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Dyspraxia and Feet?

Discussion in 'General Issues and Discussion Forum' started by Marion A Murray, Sep 21, 2009.

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  1. Marion A Murray

    Marion A Murray Active Member


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    Hi,

    I was wondering if anyone had come across patients/clients who have dyspraxia and if so was there a particular foot type relating to it.

    I am interested in dyslexia and there may be some cross over to dyspraxia. Hence I started observing friends (adults) with dyspraxia seem to have a fairly square forefoot, high arch and curly or retracting lesser toes. Obviously they have problems with balance and co-ordination too.

    Has anyone any more developed insights/knowledge relating to this that may help me take my thinking a step further?
     
  2. AJM

    AJM Member

    I doubt that you would find dyspraxia as a reliable indicator of specific foot types. It might be the other way: some features of the foot, posture and gait might be indicators of dyspraxia.

    I have seen the opposite of your example.

    Dyspraxia as you might know (from your interest in dyslexia) as a term covers a range of possible physical and neural features. Dyspraxia’s common feature of reduced gross motor and fine motor skills might be manifested in poor muscle tone in the lower leg or elsewhere, or it might be more limited in ways that do not affect the foot (even just in handwriting or speech).


    One thing leads to another: poor co-ordination, poor muscle tone and learning disabilities easily lead to reduced physical activity, or at least alienation from some team sports. (A pause and intake of breath while I completely overlook the situation in the USA where federal funding of education has ties to mandatory inclusion of learning disable students. Learning disabilities are usually associated with dyspraxia, so dyspraxic athletes are often within the USA federally funded educational institutions’ programmes for LD students.)

    Research on the physical aspects of dyspraxia is relatively limited (compared with the enormous depth of research on other topics). The evolution of terminology shows how science still grapples with the boundaries and legitimacy of what is been examined – look for early references to “clumsy child syndrome” or “developmental coordination” delay/syndrome. Early work on dyslexia probably also covered learning differences aspects of dyspraxia (so perhaps a more thorough search on dyslexia might also actually cover physical attributes of dyspraxia). Vastly more (scientific) work seems to have been done on the learning differences aspects of dyspraxia.

    If you email me, I can try to work out how to send you an eclectic bibliography of 50 or so published, science-based articles on the topic.

    I do not recall any of the research in the list specifically helping on your question.


    In dealing right now with a specific case of a dyspraxic youth needing replacement orthoses (partly to correct a significant leg length discrepancy), one has to factor in lifestyle (including sport activities), attitudes and (particularly to address dyspraxic affected learning issues) changing the way of communicating the virtues of consistent use of the orthoses. In short, the nature of dyspraxia particularly calls for all features of the person’s particular dyspraxia to be taken into account.

    If the practitioner is unfamiliar with the learning disabilities aspects and then also the consequential effect on social skills, then the practiioner might also be challenged when trying to apply the normal principles of patient communication (discussed in other threads). (I am no assuming you are unfamiliar - I am just taking the opportunity to preach to other readers.)

    Sorry for the length of post from a non-health care practitioner. I would just like to help others avoid the error of our (Australian) sniggering fourth estate who recently refused to understand or acknowledge the difference between intellectual disabilities and learning disabilities.

    Last time I was on the Isle of Lewis, it was very wet and very very windy. Promise me it will be sunny next time I'm there.

    Regards
     
  3. Ian Drakard

    Ian Drakard Active Member

    Hi Marion

    Certainly not an expert in this area but I'd tend to agree with the above post. Generally associated with lower muscle tone and I think there's an association with some of the hypermobility spectrum.

    More likely to see a flexible flatfoot if anything (rather than a high arch) and this certainly is true of the few cases I've seen.

    There was a presentation on this in one of the podopaediatrics sessions at the 2008 SCP conference (Development Coordination Dysfunction Sally Smillie, Podopaediatric Podiatrist, Medway PCT). I've attached the powerpoint

    Hope this helps
    Ian
     

    Attached Files:

  4. Sally Smillie

    Sally Smillie Active Member

    Hi Marion,

    I see Ian has kindly posted my PPT on said topic. OT are the real power-house in this area. Have a look through the references at the end of the PPT - nice little bit of reading. Don't forget that the greatest defining feature of DCD is impariment in motor planning. Hypermobility is a feature of a number of similar conditions, dyslexia included. In the PPT is a slide with a diagram illustrating this.

    All I would say to add to this is that we've begun data collection (only last week) on research into DCD (the condition formerly known as Dyspraxia) and some of the outcome measures we are using include the Foot Posture Index and the Lower Limb Hypermobility Score. So, in time we will have a data set albeit small (it is only a pilot at this stage) on these aspects of DCD and foot type. We are only looking at children.

    I can say anecdotally at least, they are almost universally hypermobile with a pes pancakus foot type. However, clinically I find they tend not to suffer painful symptoms as much as functional symptoms in that they trip/fall freqeuntly and fatigue quickly. Again anecdotally at least, they tend to fall less and fatigue later with orthoses(UCBL style). But that is the point of this research, to see if this effect is real and true. Our research incoporates pod, physio and OT and is being done inconjucntion with the Dr's Jill Ferarri and Stewart Morrison and happening in Kent.

    All the best,
    Sally
     
  5. Ian Drakard

    Ian Drakard Active Member

    Hi Sally

    Enjoyed the talk last year. Very helpful when I had a DCD patient in the following month as they'd not had much info.

    Keep us posted on research progress

    Regards
    Ian
     
  6. Sally Smillie

    Sally Smillie Active Member

    Thank you Ian. I am glad it was of some use :0) What were the results of your intervention?

    I fear it will be a some time until we get enough data we can talk about, 18-24 months I'd say. But, you will no doubt be kept informed.

    Regards,
    Sally
     
  7. Bug

    Bug Well-Known Member

    Sally is actually a member here - it would be great to hear her views so will send her a message about this thread.

    ETA: Oops - that will teach me for not clicking on the reply for a few hours. I see Sally is quick!

    We're looking forward to hearing that presentation at the Melbourne Paed's conference too (Plug Plug!)!
     
    Last edited: Sep 24, 2009
  8. Ian Drakard

    Ian Drakard Active Member

    Due follow-up appointment later this year so will know more, but initial check-up was positive. I would agree about anecdotal improvement with walking, coordination etc. The boy was also getting some good support with extra physical activity and trampolining- you can see how easy it would be to withdraw from things like this.

    I'm sure there must be some work looking at improvements in coordination and proprioception with orthotics in hypermobility in the absence of DCD. Anyone know some references?
     
  9. Sally Smillie

    Sally Smillie Active Member

    Absolutely! That is part of the point of our research. I am sure there is a proprioceptive function of orthoses and this is what I suspect produces the effect we see. Follow on from our research, assuming the orthoses do improve gait, we'd need to investigate how they do it. That is very much easier said than done.
    In addition to the outcome measures mentioned above we are assessing qualitatively the frequency of trips and falls and time to fatigue. We are also measuring "running speed and agility" and "balance" as subsets of the BOT-2 (Bruinincks-Ostertsky test for motor proficiency). Hopefully this should come into it here. Actually measuring proprioception itself is a tricky one. I'd love to look at this more.
     
  10. Sally Smillie

    Sally Smillie Active Member

    We're also doing a 6 minute walk test to see what distance is covered, before and after a rehabilitation/trreatment program and orthoses. The results will be interesting.

    Cylie, for once I was way ahead ;0) Doesn't happen often.
     
  11. susiesue

    susiesue Member

    hi,

    i am treating a boy with Dyspraxia. he has a sever ankle equinus and classic pes cavus, retracted digits. he is also a tip toe walker surprisingly enough.
    after a long battle he has been referred for physiotherapy and i have provided orthoses. (as well as a long battle with VP) i keep a copy of his casts in my clinic i can send pics if your interested.
    his GP has been without doubt been half the problem in getting him treated. ignoring my letters, offering to refer him to orthopaedics when mom took him in ect, the outlook is good now though as he can heel strike.

    he was also getting occupational therapy from school, this may have ended due to changing primary school to high school in September though, mainly to help with co-ordination and balance. i know he still struggles with shoe laces, handwriting and he can't ride a bike.

    emotionally he has issues too, not really our remit though. (parents can try and make it ours though lol)

    interesting thread. ill check back.
     
  12. Marion A Murray

    Marion A Murray Active Member

    Thanks for this information and also for the very useful PP presetantation. I am not sure how I missed that session myself at the conference. There must have been an alternative session that was more pertinent at that time.

    I will take some time to go over the presentation and can follow up on the references it offered.

    I really appreciate your help - it is very interesting and complex.

    With dyslexia some of the recent research seems to focus on some inefficiences in visual and/or auditory processing. It seems examination of some of the brain cells in both these areas may suggest a reduced number of magma cells (sp?) so the processing takes a little longer and often folks get more tired concentrating. In the 5 areas of the visual cortex it seems some areas get cells hyper-excited and using coloured overlays on print can move the processing to another of the 5 that may be less excited and function better allowing visual images to be processed more clearly.

    As for me I am sticking to my fish oils!

    Marion
     
  13. Marion A Murray

    Marion A Murray Active Member

    Would be interested in reviewing relevant literature you refer to. How do I access your email address?

    Thanks for the information - gives me lots to go on.

    I do think these hidden disabilities are not understood well by a fair number of folks whom you might expect to have a more sophisticated grasp of what they are about given all the research going on.

    I have just been helping out with a team of folks from Dyslexia Scotland doing a road show throughout the Western Isles and have had 150 people come along wanting to know more. Given a population of 26,500 throughout the various islands that was an amazing turnout. In fact it was more than they got in mainland cities of Dundee and Perth last year.

    Sorry but the islands are still fairly wet and windy but the people here are kind, generous natured and the crime level is low.

    Thanks once again.

    Marion

    M
     
  14. Marion A Murray

    Marion A Murray Active Member

    Hi Susie,

    I am really interested in your area of research into dyspraxia in children etc. I will try to get a hold of the papers.

    Your powerpoint presentation is really good too. I am the Interim Secretary of a branch of Dyslexia Scotland I helped set up for the Hebrides. I am sure if your pilot proves the usefulness of srthotics there are plenty of people here too who would yield a similar result.

    I would be interested in hearing how things progress as I don't know of much happening and agree the MDT is the way to go. On the island we do not have so many staff to get such things off the ground

    Regards,

    Marion
     
  15. Marion A Murray

    Marion A Murray Active Member

    I would be interested at looking at photos of the casts.

    The additional co-ordination issues seem fairly typical from my own observations and reading. It may also be a problem in dancing and being able to learn to drive a standard car with gears due to the clutch being footcontrolled. Someone I know well is learning in an automatic as the hardwiring carrying the impulses from the brain to co-ordinate foot movement does not work. There can also be a problem with handwriting due to overgripping - I believe OTs can help in this area. Another feature may be a problem with depth perception which may also be particularly problematic with driving. Generally I would say some of these folks have a higher incidence of minor accidents (potato peeling, cutting veg/fingers, smashing glasses...) on top of being able to trip over a blade of grass - or maybe my experience is just anecdotal.

    Glad you are finding this an interesting thread.

    Marion
     
  16. AJM

    AJM Member

    Sally’s presentation is excellent. I do not think I have anything else which is specifically from a podiatry perspective.

    At the risk of an e-slap from the forum administrator for overloading with quantity not quality, attached are two lists of references to journal articles on DCD/dyspraxia (and its antecedent (sigh) “clumsy child syndrome”): a list limited to physiological issues and a wider (eclectic) list of references.

    The shorter list is intended to help you locate only those articles that might be of direct use for your immediate needs.

    The second list is to provide a searchable reference library on the many tangential issues. A larger reference library addresses the inherent feature of DDC/dyspraxia that it commonly manifests in a combination of physiological features (e.g., motor, stance) and neural features (e.g., speech, learning, emotions).

    Ignoring the neural features would ignore the fundamental characteristics of DDC/dyspraxic conditions; however, the continuum of possible features makes the topic daunting to master for anyone looking from just one perspective (teacher, OT, podatrist ...).

    The second list has a few duplications. It is personally driven, rather than being systematically compiled under a protocol for reviews. Apologies to anyone whose published article is omitted.

    I have not compiled a similar list just of books.

    If anyone requests, I'll keep trying to work out how to export by email an EndNote group of references. That would make it easier to search/track/download copies available under their copyright.
     
  17. RachWadd

    RachWadd Member

    Hi all,

    I am hoping that, even though this thread is old, some of you out there might be able to add some further advice and possibly new info on recent studies.

    I have recently had a 12YO male patient present for advice and treatment of dyspraxia and associated lower limb issues.

    He has been diagnosed for a number of years and has had OT, physio treatment and regular orthopaedic monitoring in the past but not for the last couple of years. He has recently started at a specialist school and has been getting regular OT since the beginning of the school year.

    The patient's mother became concerned when she noted an increase in arch height and inverted gait so sought advice from her GP (who deals mostly in paeds) who has referred to a paediatrician, physio and myself.

    The patient presented with a cavoid foot, retracted digits, plantarflexed 1st ray with a trigger hallux which did not have ground contact during stance and most of stance phase of gait, met adductus, varus RCSP and genu valgum. His mother reported an initial planus-type foot, "walking on the insides of his feet" and the genu valgum has been present since beginning walking at 2YOA. The varus/cavoid foot has developed over the last 18/12.

    The patient is active - plays Aussie Rules football and basketball. His trainings include 3X 1.5 hours during the week and 1X footy game, 1X basketball game. He reports proximal muscle fatigue and ankle pain only in the last 30mins of his training sessions and not usually during games.

    My questions, following a bit of research to update my very limited knowledge on this subject, are these:

    1. Though orthoses seem to be indicated in assisting with gait, the research I have read deals with the planus foot type. Would the same be indicated in those patients with a cavoid foot? Any research been done on this?

    2. Is there any relationship between dyspraxia/DCD and CMT?

    Looking forward to your replies

    Rach
     
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