Low tone pronation

Craig Payne · Feb 7, 2006

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I like this concept.

While browsing the commercial link in this thread: Flatfeet in those with learning difficulties

I found a newsletter on their website talking about the concept of low tone pronation:
Low Tone Pronation

To help organize the brace selection process, Cascade has defined several patient groupings, based on the foot, ankle and knee presentations most often seen in our patient population. Within each of these groups, we have described how various levels of involvement present. We then matched each of these presentations to an appropriate brace design. Directly associating a brace design / bracing strategy with a defined patient presentation has worked well, both in theory and in practice.

The focus of each of the defined clinical groups is the biomechanical presentation—the posture, position or gait—that can be identified independent of the diagnosis behind the presentation. This grouping system is used with the understanding that, while not perfect, it is a reasonable and clinician-friendly way of presenting the brace selection process. In this newsletter edition we will briefly discuss the clinical grouping: Low Tone Pronation.

A physical therapist or physician will diagnose Low Tone when low muscle tone appears to be affecting develop-mental motor skills. If the low muscle tone presents with pronation, the practitioner will refer the patient to an orthotist. Some of the common patient conditions that present as “Low Tone” and then result in pronation are Down syndrome, developmental delay, spina bifida, spinal cord injury and cerebral vascular accident (CVA). With an infant, low muscle tone usually presents with decreased head and trunk control and therefore delayed rolling, sitting, crawling and walking. In addition to presenting as developmental delay, low muscle tone can also affect muscular skeletal tissues.

At Cascade the Low Tone Pronation category is defined when the foot and ankle muscles are unable to support the forces of body weight against gravity. The results can be collapse of the arches of the feet, eversion of the hindfoot and abduction of the forefoot. The foot of the younger low tone patient is usually flexible and can be fully corrected to a normal alignment with manipulation. In older patients, the foot may become more fixed over time, and as a result more difficult to correct.

There are many exercises that can strengthen affected muscles, but depending on the severity of the low muscle tone, a person may never gain the ability to support gravitational force on his or her feet and ankles. In these cases, orthoses are necessary to provide support for upright and weight bearing skills and/or to prevent additional musculoskeletal damage.

Cascade Dafo has developed a range of orthoses to help patients with varying degrees of pronation resulting from low muscle tone. Our HotDog™ and PattiBob™ off-the-shelf shoe inserts are recommended for patients with mild pronation, with little or no hindfoot involvement. The PollyWog™ shoe insert wraps partially around the foot to help control the heel eversion and forefoot abduction of more moderate pronation.

Several models in our DAFO® line of custom braces address more severe low tone pronation issues. The DAFO 4 provides full wrap-around control of the hindfoot and forefoot, while leaving the ankle free. For the most severe cases where low tone begins to affect ankle stability, the DAFO 3.5 controls the foot pronation while adding medial/ lateral stability to the ankle and knee.

Low Tone Pronation serves as a broad grouping for clinical purposes, but we recognize there is a wide range of issues within the category. Although we have found this clinical grouping approach to be quite helpful, we recognize that not all patients fit neatly into any group, no matter how broad the description. And many patients will actually fit into more than one clinical group.
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Link

martinharvey · Feb 15, 2006

Oh dear,

The PollyWog™ shoe insert
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won't go down here very well. The commission for racial equality will positively erupt! Just goes to prove we really are divided by a common language. I remember once telling a friend from the states that I stood on the pavement to look at a leak from my guttering under the cladding. It took ten minutes for us to work out a common understanding that I had really stood on the sidewalk to look at the eavestrough under the siding. I think!

emoclew · Feb 24, 2006

Craig,
This is interesting, although I'm sure there are other neurological reasons for low tone as well. I am currently treating a 9yo boy who was a very floopy baby. Mum did not follow up with further neurological tests once biopsys were mentioned, but he has one of the most unusual gaits I have seen and definatley the most pronated. He is hyperflexible all over as well.He was extrmely late in his milestones, but is a twin. I haven't seen the other twin, but evently he does not resemble my patient in gait at all. I'm not sure if he has learing difficualties. I am trying to persude mum to do some follow up tests with a paed. neurologist - I have issued some strengthening exercises and orhtoses but something in me tells me he needs further tests.Suggestions anyone?

Thanks
Lisa Merrett

NewsBot · Nov 6, 2012

Foot Pronation, Strength, Balance and Gait in Preschool Children with Hypotonia and Typical Development
Ross, Sandy A.; Winking, Kelly; Rosentreter, Caitlin; Meehan, Morgan; Althoff, Mallory; Hill, Alyssa; Pagano, Angela; Grau, Sheri
Combined Societies Mtg; American Physical Therapy Association; San Diego January 21-24. 2013

Purpose/Hypothesis : Typically developing toddlers have flat feet (pronation) and develop arches as they age and walk with a more adult gait pattern. Children with hypotonia (low tone) have increased ligament laxity and excessive pronation. According to the literature, a child normally exhibits calcaneal valgus in relaxed standing of no more than 10° through the age of three. By the age of five, a child should present with calcaneal valgus of less than 6° and by age seven a child should demonstrate relaxed calcaneal stance much like that of an adult (2° valgus). Although typically developing children have more pronation when they are younger, and children with low tone have more pronation in general, it is unclear what degree of pronation should be braced and if the degree of pronation is related to the child’s functional ability. The purpose of this study was to determine the difference between degrees of pronation, plantarflexion (pf) strength, balance, stride length and gait speed in children with low tone and typical development and explore the relationship between these variables.

Number of Subjects : Participants included 44 preschool children: 29 (13 girls, 16 boys) in the typically developing (TD) group [mean age 4.3 years (±5.1 months)] and 15 (4 girls,11 boys) in the low tone (LT) group [mean age 4.3 (±6.8 months)].

Materials/Methods : Outcome measures included gait speed and stride length (GAITRite), pf strength (hand-held dynamometer), static hindfoot pronation (goniometer) and balance (subtests of the Pediatric Balance Scale). All data were normally distributed. Right to left differences were found for static hindfoot pronation and pf strength; all other variables were averaged. Between group differences were compared using a MANOVA. Correlations were completed using Pearson’s Correlation Coefficient (p< .05).

Results : A significant difference was found between the TD and LT groups for all outcome variables (p≤.001). Mean static pronation for the TD group (10° ±3.7) was significantly less than the LT group (16° ±5.6). For the TD group no significant correlations were found between the variables tested except gait speed and stride length (r=.71). For the LT group hindfoot pronation was not correlated to function however, there was a moderate correlation between balance and the following variables; gait speed, stride length and strength.

Conclusions : The majority of typically developing children (55%) in this study exhibited greater pronation than would be clinically acceptable. Additional research needs to determine if typically developing children and those with hypotonia who display greater degrees of pronation require orthotics. Hindfoot pronation was not correlated to function in either the TD or LT groups.

Clinical Relevance : Surprisingly typically developing preschool children displayed greater degrees of pronation than expected based on the literature. It is unclear when or if we should order orthotics for children with low tone who display standing pronation similar to those in the typically developing group.
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NewsBot · Feb 3, 2014

Efficacy of Orthoses for Children With Hypotonia: A Systematic Review
Weber, Anna PT, DHS; Martin, Kathy PT, DHS
Pediatric Physical Therapy: Spring 2014 - Volume 26 - Issue 1 - p 38-47

Purpose:
The purpose of this systematic review of the literature was to determine the efficacy of orthoses for children with hypotonia and provide a concise summary of the state of the evidence in this area.

Methods:
Fifteen search terms were used to find articles addressing children with hypotonia, orthotic use, and physical therapy.

Results:
Ten articles met the inclusion criteria, but no level I evidence was found. Data were reported for body structure and activity components, but not participation outcomes. Current evidence suggests that foot orthoses and supramalleolar orthoses may benefit children with hypotonia; however, the evidence is low level.

Conclusion:
The evidence for efficacy of orthoses for children with hypotonia continues to have gaps with the following questions still unanswered: When is the optimal time to introduce orthoses? Are foot orthoses or supramalleolar orthoses more efficacious? Should orthoses be combined with physical therapy?
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Low tone pronation

Craig Payne Moderator

martinharvey Active Member

emoclew Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

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Low tone pronation

Craig Payne Moderator

martinharvey Active Member

emoclew Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Low Plasma Arginine among Patients with Diabetic Foot Ulcer

Lower extremity arterial stenosis scores (LEASS)

Ankle Edema Following Trauma or Surgery

Lower Extremity Injuries Due to Chainsaws

Intellectual Property and Royalty Payments Among Foot and Ankle Surgery Fellowship Faculty

Genu valgum & 'flat foot' but lateral deviation of STJ and low supination resistance??

Assessment and classification of upper and lower limb pain in athletes

Share This Page

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