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Overpronation and beyond...
Pronation is a normal stage in the gait cycle. A child who neutrally pronates will initially strike the ground on the lateral side of the heel, as the child transfers their weight the foot rolls in a medial direction to ensure that the weight is distributed evenly. Neutral pronation is the most ideal, efficient type of gait pattern allowing the body to naturally absorb shock.
Overpronation refers to a pattern in which the foot rolls too far in a medial direction causing the body weight to be distributed unevenly across the metatarsus and cause excessive strain on the ankle, the knee and the hip. A child who overpronates does not absorb shock efficiently, leads to poor lower extremity alignment and can cause future orthopedic concerns.
With proper support via a simple insert or proper footwear, the alignment can be corrected and child can develop functional movement patterns efficiently and with the least amount of undue stress on their body.
Over time Overpronation can lead to: bunions, Hallux rigidus, Plantar fascitis, Metatarsalgia, chronic ankle sprains, shin splints, Achilles tendonitis, stress fractures, tendonitis, Chondromalacia, Patellar-Femoral pain syndrome.
Treatment Ideas to come…
Idiopathic Toe Walking...
Toe Walking is defined as the failure of the heel to contact the floor at the onset of stance during gait.
As a Pediatric Physical Therapist I have recently encountered a surge in the incidence of children who present with Idiopathic Toe Walking(ITW). As its name implies, Idiopathic Toe Walking refers to the manifestation of this gait pattern without a known underlying pathological cause. It is extremely important to categorize this diagnosis properly. In considering differential diagnosis, we need to rule out any neuromuscular or strictly orthopedic conditions. Always assess the child’s DTRs, muscle tone and range of motion to gain the best understanding of the underlying cause of the child’s presentation. Children who present with Idiopathic Toe Walking will always be bilateral and symmetrical, as opposed to a child with spastic hemiplegia who will demonstrate unilateral involvement.
A child with idiopathic toe walking may walk on his or her toes due to hyper or hyposensitivity. The child may not like the feeling of different surfaces on their bare feet causing them to rise up on their toes to decrease the surface of their foot in contact with the floor. We also need to consider the hyposensitive child. Toe walking increases the force of impact felt during ambulation, with the ground reaction force distributed through a smaller surface area at the metatarsal heads.
Weight bearing activities using a variety of textures will help provide insight, try sand, uncooked rice or beans, on an air cushion, or a tactile disk. A comprehensive history should be taken. Children who ambulate later or skip developmental milestones which limit weight bearing are often those who present later on with ITW. Does the child toe walk when wearing shoes? Is he/she able to achieve and maintain full range of motion at the ankle? Assess the child’s overall lower extremity biomechanics, from the position of the pelvis, to the knees and feet. Assess the child’s static vs dynamic arch formation as well as plantar intrinsics. Often times children with ITW will have weak intrinsic muscles, and use the toe walking to compensate.
Treatment Ideas to come….