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Hi All

I'm looking for some advice please:

I have a five year old patient, female, who continues to tip toe walk after a year of orthotic intervention and stretching/treatment regimes from physiotherapy and parental input.

On review last week, her gastroc, achilles, were not nearly so tight as o/e 6/12 ago. I referred her for bilat. XR last week, as it felt as if ankle dorsiflexion was physically impinged in the ankle mortice.

The Consultant Radiologist has reported "much of the medial malleolus is composed of epiphyseal cartilage".

Is this normal for the child's age? Would it inhibit ankle dorsiflexion? Prognosis/treatment options if indicated?

Many thanks in advance,

 

Hi,
Can you post the x-ray pic (with permission) as that is interesting thing to say. It could either be that the radiologist was looking for things to say, there is a normal growth plate because it does extend across the who tibia or there really is some deformity within the ankle mortice. If you aren't confident in reading x-ray's, call the radiologist and talk with them about it. Don't forget, they are a doctor and in my experience, the majority are very willing to chat about what they have reported on when you aren't sure what it means and if it is a normal variation for the age.

Can i just ask though, what you expected the orthotics to do with the toe walking? Unless they were full length, but even then, there is no evidence they will do anything with toe walking. Actually, there is no evidence that anything will fully stop the toe walking. I would advise you check out some of the threads on toe walking and manage parent expections of treatment cautiously. The most you can with with treatment of ITW somehow manage to keep the muscles long enough and wait it out. In my experience, the majority come down but most will will toe walk at times or have an early heel lift. Even the ones who have been treated with all manner of things.