Case 28-Idiopathic Toe walking

Question 1

Idiopathic toe walking

Answer 1

toe walking that persists after 2 years of age without a know neurological or medical diagnosis

Question 2

NeuroDevelopmental Treatment

Answer 2

Therapeutic intervention approach developed to address posture and movement disorders. This approach encourages inhibition of atypical or abnormal movement pattern and facilitation of typical movement pattern to promote skill development

Question 3

Oligohydramnios

Answer 3

Decreased amount of amniotic fluid during pregnancy

Question 4

Toe walking

Answer 4

Gait pattern characterized by weight acceptance and weight bearing on the forefoot throughout the stance phase of the gait cycle

Question 5

General Pt plan of care/goals

Answer 5

improve active and passive DF ROM
increase incidence of heel strike at initial contact during gait
attain age-appropriate gross motor skills

Question 6

PT interventions

Answer 6

Stretching of tight lower extremity muscle group ( especially ankle plantar flexors)
gait training
strengthening of weak lower extremity and trunk muscles
use of orthoses and serial casting
HEP development

Question 7

Precaution during physical therapy

Answer 7

Pain and spasm related to overstretching the ankle plantar flexors ( especially in serial casts)

Question 8

Complications interfering with PT

Answer 8

Secondary skin complications related to serial casting
skin breakdown from ill-fitting orthoses
pain in the feet or legs

Question 9

If conservative care of idiopathic toe walking fails, surgical lengthening of the tricep surae muscle tendon complex improves ankle ROM and normalizes the gait pattern

Answer 9

Grade B; inconsistent or limited quality patient-oriented evidance

Question 10

the toe walking tool is valid and reliable assessment to differentiate children who are true idiopathic toes walkers from children who toe walk as a result of a medical or developmental conditions

Answer 10

Grade B

Question 11

Early identification and nonsurgical interventions for ITW are critical for good outcomes

Answer 11

Grade C

Question 12

Serial casting effectively improves ankle ROM and gait pattern in many children with idiopathic toe walking

Answer 12

Grade B

Question 13

which of the following statements regarding idiopathic toe walking is MOST accurate

Answer 13

Children with idiopathic to walking may have delays in language skills or language disorder

Question 14

T/F: elementary school-aged children who toe walk are not likely to outgrow the behavior

Answer 14

True

Question 15

Idiopathic toe walking almost always presents——

Answer 15

Bilaterally

Question 16

Idiopathic toe walking occurs more frequently in?

Answer 16

Boys

Question 17

which of the following examination findings is MOST suggestive of a non-idiopathic origin for toe -walking behavior?

Answer 17

Presence of spasticity in the gastrocnemius muscle

Question 18

is spasticity involved in idiopathic toe walking?

Answer 18

No, it is suggestive of UMN lesion

Question 19

Children with idiopathic toe walking have —–

Answer 19

Plantar flexion contracture
exhibits a high frequency of toe-walking behavior
and /or report pain in the feet or legs

Question 20

A 15th month old boy is referred for PT examination due to concerns related to his intermittent toe walking. other than the occasional toe-walking pattern, the examination does not reveal any significant findings.
What are the MOST appropriate PT recommendations?

Answer 20

Monitor. Toe walking prior to the age of 2 years is a commonly reported gait deviations

Question 21

In children younger than – months, toe walking is a commonly reported gait deviations

Answer 21

24 months ( 2 years)