Not Walking? Tiptoe Standing? Do Orthotics Help? Let’s See! 🧑🏻‍🦰🦶🏽 | Down Syndrome PT #114

👋🏽 Hi, I’m Amy Sturkey, a retired pediatric physical therapist with over 35 years of experience. Thank you again to this wonderful family for welcoming me back. In this session, I’m working with Everett 🧑🏻‍🦰, who has Down syndrome. Everett is now almost 3 years old. He was born almost two months premature, had corrective heart surgery, and has a G-tube. I first met him at 11½ months and have followed his progress as he grows stronger and more mobile. Everett can pull to stand, cruise along furniture, and lower himself back down. However, he is not yet walking independently. One thing we frequently see in standing is that he often rises up onto his tiptoes, especially when trying to stabilize himself. Today, I’m assessing how a pair of tall SMOs (supramalleolar orthotics) with a posterior calf pad affects Everett’s standing alignment and heel-down behavior. 🦶🏽 What We’re Assessing At the beginning of the video, Everett stands facing the couch without orthotics. You’ll notice: • Frequent tiptoe standing • Feet turning outward into a wide position • Difficulty maintaining upright alignment Sometimes children with low tone go up on tiptoes because they are searching for stability and pushing with everything they have. Next, we try a pair of Cascade DAFO high-wall SMOs paired with Billy shoes 👟. These orthotics: • Support the foot and ankle medially/laterally • Help reduce excessive rolling in or out • Include a higher posterior calf component that may discourage tiptoe standing ⏱️ Video Chapters 0:00 Meet Amy 👩🏼‍🦳 & Everett 🧑🏻‍🦰 0:25 Standing without orthotics 1:25 Looking at the SMOs 2:25 Putting on the orthotics & shoes 3:00 Standing assessment with orthotics 4:35 Heel-down standing improves 5:30 Clinical discussion about orthotics & low tone ⭐ What you’ll see • Tiptoe standing before orthotics • Feet turning outward in standing • Everett resisting assisted standing • Improved heel contact with orthotics on 🧠 Clinical note Everett often prefers to stand on *his* terms. 😄 During this session, he resisted assisted standing quite a bit once the orthotics were on, but I do not necessarily think that response was caused by the orthotics themselves. That behavior is also very consistent with Everett simply deciding when and how he wanted to participate. Once he returned to standing at the couch in his preferred way, I was able to observe more sustained heel-down standing behavior and somewhat improved alignment. 🌟 Why this matters Children 👶🏽👶🏻👶🏾 with Down syndrome and low tone often: • Use a wider standing base for stability • Rise onto tiptoes when working hard to stabilize • Struggle with foot and ankle alignment Orthotics may help: • Improve alignment • Encourage heel contact • Provide additional stability during standing and walking practice Research on orthotics in low tone is mixed. Some children benefit from additional support, while others also benefit from barefoot time and sensory input through the feet. *Uncertainty note: Responses to orthotics vary significantly from child to child. The observations in this video reflect Everett’s presentation during this specific session.* ⚠️ IMPORTANT These videos are for educational purposes only and are not a substitute for in-person pediatric physical therapy. It would be unethical for me to provide specific treatment recommendations without personally evaluating your child. 📬 Contact Email: amysturkey@gmail.com 📚 Books by Amy Sturkey (Amazon) “P is for Poop and Pee Accidents” https://www.amazon.com/dp/B0BLSRJ483 “A is for Anxiety” https://www.amazon.com/dp/B09LXQ3W6V “A is for Attention Deficit Hyperactivity Disorder” https://www.amazon.com/dp/B08QH9H5HR “C is for Cerebral Palsy” https://www.amazon.com/dp/B088TSJCYP “D is for Down Syndrome” https://www.amazon.com/dp/B079P8HH49 “A is for Autism” https://www.amazon.com/dp/B071F4FFTB 🧠 Professional PT Books Pediatric Physical Therapy Strengthening Exercises for the Hips https://www.amazon.com/dp/0998156736 Pediatric Physical Therapy Strengthening Exercises for the Knees https://www.amazon.com/dp/0998156760 Pediatric Physical Therapy Strengthening Exercises for the Ankles https://www.amazon.com/dp/B08TX2ZCFD 📺 Everett Playlist https://youtube.com/playlist?list=PLAkJbMrHyKjPqgM4rbEV8G1bMdC1Dyzaw