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Hi All,

I'm looking for some advice regarding this child. I have not actually seen this child
in clinic yet but her mum ( a friend) has rang with great concern for her 15 month old girl.
She walked when she was 11 mths old (has been walking for 4 mths), but will not let her right heel touch the ground.
She wore prewalkers for about the first month of walking but will no longer wear shoes.
She walks a heel-toe gait on the left but toe walks on the right.
Pregnancy was normal, caesarean birth.
Has a sister with no anomalies.
I have asked her mum to palpate around the heel area and I've got the feedback that her 15 month old will not let this occur, pulls foot away.
Her mum intends to bring the child for assessment this week, I have never seen a child this young so any advice and guidance would be welcome.

Cheers,
Curly

 

I've had a few come through, commonly with either a missed TEV or in one case a true calcaneo-equnis, born with an equinus. However with uni there is also cases out there of tumours in gastrocs, tethered cord (spina bifida), fractures that have healed wrong, rarely neuro but possible in the case of Hemiplegia but then the contact with the other foot could be subtle, so check when she tries to run or squat.

Basically, you will need to do a good birth history, making sure you check normal birth weight/delivery/term etc then a good neuro work up and x-rays.

Check if she is actually able to get her foot to the ground and has she ever, if the height increases? During ROM testing is there an increase in tone or a catch? Reflexes also. On x-ray you want weight bearing or simulated weightbearing (where the child sits and they push with a board against the foot so you get it as close to 90 as you can. Get an AP and lat and you want to check mainly for the kite angle.

Then you will know the right discipline to refer her to - ortho or neuro as she will need to go to one for either surgery/casting or botox/casting.
Where are you located and we might be able to point you in the right direction?

Good luck!

 

Hi Kylie,

Thanks for the advice, there is certainly lots of direction in your post.
All I have to do now is wait for her Mum to bring her to clinic.
I'm located in Sydney.
Cheers again,

Curly

 

Your welcome.

Other option is to refer off to the Westmead. While they don't have pod's on staff the paed physio's that I have chatted with are great. That way, they can also get her into a cast or for further medical opinion if needed. I'm not sure in NSW if you can refer in or if you need the GP. I know in Vic we can.