My son won't walk

Ask a PT

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Posted - 02/19/2008 :  09:12:07  Show Profile  Reply with Quote
Our user asked: "My 6 year old son broke his tibia just after Christmas in wrestling practice. He is now out of the cast and his doctor says that he is ready to walk. His dad and I have been working with him, but he just won't walk. We've stretched his hamstrings and muscles on top and underneath the foot because he was complaining with tightness in those areas. He says that's better, but he still won't walk. I don't think that there is anything wrong with his muscles. We have had him lie on his back and push against us. He is as strong as an ox. He isn't complaining with any pain when we try to walk with him. He seems to want to walk, but will only do so if he can hold on to somebody or something. Even then, he walks humped over and with more of a step-scoot rather than a normal gait. Any ideas for helping him? Thanks."

Ask a PT Response: "This is not an uncommon occurence in children when they have sustained a lower extremity injury and have been placed in a cast. In most cases when casting is involved, the child will have a restriction status of non weight bearing (NWB). Because of this limitation, the child has to learn to adapt to this restriction so that he or she can maintain mobility. Essentially the child's neuromotor system for walking has been reprogrammed so that it can achieve maximal function while maintaining NWB. After the cast has been removed, the child essentially has to relearn how to walk again. The child will have to reprogram the neuromotor program that is involved for the task of walking which now involves doing so with full weight bearing through the involved lower extremity. This is often the most difficult part.

From what you mention, it sounds like your son is doing well. The cast is off, so I am assuming the fracture of the tibia has healed. You also mention that he has no pain, appears to be strong, and has improved his flexibility. If your son is not seeing a PT at this time, it may be a good idea to consult with one so that the PT can conduct a full evaluation to determine what his deficits are. This could lead to a faster recovery and more optimal functional performance. Based on what the PT finds, the PT will most likely break up the task of walking into parts and incorporate bearing weight through the involved lower extremity into various activities. Since the PT will be working with a child, the PT will have to come up with fun activities for the child which will entertain and maintain the child's attention while achieving the rehab goals. Activities which the PT could have the child perform could be scooting around on a stool, playing crab with posterior on floor and getting around on all fours (hands and feet) on the floor, tipsy toe walking or heel walking on both feet, squatting to squish a ball, kicking a ball while holding onto something, shooting in (simulating a wrestling take down), etc.. As far as walking, the PT may have the child train for walking by utilizing a wheeled walker or hand held assist. That way the child can hold on to something and train for gait while placing weight through the involved lower extremity. As the child becomes more adapted to ambulating and putting more weight through the involved lower extremity, the PT can wean the child away from the use of an assistive device or hand held assist. Time will play a big factor as far as progress for the child. The child needs the time to not only redevelop his or her neuromotor skills but obtain more confidence with walking as well. The above are just some examples of activities a PT could do for such a patient. It is probably in your son's best interest to be evaluated by a PT as this will yield a more specific treatment plan for your son. I hope this helps and I wish your son the best of luck for a full recovery."