Toe Walking & Tactile Input | Textured Insoles as A Treatment Option?

Walking on the toes as a child may be considered a normal phase of learning to walk, however in the child past 3 years old the absence of heel contact at initial contact is not normal.

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7% of children present with toe walking past the age of 3

According to Williams et al. (2010) an average 7% of children present with a toe walking gait.  Any child walking on their toes should be assessed for medical causes of the gait pattern.

Some of the most common causes of toe walking include:

  • Equinus (structural limitation is ankle dorsiflexion)

  • Upper motor neuron trauma (cerebral palsy)

  • Neurogenic factors (autism)

But what if all of the above possible causes are ruled out?

What could be the driver of the toe walking?

This is where the diagnosis idiopathic toe walking (ITW) comes into play.    ITW means there is no known cause for the child’s gait pattern and absence of heel strike at initial contact.

Treatment Options for Toe Walking

If there is no known cause for a child’s toe walking it makes treatment options difficult. For ITW, most practitioners focus on ankle mobility as the most addressable option.

This means treatment options for these children include:

  • Physical therapy and manual release work

  • Stretching and night splints

  • Botox injections to calves

  • Achilles tendon lengthening

All of these treatment options have downsides including skin irritation, compliancy and invasive risks of infection and scarring.    Specialists are now looking for new treatment options for these children.  Treatment options that are simple, non-invasive and will have increased compliancy.

New Treatment Options for ITW

Researcher Dr Cylie Williams of Monash University in Australia has been exploring new treatment options that look specifically at the tactile input in these children.   It is proposed that by changing tactile input through the feet, one could change the neurological input and potentially influence the gait pattern.

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Whole body vibration can potentially offer a short term benefit to toe walking children.

Dr Williams’ initial exploration into this topic was related to whole body vibration (WBV).   In her prior research she has noted varying vibration threshold in children who are idiopathic toe walkers and those with a normal heel toe gait.   The benefits of WBV are promising to this pediatric population however the only downside is that the effect is short term, temporary and requires a WBV platform such as Power Plate.

Dr Williams is seeking new tactile stimulation methods and has turned to Naboso Neuro Insoles.   Starting early 2019 Dr Williams will be researching the effects of Naboso Insoles as a simple, non-invasive intervention for ITW.

Sensory Seeking Children

As the inventor of Naboso Technology and our sensory products, my interest is of course in those children who are sensory seeking and the possible role the Naboso Insoles and Mats can have on the behavior and movement patterns in these children.

Lane et al. (2009) has identified three main types of sensory processing disorders in children with autism:

  • Sensory sensitive (covering ears to loud noises, restricted food preferences)

  • Sensory under-responsive (failure to react to pain)

  • Sensory seeking (rocking, hand flapping, noise-making

Due to the correlation between autism, sensory processing disorders and toe walking the possible application of Naboso for these children is exciting.    As the research around ITW and tactile input continues to be explored we will hopefully have new data to share on this topic.

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Naboso Children’s Insoles provide tactile input for the sensory seeking toe walking child.

In the mean time we encourage any professional working with ITW children to consider the possible role of Naboso Children’s Insoles and our Naboso Textured Mats.

In health,

Dr Emily Splichal, DPM, MS 

Citations:

Lane, Alison et al. (2009) Sensory Processing Subtypes in Autism. J Dev Autism Disorder 40: 112 – 122.

Williams, Cylie et al. (2010) Idiopathic Toe Walking and Sensory Processing Disorder. J Foot and Ankle Res  3: 16

Graduated Stimulation of the Naboso Insoles

One of the most common questions we get asked is - what is the difference between the Naboso 1.0, 1.5 and Neuro Insoles?

To help you get the most out of our graduated stimulus in the Naboso Insoles we created this quick go-to guide to find YOUR best Naboso™ stimulus level. 

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The Naboso™ Experience

All Naboso™ Insoles features a unique, proprietary textural design that is based on the science of the skin on the bottom of the feet.  Packed with special nerves that are sensitive to different stimulation, the feet are designed to continuously read our environment.  

The Naboso™ Insole reconnects you to your foundation by very specifically stimulating these nerves.   Users can expect to feel their feet in a whole new way!  

From decreased foot fatigue and pain to improved posture and joint stability - the benefits of Naboso™ Insoles far exceed that of just the foot.  

The Graduated Stimulus 

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The Graduated Stimulus

Our graduated stimulus provides each customer with a unique experience based on their needs and foot sensitivity. 

If you are new to foot stimulation and consider your feet sensitive then we recommend starting with our Naboso 1.0 (yellow box). For optimal stimulation of the feet with the 1.0 we recommend wearing these insoles barefoot.

If you are active and want to run or workout in the Naboso™ Insoles we recommend turning up the volume of the stimulus to our Naboso 1.5 (red box). For optimal stimulation with the 1.5 we recommend wearing these insoles barefoot or with thin socks.

Finally, if you stand long hours, are used to barefoot stimulation or have a chronic neurological condition such as MS, Parkinson's or neuropathy then we suggest using our Naboso Neuro Insoles (blue box). For optimal stimulation with the Neuro we recommend wearing these insoles barefoot or with thin socks.

Enhancing Sensory Stimulation to Improve Balance in Multiple Sclerosis

Balance impairment is a common symptom in patients living with Multiple Sclerosis.   From an increased fall risk to reduced independence, compromised dynamic stability can place a heavy emotional burden on these individuals.

When developing a balance and fall reduction program for MS clients, research has shown that approaching it from a sensory perspective is the most effective.

Below are the top three sensory stimulation pathways that can be used to optimize balance and stability in your MS clients.

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Sensory Gateway #1

Visual System

According to the Multiple Sclerosis Society, vision problems are some of the most common symptoms associated with MS.  The most common eye complications include optic neuritis, diplopia, nystagmus and internuclear ophthalmoplegia.

Our eyes are designed to move and accommodate for light, providing us with as much sensory detail about our environment as possible.  A decrease in visual acuity has been associated with impaired balance and delayed accuracy in motor patterns.

A 2018 study by Herbert et al. demonstrated the efficacy in the integration of eye movement exercises and visual stimulation in improving balance for those with MS.    The study that focused on the BEEMS (balance and eye motion exercises for MS) integrated the following exercises for improved sensory integration and brain balancing.

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Sensory Gateway #2

Vestibular System

The first sensory system to develop after conception is the vestibular system.  Often referred to as the gateway to the brain, the vestibular system is critical in how our brain and body relates to gravity.

In MS, vestibular disturbances typically present as vertigo, balance disorders, and the presence of nystagmus (rapid involuntary movements of the eyes).  When considering the implications of vestibular disturbances it is important to understand if the cause is related to disturbances in the peripheral vs central vestibular system.

The vestibular system can be divided into two main systems: the central system (the brain and brainstem) and the peripheral system (the inner ear and the pathways to the brainstem).   A 2008 study by Zeigelboim et al. found that vestibular disturbances related to MS were disruptions in the peripheral system, with a higher prevalence in female patients.

The following exercises are recommended to address the vestibular disturbances associated with MS.   You will notice that many of these exercises also integrate the visual system, as all of our sensory systems a linked in function with one input system enhancing the other.

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Sensory Gateway #3

Proprioceptive Touch System

The final sensory system is one that is quite familiar to those who follow EBFA Global’s work and allows us to tap into the homunculus of the motor cortex.

Our hands and feet are some the most sensitive sensory gateways of the human body and allow us to connect vision with an exteroceptive world.   Neuropathies and disruptions in peripheral proprioceptive and vibratory input are often associated with MS and should be addressed before symptoms present.

The skin on the plantar foot and palmar hand contain four main mechanoceptors:

SAI – two-point discrimination & texture

SAII – skin stretch

FAI – low-frequency vibration

FAII – high-frequency vibration

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Sensory Stimulation

Balance & Fall Reduction Program for Multiple Sclerosis

The following exercises integrate visual, vestibular and touch sensory stimulation into every exercise.   All of the exercises can be progressed from seated to standing to legs crossed and tandem to single leg stance.

Equipment needed:   Naboso Barefoot Mat, Ball (Textured), Card

To learn more about the sensory input systems and how they relate to brain, body and balance please visit:   www.ebfaglobal.com or www.nabosotechnology.com

Dr Emily Splichal

 

Beyond Biomechanics | Addressing Foot Pain with Sensory Stimulation

When I teach on behalf of EBFA Global or speak to my patients I always emphasize that there are two sides to foot function (and dysfunction) – biomechanical and neuromuscular.    Now both play and important role in foot function which means that both must be appreciated - however to solely treat foot pain with just one belief system in mind is inherently flawed.

In most Podiatric Medical Schools we are taught foot function and foot pathology solely from a biomechanical perspective.   This means that every patient is tested for foot mobility and told to stand statically to determine arch height and foot type.   Based on this foot-focused biomechanical assessment and foot classification system the patient cause of injury and treatment protocol is determined.   Some of the favorite treatment recommendations include motion-controlled footwear and custom-posted orthotic both of which are prescribed with the hopes of controlling foot-focused biomechanics and thereby reducing their foot pain.

How "tuned in" is your nervous system? Advances in barefoot science.

With the foot as the only contact point between the body and the ground - much of this “noise” enters our nervous system through the feet.   If this foot “noise” is tuned out or unable to be sensed by the nervous system inaccurate movement patterns and delayed time to stabilization (i.e. injury) is the result.

One of the biggest causes or reasons for the inability to sense the essential noise of human movement is footwear.   Thick, cushioned, supportive footwear with smooth insoles completely “tunes out” the foot during dynamic movement.

The Evolution of Touch, Emotion and Barefoot Science

Touch is a powerful input system that 1.  allows us to navigate and manipulate our environment (i.e. feeling the sharpness of rocks under our feet cues us to walk slower) and 2. allows others to navigate and manipulate our environment (i.e. feeling someone grabbing you strongly warns you of a possible attack).

Now when it comes to evolution – touch is no different.   The art of touch has gone from simply survival (is this a threat or not) to more finite and discriminative.  This higher processing of touch refers to both the hands and feet - allows us to coordinate complex tasks such as micro-dissection surgery to the ability to read braille.

Advancing the Science of Proprioceptive Insoles

Imagine experiencing the same proprioceptive stimulation and neuromuscular control you do barefoot - but in your shoes!

The concept of enhanced neuromuscular control in footwear was first introduced by the advance in minimal footwear.   From Vibram FiveFingers to VivoBarefoot shoe companies and footwear are now allowing more and more natural foot function than ever before.