbow hypermobility.

A mild case of elbow hypermobility.

In a lot of cases, being hypermobile may have absolutely no consequences for your child-they may just realise that they are slightly “bendier” or  more flexible than their friends. But for some children, where they have several hypermobile joints, it may first become noticeable when they aren’t quite as quick to reach their developmental milestones.

 
Delayed walking can sometimes be an indicator that a child may have hypermobility around their ankles. For these children, supportive, well fitting footwear is crucial. Shoes should have a good supportive heel and sturdy upper material to offer you child’s foot maximum support and stability. Occasionally a child may benefit from specialist orthopaedic boots which can be prescribed through a physiotherapist, orthotist or podiatrist (dependent on the service in your area).

 
Children with hypermobile joints may complain of tiredness and fatigue quicker than their friends or siblings. This is due to their muscles having to work harder to stabilise the joints and can also be due to muscle weakness. They may be more prone to injury as their joints allow the body to adopt positions with greater ranges than the norm, which can lead to the soft tissues becoming over stretched. In the most severe cases joints may even dislocate.

 
For some children though this can even become an advantage-gymnasts and dancers are well known for needing to be ultra flexible and many children with hypermobility will excel at these types of disciplines. However it is important for their coaches to always be aware of their hypermobility to minimise the risk of injury.

 
So…what do you suspect your child is hypermobile? Firstly be aware of which of your child’s joints seem to have excessive ranges of movement. This is so that you can monitor any injuries or aches and pains to see if they are related. Pain relief can be given as and when appropriate for your child. If there are ongoing problems with pain and/or injury, then trying to strengthen your child’s muscles can often help. Swimming is a great way of targeting lots of muscles, and children often find it less stressful on their joints because there is no impact. For younger children, soft play areas and using trikes can be good ways of trying to encourage muscle strengthening.

 
In a few cases, severe or widespread hypermobility or hypermobility alongside other specific symptoms, may be an indicator of another condition. If you have concerns that this may apply to your child, you should consult with your child’s GP. There is also lots of information and advice on the Hypermobility Syndrome Association website www.hypermobility.org There is also an information leaflet produced by the APCP (Association of Paediatric Chartered Physiotherapists) which can be found at www.apcp.csp.org.uk/publications/parent-leaflets

 
If your child has hypermobility and you would like an physiotherapy assessment and further advice, please contact Therapy Stars on info@therapystars.co.uk or 07813 764938.

Why is “Tummy Time” important?

Those of you who have recently had a baby or have young children have probably heard about “Tummy Time”. This is where you are told to encourage your baby to spend time playing or lying on their front. But why…?

Evidence has now shown that the safest position for our babies to sleep in is on their back. This is to reduce the risk of Sudden Infant Death Syndrome (SIDS) or cot death. However it is still vitally important for developing babies to spend quality time on their tummies. If a baby is always on their back, they not only miss out on a different perspective of the world, but they may develop flat spots or changes of head shape and/or poor development of their motor skills.

When a baby is positioned on their front, they are encouraged to lift their head and therefore strengthen their back and neck muscles. They also go on to learn to turn their heads from side to side in reaction to what is going on around them. As they get older and stronger, they then start to use their arms to lean on, and strengthen the muscles around their shoulders. This all helps as your baby continues to develop and learn new skills. These muscles are then used as your baby learns to roll, sit, crawl and walk.

You can start to position your baby on their front from birth, but many wait for the first few weeks due to the umbilical cord stump. But once this has come away, your baby needs to start to experience “Tummy Time”. The easiest way to start may be to position your baby tummy down but on your front. This way you can feel that you can monitor them closely. Many babies will find the position hard work, especially at first, so little and often is usually the key! There is no set time so do what works for your baby.

Please remember that the accepted advice is now that babies should only be place on their tummies when awake and supervised. It is not advised for your baby to sleep on their fronts.

If you have any concerns about your baby, or need any advice regarding “Tummy Time” please feel free to contact us on info@therapystars.co.uk or Sian on 07813 764938.

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