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I found a newsletter on their website talking about the concept of low tone pronation: Low Tone Pronation
Quote:
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.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
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!
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?
Low tone pronation
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