son has started toe walking...

[prairiewindmomma]

My 5th grader with sensory issues has started toe walking.....actually it's ball of his feet. His heel rarely strikes the ground. He's also picked up a weird gait while attempting to run.

 

he has long had coordination issues; he still doesn't ride a bike.

 

I assume I need to get this addressed....Any ideas on where to start?

[Paige]

You should start w/ a neurologist if you want to get it looked at. If his ankle is flexible, the toe walking alone (both feet, right?) is probably just something you can remind him not to do. The problem is that if he does it consistently, his heel cords will become tight and he can cause damage to his knees, joints, and even bones. It would take about 6mos of constant toe walking for that to start to become a problem. (speaking from experience here.) The general lack of coordination in addition to the toe walking might indicate something beyond a sensory issue, however, and may be worth an evaluation. He may also be walking on his toes because the heel cords have become tight due to a recent growth spurt. If his ankle is not flexible or not as flexible as yours, then you'll want to see an orthopedist too. In general, though, I don't think toe walking is a big deal. I have a DD who has had surgery because of damage caused by her toe walking, but I have another DD who has started walking on her toes and I am not worried about her and don't feel the need to seek an evaluation at all. The one DD has a problem and the other has a bad habit.

[TippyCanoe]

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[Tiramisu]

My dd's gait changed and she started toe-walking due to the development of a problem in her lumbar spine that affected the nerves in her legs. She was also running very strangely, kind of limping along. It started 3rd grade and become worse in fourth. Our pediatrician was clueless and wouldn't talke my concerns seriously. She was eventually diagnosed by an orthopedist.

 

The first sign was pain in the back of one leg, then two. Later we noticed she lost her flexibility in her hamstrings. She never lost flexibility in her ankles.

 

She has SPD and lax ligaments. The lax ligaments allowed her spine to become misaligned, but there was an underlying defect of the lumbar vertebrae that we were never aware of.

 

In addition to checking your ds's ankes like a PP suggested, can you have your ds lie down flat on his back and try to raise each leg, one at a time, to get an idea of the flexibility of his hamstrings? I would go to a good pediatric orthopedist and neurologist to make sure all your bases are covered.

[Dobela]

Start with your pediatrician. You will most likely be referred to a physical therapist. While OTs will work with children on this, most are also seen by a physical therapist as well. My daughter has balance issues as well as coordination issues and is seen by both a PT and an OT. Much of what they do overlaps, but their approaches and techniques are somewhat different. If at some point it is decided that he needs an orthotic, those are usually recommended by a PT.

 

I also think that more experts are important, like a pediatric neurologist, but since those often take months to see, I would begin with the PT/OT route to slow any damage or to catch any issues that may be easily solved in the meantime.

[prairiewindmomma]

I dont think we are needing a neuro at this point....we went that route when my dd had a brain tumor. My ped is not good with these types of issues and neither are the local orthos. When dd needed an afo we had to drive to a ped hospital.

 

I guess I will check in to developmental peda that are associated with the ped ot/pt clinic in the big city.

 

I checked...he is capable of normal gait but I think his muscles feel tight...not spasming tight but not lax either.

[melmichigan]

My DS7 does this. He has nothing else wrong, it's just a sensory thing that became to much of a habit. His heal cords are fine, he had a small amount of overdevelopment in his calf that will correct with proper gait. He has been sized and we are awaiting delivery of Kiddie Gait braces that will correct the problem.

 

I would start with your pediatrician. It may be something that simple, otherwise a developmental pediatrician would be able to help refer you for PT if needed.

 

My DD9 also toe walked related to her cerebral palsy, that is addressed in a completely different manner with intense PT and AFO's for many years. She still wears bracing today.

Edited August 20, 2012 by melmichigan

[Tiramisu]

I dont think we are needing a neuro at this point....we went that route when my dd had a brain tumor. My ped is not good with these types of issues and neither are the local orthos. When dd needed an afo we had to drive to a ped hospital.

 

I guess I will check in to developmental peda that are associated with the ped ot/pt clinic in the big city.

 

I checked...he is capable of normal gait but I think his muscles feel tight...not spasming tight but not lax either.

 

Could your ped order Xrays of the spine, the long scoliosis type of X rays, both front and side view, making sure the lumbar spine is visible? It would be a simple, and probably free, way to rule out a spine issue. I wouldn't even think of this as a possibility except that your post said he has "started" to walk on his toes, meaning that it's something new. That's the part that makes me wonder if it's not neurological or orthopedic rather than developmental.

[eoffg]

One simple thing that you could test yourself, is his 'Plantar Reflex'?

 

This simply involves running the back end of a pen up the lateral side of his foot, with moderate pressure.

I'll add a 30 second video that demonstrates it.

But the crucial thing is how his foot responds?

Where his toes should turn down, as well as his foot.

In a sort of grasp response with the foot.

 

But what is critical, is if his toes fan out and his big toe turns upwards.

As well as his foot turning upwards?

Which is called a 'Babinski sign'.

This Babinski sign is a reflex that we are born with, and usually disappears within 3 months of birth.

But a re-emergence of it is of considerable concern, where a later change to toe walking, can be an indication of this?

Though it's simple enough to do the test yourself.

 

http://video.google.com/videoplay?docid=-1862844561537172698