Joseph and his "Toe Walking"

Toe Walking is the root of all evil! It has invaded my sons life and is fighting us tooth and nail to leave!

Joseph was 2 yrs old when we noticed his toe walking was getting pretty bad. I talked to the dr and they said by 3 most kids will have out grown it. So we wait until he is 3 and we are actually spending his 3rd birthday in IL visiting my dad and step mom before Tobe deployed to Iraq. My step mom is an OT and she noticed how much worse Joe's toe walking has gotten. He literally is always on his toes. She did some leg movements with him and noticed his muscles in his calves were contracting from not being stretched properly because of the way he walks. Well this can be debilitating and should be corrected before it gets worse or even permanent.

So as soon as we got back to GA we scheduled an appointment for his Dr. and they referred us to an Orthopedic Dr, which took forever to get. We went and seen the Orthopedic Dr. (Feb 2008) and he suggested we try casting him so that he can't toe walk and then by time we take them off he can walk without toe walking. So I agreed and they casted him that day.

He wore casts for 4 months, changing them periodically. He loved picking out new colors every time!

Tobe came home on R&R and made Joe's last set of Casts super cool by drawing spider man and spider webs on them. Joe was so thrilled.







He couldn't wear shoes with them and hey were super slick so we bought slippers with the grippers on the bottom and he wore those for 4 months. You couldnt see his casts with his pants and the slippers on so it just looked like I let my kid wear slippers around town. Yeah.. I got a bunch of nasty glares. And when he wore shorts and they could see his casts...
Then I got the I must be abusive or let someone abuse my kid look. Cause we all know if a person breaks both their legs they walk on them..right?

After the casting was done (June 2008) they made him some braces that came from a molding of his foot/leg. He got to pick out a design for them and he picked out a sweet patriotic design. He then had to wear those around 24/7. He looked kinda like forest gump, but so much cuter. He had to wear shoes that were 2 times bigger and triple wide to fit over the bolts on his braces. That made him look even more goofier. At least he's cute and everyone raved about his braces. He was proud to wear them. :)






His braces became to small and we are now in AK and I went to the Dr and asked for a new Orthopedic referall. He is STILL toe walking, he now had flat foot from the casts which causes him to walk with his feet inwards and his ankle is positioned towards the side of his foot rather than the middle. I saw the Orthopedic Dr yesterday (28Jan10) and he said that he sees so little of this that he really works hand in hand with the Podiatrist. He talked to the Podiatrist about Joe before our appt and they agreed that Joe would go see them. He is going in to see the Podiatrist next week. They don;t recommend surgery until 7-8 yrs old until they know he wont out grow it. They did xrays on his feet so we can take a plan of action on his flat feet. He will probably need inserts in his shoe to help his arch which they said is flexible and should be easy to correct. (Not that they can move his ankle back to the correct position or anything, but whatever!) They will also look at his walking and evaluate whether they think he should need to wear braces (AFO's) again. (Which I am going to fight for because I don't just want to sit and wait for the next 4 years and not try to get him to stop walking incorrectly.) They are also going to put in a referral for us to go to a couple Physical Therapy appts and learn some stretching exercises we can do at home for his legs to loosen up his muscles and keep them from contracting. So I guess I will update after his Podiatry apt next week and see what they have to say!!!

3Feb10- Joe had his Podiatry appointment today! They think his tendons are too short in his ankle and thats why he toe walks, thats why his ankle doesn't line up straight with his foot. They are going to give him new AFO's (braces) with some arch support to correct his flat feet. They want to re evaluate him in 3-4 months and then possibly poke some holes in his tendons. That will allow them to stretch out to their appropriate length and in time those holes will close on their own! SO that's where we are at right now!

18Feb10- We went to Joseph's Physical Therapy appointment today. It was informative, yet confusing as her diagnosis was very off from what we've been told. She confirmed he is flat footed, nooo surprise. He has a SEVERELY pronated foot! (read this if you do not know what that is! http://www.uihealthcare.com/topics/footcare/foot3353.html) She stretched out his legs and thinks he is not contracted at all. There is a little tightness in his upper calf that she said is a normal tightness for someone who hasn't stretched out. She says in fact he has an excessive flexibility in all his muscles and joints. Since he has such flexibility he really has no muscle control and so thats why his legs and feet just flop wherever they want to when he isn't actively trying to control where he goes! Joe has a BAD habit of "W-sitting" (go here.. http://www.learninglinks.org.au/pdf/infosheets/LLIS%2025_W-Sit.pdf) and she is worried about his hips and alignment. So now we have to work on getting him to sit criss cross or straight legged and not like a "W"! She thinks we should wait to do anything drastic until all he has done the majority of his bone growth. She thinks the stretching of the tendons is wrong because she feels there is no tightness and that isn't even why he is to walking, she thinks he needs to slowly develop tighter muscles and him primarily do it on his own as of now as not to affect his growth. She says the flexibility condition he has is called Hyperflexibility. This is excessive flexibility, either of one or a number of joints, resulting in joint laxity and an increased risk of dislocations, hyperflexibility of the lower limbs can lead to bow-legs or knock knees. She wants to see him twice next week!





See his ankles? Thats from the pronated foot and causing his flat feet!




His feet always lay like this!



One of his feet are always turned in!




This is how he always stands and walks!

23Feb10- I talked to his therapist during PT today and she thinks he would benefit from pediatric Physical Therapist or Occupational Therapist who specializes in what my step mom does which is sensory integration based therapy. He has the Hypotonia which is low muscle tone and that needs to be addressed in order for him to completely overcome this. She says she knows how to somewhat treat him because she is a physical therapist and her own son had this problem, but she feels he would get the best benefit from someone in pediatrics. So she is calling the podiatrist who referred him there and is going to talk to him. She is going to search for a local pediatric PT or OT that accepts tricare and is going to ask him to put in a referral for him. In the mean time she will do the research for how to best treat him for the time being. If for some reason a pediatric PT or OT is unattainable to us then she will ask them for suggestions and tips on how to properly treat him and then she will continue with his care. For now he has to practice kicking a ball with the inside of his feet and not the outside. This is really hard for him as his feet are always pointed inward and he uses the outside of his feet for everything. He also has to walk on his heels and strengthen his calves. He also has to get in the push up position and put his weight of his body onto his legs to try and strengthen them. He is suppose to do these exercises twice a day! Im going to make it a game and fun for him so he will hopefully enjoy it and it wont become something he dislikes doing and he will want to try and do it with all he's got! Next apt is in 2 days!