Re: hypotonia and flat feet

[Guest guest]

I do have experience with orthotics. Lindsey, my 6 year old wore them for

four years. we were fortunate that the neurologist referred Lindsey to the

podiatrist 13 months old.. by 14 months she was wearing her first pair, at

the time she was up on her toes all the time and was very unstable. they did

WONDERS! after that i let the PT take care of the orthotic issues. but we had

so much trouble with some of them, she even taped Lindsey and sent it to the

cascade orthotics people to get advice on what she needs, but we had blister

after blister, she's had several different styles.

i took her back to the podiatrist and he insisted she begin PT again and he

made some new orthotics for her. she is no longer wearing them, but its by my

choice, the podiatrist doesn't know, now the pediatrician after me to get her

some because she rocks back on her feet and she's bound to have problems when

she older (she says) but I've had enough seeing my little girl with so many

open sore blisters.and she can physically do everything.

I'm sure the PT knows what she's doing, but if I was in your shoes I would go

to a podiatrist just to get his opinion, especially if he still cannot walk

up and down stairs. Have you been to an orthopedics DR? I learned a lot

going to one of those too! Lindsey was completely unable to walk on a

straight line at 5 and he said her joints are extremely loose and with

global hypotonia. he told us alot.

Lindsey's feet are flat and pronated with weight baring. They seems totally

flat before but she does have an arch now, just not when she's applying

pressure.

Jennie

<A HREF= " http://lindsey03.homestead.com/mygirl.html " >Lindsey's website

</A>

[Guest guest]

My son was in orthotics long before he could even walk. A PT is usually the

best to evaluate, in my experience, but a physical medicine MD can do it,

too. He wore everything from full braces down to shoe inserts and now walks

pretty darn well, even runs (and ice skates a bit). You also need to work

with a good supplier of orthotics.

Sue C. in Mich.

[Guest guest]

Hi Donna,

My nephew Jack (!) is 5 and his mum got him fitted for orthodics about six

months ago because of his flat feet. In general he is not very confident in

much of his co-ordination at all, but he still is not very confident on

stairs at all (he won't go down them unless someone is holding his hand)

because he can feel how unsteady he is. But his running and walking has

improved in the six months since he was fitted with the orthodics. I don't

really know whether it was the orthodics that helped so much, or just that

Jack's co-ordination is slowly getting better.

Hope that helps?

cheers,

>From: donnamajor <dmajor25@...>

>Reply-

>< >

>Subject: [ ] hypotonia and flat feet

>Date: Mon, 10 Feb 2003 16:26:41 -0600

>

>Does anyone have any experience with wearing orthothics? (sp?)

>Jack is 3.5 and his physical therapist is suggesting he be fitted for

>orthothics. He feels this will help support him since his balance and

>coordination is so poor. And that this may help him with walking up/down

>stairs since that is still something he cannot do. I was wondering if this

>too (flat feet) is commom with hypotonia.

>

>I was also wondering if I should trust the opinion of a pt, my pediatrician

>was useless and said to do whatever the pt said to do. He did say to go to

>a

>podiatrist if I wanted a second opinion.

>I was just wondering if this was common for anyone else?

>

>donna

>

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[Guest guest]

........walking up/down stairs since that is

still something he cannot do. I was wondering if this too (flat feet)

is commom with hypotonia.......

donna

Donna,

Walking up and down stairs is a problem with hypotonia. Going up

stairs will come before going down. They fear falling if their knees

go out. Our 10 year old grandson still has difficulty with downstairs

(one step at a time if he is tired). He continues to work with a PT

and an OT. His flat feet now have an arch when he stands on his toes

and he wears regular shoes with sports heel cups added to them if he

has pain in his feet.

I would say to trust your therapist and take your son to an

Orthopedist if you want a second opinion.

Grandmabrk

[Guest guest]

Donna:

We started with braces for our son at 14 mths and they lasted about a year.

He also has hypotonia. We only used them when we had him in the stander or

while he was working with the PT. He does still roll on the inside of his

feet when in standing on a carpet or other surface like that. On a hard

surface he does very well. We did get him inserts that fit into his shoes

called " Pattibobs " . Evan really doesn't like them in his shoes and prefers

not using them, so we have done away with any bracing. Our PT is certified

in TAMO physical therapy and that training doesn't encourage bracing. It's

based more on how gravity, etc. works on the body, and using it to work for

you. http://www.tamo.com Ingrid, the one that developed this type of PT,

does amaizing things to get children/adults to maximize their ability. She

saw Evan when she was in town teaching a course.

Oh, I should tell you we did see a podiatrist and he left it up to our PT as

to whether we got braces. They did do x-rays on his hips, etc. to be sure

he was in alignment, etc. so braces could be used.

I'm sure the braces served a good purpose. Will we continue bracing?

Probably not, knowing what I know now and have seen from the TAMO therapy I

have mixed emotions about bracing.

Do you mind me asking how old your son was when he started walking

independantly?

Best wishes to you in your decision making.

Lynn (mom to Evan 26 mths.)

[Guest guest]

Hi Donna,

My son has CP and is 8 years old, also hypotonic. He did wear orthotics for

his feet at around 2 or 3 years of age. It was his orthopedist who requested

them prompted the suggestion from his PT. ph also has flat feet. You

might want to check with an orthopedist for another opinion.

Hope this helps.

Rgds/

[Guest guest]

My daughter has low tone in her trunk due to CP and her feet pronate

significantly. She is 31 months old and although she is not yet able

to balance herself to walk, she can balance herself in standing

briefly and can walk with me holding her by one arm.

Orthotics were strongly recommend because of her pronation and we

tried them when she was younger and then again recently. We found

that they did correct her foot position but that didn't translate

into improved balance/function.

We prefer not to use them and we do lots of exercise to help correct

the problem dynamically. Our exercise program was developed by a PT

in Caracass and we learned from Ester Fink, PT in Canada. It's

called MEDEK.

Donna, I would like to hear more about your experience with TAMO. I

read the information on the website with great interest. Could you

share more?

Kim

[Guest guest]

Donna -

You bet we've had experience with orthotics. Josh, who has

hypotonia and will have flat feet most likely, wore an ankle

orthotic (DAFO's) just before he actually started walking in order

to add strength to the ankles. Then he started walking assisted and

when we took the DAFOs away for awhile, we noticed that his ankles

were pronating (going in). When he really started walking a lot, we

used the DAFOs for 2 1/2 hours or so a day while he was in preschool

and doing a lot of movement. We used them at daycare in the

afternoon when I could get there and put them on (I didn't think the

teachers would do it properly). They finally learned and he wore

them all day until he got home and went around barefoot. Then he

went into the next level room at daycare and those teachers wouldn't

know how to put them on if we gave them a video! So, Josh wore them

part-time and then started getting bruises on the ankles from them

(he had lost a lot of weight with free and constant mobility so they

didn't fit as well). We stopped using them until we could get them

fitted again - got new ones but his PT noticed his toes were going

out while the ankle was still going in some. The ortho guy put on a

little leather strap to hold his toes but his toes got really jammed

into the ortho and shoe one day so we stopped. We got them fixed

again but then noticed a scrape along the instep and more bruises on

the ankles so we stopped again. We noticed recently that the ankles

were still going in some and his PT feels we need to use them again.

We're getting him fitted for a different style next Wednesday - hope

these work.

The orthos are not really to strengthen the ankle since a child with

hypotonia may have strength in the muscles but not the tone that's

necessary for free movement. The orthos provide the strength, or

brace, while the muscles tone (at least thats's how it's been

explained to us). Once the muscles tone and the strength is there,

then the orthos will no longer be necessary.

The one thing to watch out for - the plastic orthos like we have had

make the feet get very, very warm. Using lighter weight socks can

lead to the bruises if the orthos are not fitted exactly correctly.

We've been through three or four pairs now and the hardest part of

using them was getting shoes to fit over them. When you do get

shoes, take out the inner sole of the shoe - the shoes will be about

1 1/2 to 2 sizes larger than your child's foot but with the inner

sole out, you can get away with buying a slightly smaller shoe and

it will still fit. Keep the sole, though, because when your child

outgrows the ortho and needs another one, he/she will fit in the

shoe without the ortho as a back-up and you can get another shoe to

fit the new ortho (make sense?). We found that Skeechers make a

shoe that is wide enough, priced reasonably, and lasts a long time.

Good luck!

Sherry, , (in driver's ed now!), and (going on

5, running and chattering all the way!)

> Does anyone have any experience with wearing orthothics? (sp?)

> Jack is 3.5 and his physical therapist is suggesting he be fitted

for

> orthothics. He feels this will help support him since his balance

and

> coordination is so poor. And that this may help him with walking

up/down

> stairs since that is still something he cannot do. I was wondering

if this

> too (flat feet) is commom with hypotonia.

>

> I was also wondering if I should trust the opinion of a pt, my

pediatrician

> was useless and said to do whatever the pt said to do. He did say

to go to a

> podiatrist if I wanted a second opinion.

> I was just wondering if this was common for anyone else?

>

> donna

[Guest guest]

Unfortunately, it is not true that muscles will tone/strengthen while

using orthotics or any other kind of brace. The muscles around the

joints braced by the orthotic will get weaker and not stronger. This

is well documented and there is no controversy on this point.

However, you can minimize this problem by providing

exercise/activities without the orthotics each day. As a PT, I have

heard many other PT's say that orthotics will " make the base of

support more stable " and " result in improvements in balance, walking

etc " . The most recent volume of the Journal of Pediatric Physical

Therapy has a study that shows no difference in function between

orthotics and no orthotics for ambulatory kids with CP who used

orthotics for 3 years or more.

I say all this not discourage use of orthotics, per se, but they come

with alot of problems (as many parents have experienced) and they are

not always helpful or truly necessary just because the feet are

pronated or the knees are hyperextending. Exercise can remediate

these issues, to some extent.

For those using orthotics, Sketchers are a great choice and also K-

Swiss (the tennis shoes) come in extra width and open up really far

down into the toe box making them easier to get on over the brace and

allowing you to get a smaller size shoe.

Kim ,PT

> The orthos are not really to strengthen the ankle since a child

with

> hypotonia may have strength in the muscles but not the tone that's

> necessary for free movement. The orthos provide the strength, or

> brace, while the muscles tone (at least thats's how it's been

> explained to us). Once the muscles tone and the strength is there,

> then the orthos will no longer be necessary.

>

[Guest guest]

Hi,

I tried to respond but I guess the response got caught up in the

problems with . Anyhow, I really need to differ with you on

the orthos issue. You say that there is no controversy, actually

there is. Our pediatrician tends to agree with you that the orthos

don't necessarily do what they are said to do, i.e. provide a brace

while muscles tone. However, our PT, and head doctor for our Easter

Seals in our region, several other PTs and, admittedly, the man who

fits Josh for the orthos, have explained that the type of orthos we

have do provide for movement in the feet - Josh can flex and extend

his foot while wearing them so the muscles are getting a workout as

the orthos provide a steady, strong base for him. His muscles, as

doctors have seen and documented, have indeed gotten stronger and

more toned that before he wore the orthos. Whether that would have

happened if there had been no orthos, who knows. All I know is the

orthos provided him the stability he needed to walk more and,

thereby, exercise the muscles in the ankle, foot, and calf areas.

So, there is controversy. Nothing is written in stone. And,

parents should get both sides of the issue before making a decision -

we certainly did and decided to go with the orthos. We think it

was the correct decision for Josh.

Sherry, , , and

> Unfortunately, it is not true that muscles will tone/strengthen

while

> using orthotics or any other kind of brace. The muscles around

the

> joints braced by the orthotic will get weaker and not stronger.

This

> is well documented and there is no controversy on this point.

> However, you can minimize this problem by providing

> exercise/activities without the orthotics each day. As a PT, I

have

> heard many other PT's say that orthotics will " make the base of

> support more stable " and " result in improvements in balance,

walking

> etc " . The most recent volume of the Journal of Pediatric Physical

> Therapy has a study that shows no difference in function between

> orthotics and no orthotics for ambulatory kids with CP who used

> orthotics for 3 years or more.

> I say all this not discourage use of orthotics, per se, but they

come

> with alot of problems (as many parents have experienced) and they

are

> not always helpful or truly necessary just because the feet are

> pronated or the knees are hyperextending. Exercise can remediate

> these issues, to some extent.

> For those using orthotics, Sketchers are a great choice and also K-

> Swiss (the tennis shoes) come in extra width and open up really

far

> down into the toe box making them easier to get on over the brace

and

> allowing you to get a smaller size shoe.

> Kim ,PT

>

>

> > The orthos are not really to strengthen the ankle since a child

> with

> > hypotonia may have strength in the muscles but not the tone

that's

> > necessary for free movement. The orthos provide the strength,

or

> > brace, while the muscles tone (at least thats's how it's been

> > explained to us). Once the muscles tone and the strength is

there,

> > then the orthos will no longer be necessary.

> >

[Guest guest]

You need only look at the literature. Some orthotics are

called " dynamic " because they do indeed allow for a little bit of

movement. But try taking the orthotics and bend them around. Not

moving much. I have no doubt that you can line up PT's and MD's who

prescribe orthotics as a matter of course. That was exactly my

point. But the research doesn't support their use as they are

typically prescribed in children. And most parents never hear that.

Kim PT

> Hi,

> I tried to respond but I guess the response got caught up in the

> problems with . Anyhow, I really need to differ with you on

> the orthos issue. You say that there is no controversy, actually

> there is. Our pediatrician tends to agree with you that the orthos

> don't necessarily do what they are said to do, i.e. provide a brace

> while muscles tone. However, our PT, and head doctor for our

Easter

> Seals in our region, several other PTs and, admittedly, the man who

> fits Josh for the orthos, have explained that the type of orthos we

> have do provide for movement in the feet - Josh can flex and extend

> his foot while wearing them so the muscles are getting a workout as

> the orthos provide a steady, strong base for him. His muscles, as

> doctors have seen and documented, have indeed gotten stronger and

> more toned that before he wore the orthos. Whether that would have

> happened if there had been no orthos, who knows. All I know is the

> orthos provided him the stability he needed to walk more and,

> thereby, exercise the muscles in the ankle, foot, and calf areas.

> So, there is controversy. Nothing is written in stone. And,

> parents should get both sides of the issue before making a

decision -

> we certainly did and decided to go with the orthos. We think it

> was the correct decision for Josh.

>

> Sherry, , , and