Cerebral Palsy and Toe Walking

Introduction

You may notice that your child is walking on their toes or tip toeing around the house. However, there is usually no reason to worry as some children may just like to walk on their tip toes (while pretending to be a ballet dancer, for example), whereas others may just have tight calf muscles causing them to have a bouncy gait.

When to Seek Help

You should talk to your podiatrist if:

• they always walk on their toes and have stiffness in their muscles

• they uncoordinated

• this is accompanied by delayed development in their motor skills

• there is a waddling gait or a lot of stumbling

Cerebral Palsy

Cerebral palsy is a condition or group of disorders, present at birth (congenital) or acquired, which adversely effect the movement, muscle tone and balance of a child. Cerebral palsy occurs due to damage to the brain centre that control the movement of muscles.

Causes

There are other factors that can cause cerebral palsy such as:

• deprivation of oxygen at birth (asphyxia) or reduced oxygen levels in the womb or during birth

• womb infections leading to abnormal inflammatory response, which can cause an autoimmune attack on the developing baby's nervous system

Other causes include:

• placental pathology

• inborn errors

• genetic causes

Risk factors for cerebral palsy are premature delivery, coexisting at birth abnormalities, growth restrictions in the womb and excessive multiple pregnancies.

Types of cerebral palsy

Spastic hemiplegia – one arm and one leg are affected on the same side of the body. Spastic diplegia – both legs or both arms are affected. Monoplegia – only one leg or one arm is affected. Quadriplegia – both legs and both arms are affected. Sometimes, the muscles of the trunk, mouth, tongue and windpipe are also affected making it difficult to eat and talk. Triplegia – both arms and one leg or both legs and one arm are affected.

Treatment Options

Orthotics

Orthotics can help prevent functional problems from getting worse and allows the passive correction of the deformity in a non-rigid spasticity; they also provide stability during gait and assist with function. Orthotics do not necessarily have to extend above the knee, but their main function should be to provide joint and foot alignment.

Ankle Foot Orthoses / Ritchie Braces

AFOs (ankle foot orthoses) or other products, such as Ritchie Braces can also be recommended if they have excessive calf muscle tightness. A solid AFOs ensures foot control and helps the ankle joint. Also, they increase side-to-side stability and help the foot with ground contact. Research has shown that these braces reduce the high impact forces early in children with spastic diplegia.

Physical Therapy

Physical therapy helps maintain balance, with postural exercises being the most effective. Furthermore, lower extremity exercises such as Theraband calf muscle exercises can also help increase the muscle strength. Presently, physical therapy options include: neuro-developmental therapy, sensory integration therapy, bracing, stretching and pressure point stimulation.

Intramuscular Injections

Newer treatment types include intramuscular injections for spasticity. Injections include local anaesthesia in order to block the nerve supply to the muscle and reduce spasticity. Botulinum (the same thing used for "botox" injections) can also be used for intramuscular injection to block and release the muscles. This helps to relieve spasticity.

Conclusion

If you child has a problem with walking or if you just want your child checked to see if their function is within normal limits, see our podiatrists today for a thorough assessment and discussion of options.