Originally Posted by Bug
I don't think you can rule out Aspgers having an effect on the tib ant. If she toe walks in times of anxiety or excitement then that muscle won't be as strong due to the adopted gait pattern. She may also have an increased foot slap due to a decreased proprioceptive feedback which will change the way muscles fire.
Glad to see your comments on this Cylie, thank you.
For my two bobs worth I agree with Cylie's comments above. I see it everyday with Aspergers kids, and their toe walking is very much more resistant to the types treatment we treat our non austistic spectrum disorder (ASD) kids with. Cylie is the one to comment more on this. The ASD toe walkers especially will toe walk in a state of heightened emotion as mentioned above, I've seen this lifelong in ASD patients. ASD toe walkers are typically persistant toe walkers for a lot lot longer (possible lifelong) than any other persistant toe walking group. I think it essential to retrain tib ant in the rehab of any toe walker to introduce proper patterning of tib ant activity in gait, even more so in ASD patients due to the long-term persistance.
My other comment is on sensory stimulation. It is a very strong feature of ASD to have some form of sensory processing difficulty and if this is never addressed then the patterning will persist. I suspect that it is primarily for sensory reasons that people on the autstic spectrum toe walk. Once adequate ankle dorsiflexion is acheived (stretching/serial casting), then clinically we see them come down after a series of joint compressions and/or tubi grip almost immediately. This effect only lasts a few hours though. Cylie, I'd love to hear yours and Brett's perspective on this?
Thirdly, plantar fasciitis would not be unusual in a gait that has weak tib ant, I see it too in young dancers who walk in a dainty, very slight toe-heel gait, as shock is not being attenuated by the mechanisms designed for it, namely heel strick and STJ pronation. By strengthening tib ant and re-training it's firing patterns to create a heel-toe gait pattern will help. Must address sensory feedback needs too (since they're proabably the underlying cause for the patterning anyway - try a sensory trained OT) and it should help enormously.
Good luck, nice to see you thinking outside the box