Video notes:
– Rule out spasticity and conditions that may cause this, e.g. Cerebral Palsy (CP)
– Is it a feedback issue? Hypersensitivity? Consider spectrum disorder? Consider softer orthoses and soft top covers with nice tactile feel. If you have examples in clinic room, let them feel and touch them and choose.
– Idiopathic:
- often in kids that can’t sit still
- hypermobile
- tummy sleepers
- W-sitting
- soft tissue adaption and neurodynamic function is they feel more stable on tip-toes
- often worse when they increase speed
- stretching won’t work, generally the muscles aren’t tight
- Use night splints for however long it takes to get them back down to the ground, then the same amount of time after that to cement the concept into their neuromuscular pathways so they don’t relapse. Educate parents that you are trying to make a long-term change so they don’t need podiatry later in life.
- AC kids device with plantar skive to support whilst doing hypermobility exercises
- Wear shoes ALL THE TIME
- Generally takes 9-18 months to get them down to the ground and get them to stay down.
- Treat early. Once 10+ years old very unlikely to be successful. “Wait till 8, its too late.”
- If over 10 years old with spasticity, still use night splints, but the focus/goal of treatment changes to be more about adding length to calf muscles. Consider Botox to relax the muscles.
