Shortened Tendon

[Aengus]

I have a nephew, 6 , who was born with both Achiellies Tendons too short. He is forced to walk on his toes all the time because of it. He has had surgery to help lenghten the tendons and wears braces to help. This summer, he started shotokan karate and while it has helped lenghten his heels somewhat, he still has a hard time standing with his heels on the ground. My question is can warrior wellness help him or with him being young, should we just concentrate on stretching the hamstrings and calf muscles? I've been working with him some to keep him form getting discouraged but I can tell it is already having some affect on his self confidence.

Thanks

[JasonE]

Not being a health care professional, take my opinion with a spoonful of caution and get a second opinion.

I believe Warrior Wellness is beneficial as it will help him release tension and development balance and proprioception that will serve him well throughout his life. To some extent, the movements may promote the development of his tendons.

However, I believe that working on Bodyflow movements such as the various Squat positions will also be helpful. A simple long-term goal would be for him to do a good Flat Foot Squat. Simple, fun movements like frog-hopping (Quad Hops) and other movements in and out of the various squats will improve overall function and coordination without putting so much emotional focus on his particular issue.

Some controlled, supervised stretching should also be considered as part of an overall approach. This is where I think you really should look for a sports therapist for guidance. Your nephew is young enough to possibly achieve normal or near-normal tendon length, but you don't want to cause him other long-term problems in the process.

Good luck to you both.

[Jarlo Ilano]

Are they braces that he wears the whole day, or are they worn only while sleeping? Night splints provide a fairly comfortable low level stretching force, so that he can essentially be stretching all night as he sleeps. It is essentially a fixed brace (often with a wedge that can be slid beneath the ball of the foot) that keeps the ankle from plantarflexing during sleep. It's not too bad once you get used to it. I wore it for some weeks for my plantar fasciitis problems. There is another fancier deal, called a Dynasplint. A metal brace with hyrdraulics. The advantage is debatable.

Have their been any further recommendations from his physicians? Please consult them further if possible. They could recommend other options. If they do not, be assured that stretching and working it on your own is most likely not harmful.

However you may want to consider discussing more about how the condition is making him feel. Find a way for him to deal with it better, as it resolves. Because it will be awhile before it is "normal".

I've worked with some of these kids before. To some its no big deal, to others....

If you have any more questions, please ask.

(I am a Physical Therapist, by the way.)

[Aengus]

Jarlo,
I talk to my sister-iin-law last night at Class and she said that the Docs want to do surgery again and that is will only get worse as he gets older.
Found out that he has a muscular disease call Charcot-Marie-Tooth. It's hererditary and runs in my family. Good thing is either you have or you don't. Looks like it got passed down through my brother unfortunatly. The disease is a degenerative muscular disease that as far as I can tell, causes the nerves to slow on their firing or stop firing altogether so the muscle is not getting stimulation. This causes atropy and also causes the muscle to start to draw up. My Dad has it and when they tested him, they would probe him with an ecletrode and see how much the muscle would contract. They stopped when they got to Dad's calf. that was the first place the muscle would fire at what I gues was an acceptable value.

Needless to say that if my nephew is afflicted with this, he gonna have a long hard work ahead of him. His mom said he stretches everynight. I'll mention the nightsplints to her. I've heard of them and friends of mine said they worked wonders. I just don't want the little guy to have to be cut on any more.

Thanks

[JasonE]

I'm sorry to hear this information. :( It certainly changes the long-term picture, though the short-term situation remains the same.

Even if your nephew never achieves normal tendon length, he might still surprise you all.

When I went to my very first taekwondo lesson many years ago, I was partnered with a kid about 5 years younger than me. We did a bunch of drills, and he was way better than most of the kids. For that matter, he was much better than most of the kids and adults ranked higher than he was.

Near the end of the class, we did partner stretches and I was shocked to learn that he had absolutely no toes on one of his feet. This was almost incomprehensible to me at the time, but there it was: a toeless foot. From watching him perform, you'd never have guessed. As I've learned more about the body, the kid's balance and control become ever more amazing to me.

Help your nephew as best you can, and he will probably amaze you too. :)

[Jarlo Ilano]

Dale,

Sorry to hear about your nephew. It looks like there is a long road ahead, with a lot of difficult choices to make. In this type of situation, you will need to consider both your personal feelings and the recommendations of the physicians. It will be hard to be objective when you think about your nephew going under the knife again (and perhaps again). So, a frank discussion over the risks vs. benefits, needs to be had everytime something major like surgery comes up.

You may wish to ask if they feel the condition would worsen if you gave the nightsplints and stretching regimen a trial first, before surgical intervention.

It sounds like you will be a great support for your nephew and his parents. They will need it, and I'm sure they appreciate it greatly.

I apologize that I cannot help more. Unfortunately, I don't have specific experience with this condition. But much like others with muscle degeneration conditions, the therapy involves stabilizing his joints as much as possible, while allowing as much free movement as possible.

Here is a blurb from the NIH. http://www.ninds.nih.gov/health_and_medical/pubs/CMT.htm


How is Charcot-Marie-Tooth disease treated?

There is no cure for CMT, but physical therapy, occupational therapy, braces and other orthopedic devices, and even orthopedic surgery can help patients cope with the disabling symptoms of the disease.

Physical and occupational therapy, the preferred treatment for CMT, involves muscle strength training, muscle and ligament stretching, stamina training, and moderate aerobic exercise. Most therapists recommend a specialized treatment program designed with the approval of the patient's physician to fit individual abilities and needs. Therapists also suggest entering into a treatment program early; muscle strengthening may delay or reduce muscle atrophy, so strength training is most useful if it begins before nerve degeneration and muscle weakness progress to the point of disability.

Stretching may prevent or reduce joint deformities that result from uneven muscle pull on bones. Exercises to help build stamina or increase endurance will help prevent the fatigue that results from performing everyday activities that require strength and mobility. Moderate aerobic activity can help to maintain cardiovascular fitness and overall health. Most therapists recommend low-impact or no-impact exercises, such as biking or swimming, rather than activities such as walking or jogging, which may put stress on fragile muscles and joints.

Many CMT patients require ankle braces and other orthopedic devices to maintain everyday mobility and prevent injury. Ankle braces can help prevent ankle sprains by providing support and stability during activities such as walking or climbing stairs. High-top shoes or boots can also give the patient support for weak ankles. Thumb splints can help with hand weakness and loss of fine motor skills. Assistive devices should be used before disability sets in because the devices may prevent muscle strain and reduce muscle weakening. Some CMT patients may decide to have orthopedic surgery to reverse foot and joint deformities.


I can ask my good friend if you'd like. She is a pediatric therapist in Washington State. I'm sure she would be more familiar with this.

Let us know how it is going, and if we can offer anything.

Best wishes to your family.