Hypotonia is a medical term used to describe poor or decreased muscle tone, and it’s sometimes also known as floppy muscle syndrome. Rather than being a disease in itself, hypotonia is often a symptom of an underlying condition.

What Is Hypotonia?

Hypotonia roughly translates to “lowered muscle tone and muscle tension”. As healthy muscle tone is what enables us to move, control our posture, walk, and carry out everyday tasks, hypotonia that affects the feet and legs can have significant impacts on a person’s independence, mobility and quality of life. 

In healthy individuals, the fibres of a muscle overlap in a way that they can easily pull on one another and contract the muscle when required, moving your body in the way you need. In hypotonia, the muscle fibres do not overlap in the same way, and more force and energy is needed to move the muscle. This means that people with hypotonia often struggle with weakened muscles and reduced strength. There may also be problems between the signals that travel from the brain to the nerves which tell the muscles when to contract, and by how much.

Symptoms Of Hypotonia

Hypotonia can affect people at any age, and it affects people differently at different stages of life.

Signs of hypotonia in babies and children may include:

  • A floppy or “rag doll” appearance 
  • Flat foot posture
  • Breathing or speech difficulties 
  • Loose or flexible joints and ligaments 
  • Little or no head control
  • Have delays in reaching physical milestones like sitting, crawling and walking, or grasping food or toys

Signs of hypotonia at any age may include:

  • Decreased muscle tone and strength
  • Poor reflexes, as it takes the muscles longer to react and move 
  • Flat foot posture
  • High levels of flexibility or joint dislocations
  • Tiring quickly, as muscles must work harder to perform regular movements
  • Poor posture

Risk Factors: What Causes Hypotonia?

Hypotonia can be caused by damage to the brain, spinal cord, nerves, or muscles, and this damage can be the result of injury, illness, environmental factors, or genetic, muscle, or central nervous system disorders, including:  

  • Down syndrome
  • Margan’s syndrome
  • Muscular dystrophy
  • Cerebral palsy
  • Trisomy 13
  • Prader-Willi syndrome
  • Myotonic dystrophy
  • Tay-Sachs disease
  • Spinal cord injuries
  • Severe infections such as botulism
  • Brain damage
  • Contact with poisons or toxins

Sometimes, children are born with hypotonia that isn’t related to any condition, which is called benign congenital hypotonia. In other cases, a cause for hypotonia is a mystery, and cannot be identified. 


Diagnosing hypotonia usually involves an assessment which looks at motor and sensory skills, balance and coordination, reflexes, and nerves. Diagnostic tests that may be helpful include a CT or MRI scan of the brain, as well as nerve conduction tests and measuring electrical activity in the brain.

Once an accurate diagnosis has been made, medical specialists including podiatrists can address a person’s unique symptoms, and create a tailored treatment plan to relieve symptoms and help patients to achieve their movement, mobility and independence goals, and live the life they love.

How To Treat Hypotonia

It’s reassuring to know that not all cases of hypotonia require treatment - some premature babies who are born with hypotonia may recover by themselves as they grow. In other cases, managing hypotonia depends on the underlying cause, and can involve a wide range of strategies:

Non-Surgical Treatment 

  • A gentle physical therapy programme that’s tailored to the person’s current symptoms and strength, being careful not to overload muscles and instead incorporating useful, practical movements that are completed on a daily basis, such as getting dressed.
  • Surestep SMO the Surestep supramalleolar orthoses (SMO) is a revolutionary treatment for children with low muscle tone. Together with the right Surestep footwear, it sets children up for success and enables them to have a new level of mobility and independence. 
  • Ankle foot orthotics (AFO’s) or custom braces to help maintain a good alignment of the foot and ankle and promote stability and mobility. We prescribe innovative, custom-designed braces like the Exo-brace to help with foot drop and ankle stability.
  • Custom foot orthotics to help support the feet, improve stability, promote gait and accommodate any weakened foot muscles inside the shoe to give greater control
  • Footwear modifications to best accommodate your current symptoms and improve stability and comfort in your existing shoes
  • Skin and nail care to manage any painful skin or nail conditions like corns, calluses and ingrown toenails that may arise from a poor gait pattern due to flexible knees, hips and ankles and weakened leg muscles

When working with patients with hypotonia, podiatrists often work collaboratively with other health professionals including occupational therapists and speech and language therapists, among others.

Surgical Treatment

In severe cases, surgical interventions may be required to assist patients who: 

  • Have spinal deformities that significantly affect their quality of life 

Experience frequent dislocations, joint weakness and slipping or subluxations


What is muscle tone?

Understanding muscle tone is crucial for understanding hypotonia. Muscle tone is the amount of tension in a muscle when it’s at rest. Muscle tone at rest is a very different concept from muscle strength - muscle tone is passive, and denotes your natural muscle tension when you’re resting and not engaging the muscle.

Are people with hypotonia more likely to develop foot pain?

Yes they can be. This is because they tend to have a naturally flatter foot posture, and their muscles have to work much harder to take each step and perform their regular movements. This can lead to pain and overuse, while creating other compensations in the feet and legs.

What is the outlook for children with hypotonia - will they walk, run or play sports?

Every case is different so we cannot say for 100% certainty, but many children with hypotonia do walk - even if it’s a little later and there are some detours along the way. We work with every person in the exact stage they’re at to help support them for the best outcomes for the future.

Are you a registered NDIS provider?

Absolutely. Under NDIS we can offer you a range of devices such as custom foot orthotics, AFOs and custom braces under the assistive technology support. For many people, this greatly improves their mobility, independence and quality of life.


Monday 7:30am - 6:30pm
Tuesday 7:30am - 6:00pm
Wednesday 7:30am - 6:30pm
7:30am - 6:00pm
Saturday CLOSED

Ground Floor, 344 Queen Street,
Brisbane City QLD 4000



Monday 7:30am - 6:00pm
Tuesday 7:30am - 6:00pm
Wednesday 7:30am - 6:00pm
7:30am - 6:30pm
Friday 7:30am - 5:30pm
Saturday 7:30am - 4:30pm

Newmarket Village, 114/400 Newmarket Rd, Newmarket QLD 4051