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Toe Walking… What causes it and what to do next!

10/28/2020

Standing and balancing on tip toes is a skill that requires strength and balance. Typically developing children should achieve this skill around 2 years old. However, consistent tip toe walking can become a problem if it is child’s primary gait pattern. If your child is walking up on their tip toes more than 60% of the time at home and has been walking for more than 3 months, it is recommended that they be evaluated by a physical therapist to determine to root of the problem and begin working towards a more typical gait pattern.

What are some reasons a child might toe walk?

1. Sensory Based Toe Walking: Children may begin toe walking due to difficulty processing sensory input on the bottom of their feet. With sensory based toe walking, it usually presents bilaterally (meaning child is up on tip toes of both feet), it oftentimes changes depending on the surface they are walking on (i.e. carpet v. hardwood; barefoot v. shoes), and oftentimes the child may show other signs of sensory aversiveness in addition to toe walking (i.e. difficulty tolerating certain clothing, clothing tags/seems are irritating to them etc.).
2. Instability Based Toe Walking: Children may walk up on their tip toes because they never developed the appropriate balance reactions and foot/ankle strength to feel stable with their feet flat on the floor. This type of presentation is typically bilateral (meaning child is up on tip toes of both feet). Typically, when the child places their feet flat on the floor, you may notice excessively flat feet and lack of medial arch development.
3. Neurological Based Toe Walking: Children with neurological involvement commonly walk on tip toes due to changes in muscle tone (typically increased muscle tone). Usually this type of toe walking is asymmetrical (meaning the child only walks up on toes of one foot).

If my child continues to toe walk, what will happen?
If toe walking is not addressed early on, it can lead to problems with muscles and gross motor development down the road. The primary problems that arise from prolonged toe walking include, shortened heel cord and significant tightness of calf muscles (primarily gastrocnemius), weak hips, ankles and feet, decreased stability and balance, and difficulty/delayed achievement of higher-level gross motor skills.

What is the next step if my child is demonstrating this gait pattern?
Schedule and evaluation with a skilled pediatric physical therapist to begin an individualized therapy plan and home program in order to address the root of the problem and work towards a more optimal gait pattern!

In the meantime, … Is there something to be working on at home?
It is important to be evaluated by a skilled, pediatric PT to determine the root of the problem and begin an appropriate, individualized treatment plan. However, here are 3 simple exercises which can be practiced at home that can begin to address some common deficits found in toe walkers and are helpful for strength and development in all children!

1. Backwards Walking
2. Single Leg Balance
3. Glut Bridges

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it's all about balance!

8/24/2020

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Does your child tend to avoid activities that are challenging for them or fall down more often that their peers? Do they avoid moving slowly or staying still for more than a few seconds at a time? If so, these may be signs that they lack the appropriate strength and the ability to utilize effective balance strategies to stabilize themselves throughout the day.

There are three primary balance strategies that we use when navigating our environments. The first strategy begins at the ankles. When an individual faces a small balance perturbation the first muscles to kick in to save them from falling are all the muscles that surround the ankles. If the perturbation is too large for the ankle muscles to return the individual to equilibrium, then the body will automatically utilize the hip muscles to regain balance. Finally, if the hips are unable to respond adequately enough to achieve balance, the final strategy that our body’s will use to prevent a fall is a stepping reaction.

Each of these individual reactions should happen quickly and without consciously planning them out. However, for some kiddos these reactions may be delayed or the muscles around the hips and ankles may be too weak to effectively prevent a loss of balance.

Here are some of our favorite interventions to help kiddos strengthen the muscles they need to maintain balance and improve the speed and effectiveness of these balance reactions!

1. Half Kneel Position:
Progressions: add a pillow under back knee and/or front foot, throw/catch a ball or bounce a balloon back and forth
Modifications: hold onto a wall or support surface for stability

Can you spot the difference in the images above? In the left picture, the knee is aligned directly above the ankle whereas in the right picture (without arm support) the knee collapses to the inside of the ankle. This is a classic sign of a weak outer hip. When performing this activity, look out for good alignment and be sure your child's strength can support their alignment before progressing to a harder version!

2. Balance Beam Walking: draw a line on the floor with sidewalk chalk or make a balance beam out of pillows or half of a pool noodle at home!
Progressions: play red light green light while walking across beam (at red lights stop and pause while balancing for 10 seconds before continuing to walk), add in a cognitive challenge (practice spelling words or playing fun, word games while walking across)

Get creative outside! There are lots of balance beams out there... Make a game of finding as many as possible on a walk around the block!

3. Single Leg Standing:
Progressions: stand on a pillow or throw and catch a ball while balancing
Modifications: rest lifted foot on a soccer ball, and elevated step, or a foam roller; use something to hold onto (try to let go for 1-2 seconds at a time to start off)

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Torticollis and plagiocephaly simplified!

7/22/2020

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As a parent, hearing diagnoses like Torticollis and Plagiocephaly can be intimidating and overwhelming. In this post, we will simplify these 2 (very common) infant diagnoses which we encounter and treat here at One Point regularly.

Torticollis:
This is basically a shortening of a muscle in the neck (usually the sternocleidomastoid muscle or "SCM") associated with an asymmetrical head position. Babies with torticollis tend to tilt their head to one side and turn their head to the opposite side. Other muscles can also be involved depending on the individual but the "SCM" is usually the primary culprit.

Plagiocephaly:
This is basically a flattening on the back of one side of the skull. This flattening makes it difficult for infants to turn their head in the opposite direction when lying on their back.

These 2 diagnoses go hand in hand as they both lead to an infant preferring to turn their head to one side versus the other.

The good news is, with some simple, conservative interventions these 2 conditions are easily treatable!

The primary focus of physical therapy treatment in babies with torticollis and plagiocephaly is making sure infants get full range of motion of their neck via stretching and positioning as well as making sure that infants develop symmetrical, age appropriate neck strength. Depending on the individual, infants may also be referred to a specialist to receive a cranial remodeling orthosis (more commonly known as a baby helmet) to help round out their skull!

What can you do now with your infant to help combat the risk of torticollis and/or plagiocephaly? TUMMY TIME (always the answer when it comes to infants!) Making sure your baby is getting plenty of time on their tummy to strengthen their neck muscles and improve head control is crucial for so many reasons, including reducing the risk of plagiocephaly and torticollis.

It is also a good idea to observe your baby and see if they prefer to look to one side or appear to frequently tilt their head to one side. If so, it is a good time to consult with your pediatrician and come in for a physical therapy evaluation to get started with some treatment to ensure that your baby has the opportunity for optimal, symmetrical gross motor development moving forward!

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welcome to our first blog post!

6/2/2020

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Our goal for this blog is to provide a resource to the community highlighting what we do as physical therapists and to spotlight our patients. We are a therapist owned and operated clinic with the mission of providing well rounded, physical therapy services to the Atlanta community.

One major misconception about physical therapists that we want to address in this first post is that all physical therapists do the same thing. Although all PT’s do go through the same 3 years of rigorous, post grad schooling to become general providers, it is common for therapists to choose specific areas of care to pursue after completing their degree. At One Point, we have four clinicians, Collin, Kelvin, Erin and Karleigh who each concentrate in specific aspects of care. Collin and Kelvin are the experts in orthopedic and sports related injuries while Erin and Karleigh primarily work with the pediatric population with emphasis on neurological and developmental diagnoses. Erin also treats women’s health and pelvic floor clients.

The goal of One Point is to provide a one stop shop for any and all physical therapy needs in a convenient and comfortable setting. You can feel confident that your care here will be specific to the individual challenges that you are facing and that we will work with you to help you achieve all of your therapeutic goals!

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Toe Walking… What causes it and what to do next!

it's all about balance!

Torticollis and plagiocephaly simplified!

welcome to our first blog post!

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