Tippy-Toe-Tanner evaluation

Well, today (Kinsey's birthday) was Tanner's physical therapy evaluation as set up by his pediatrician. At his 2 year visit, she and I both were concerned about the tippy-toe walking now that he is still doing it past two years old. The texture, nor temperature of the surface have ever mattered, so this was a concern. He walks this way 90% of the time, and anything over 50% it a problem in their eyes.

Overall, it could have been worse. He does not have any cerebral palsy indicators, as we all knew, nor autistic signs. Both are associated in some way with premature birth and tippy-toe walking. She does not foresee and serial stretching, overnight braces, or surgeries at this point. He was asked to do several tasks, such as squat, jump, run, walk slowly, and then generally play with different toys of the therapist's choice. He had a difficult time with squatting...infact had to manually be forced to do it with heels on the floor. As I think about it, Tanner usually just sits down or sits in a W-position rather than squatting. This was a negative. Then, he was asked to jump, which he didn't really display well during the visit, but I have seen him do off the couch at home! Since he was unable to jump and keep his balance after jumping, this was also a negative. He then had to lie on the floor, on his belly, and she measured his calf muscles and their attachment to the Achilles tendon. She literally wrote on his legs with a ball point pen and then then did some calculations. She also did some reflex testing and pressing on his feet. He was really good for all of the manipulations, only requesting the BIG ball that was out of his reach about 20 times. haha

Ultimately, with insurance covering 90% since we haven't met our deductible, we came out of the appointment with some strategies, and the directive to purchase high top shoes that will be altered with taller heels. The alteration is at a $47 value! Since he has not learned to put his body weight on his heels for over a year now, his calf muscles have developed incorrectly. His left calf muscle is even shorter than the right. She said his calves were "mildly tight" and that she shouldn't feel the 1st resist of his foot until 10 degrees with his toe up and ankle bent. Well, she felt it at 0 degrees with the left and at 5 degrees with the right foot. His muscles will continue to develop incorrectly if nothing is done about it. So, we have three strategies for home therapy.

1. calf stretches as per the handout received 2x per day for up to 30 seconds each time, with knee bent and knee straight.
2. hold him in a squatting position in order to stretch the tendon and muscle with a 3-4inch object under him once per day
3. rub the bottom of his feet with a washcloth after bath 10x each foot once per day with pretty strong pressure to desensitize his feet (he doesn't care for having his feet touched)

We went to Sears after his appointment and purchased some Chuck Taylor's, or Converse high tops. He wore them around at Mimi's some today. Those are the shoes that we will pay to have altered. Afterwards, it is my understanding that it will look like a wedge-type shoe or high heel. He is to wear these shoes for a minimum of six hours per day, preferably a couple hours in the morning, afternoon, and evening. Every week, he will have to go back in and be re-evaluated and hopefully get a section of the heel chopped off. This will bring his heel closer to the floor each week and force him to put his own body weight on his heel for balance. It should also stretch his plantarflexor, or heel cord, which will allow his calf muscles to extend properly.

He didn't realize anything was wrong and seemed to enjoy his appointment, and especially liked his therapist, Jean. On the way there, we told him he was going to the doctor's office, but he would get to play a lot. He looked very serious, and then in quite the sad voice he said, "I don't want doctor...I don't want shots." hahaha cute....boy, he's a thinker! What a memory!

I sure hope all of this works and allows him to develop appropriately with no discomfort! It may be hard on us somewhat, and Amy (his babysitter), but it's the best thing for Tanner and that's what matters!