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Hypotonia

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What Is Hypotonia?
Symptoms
Risk Factors
Diagnosis
Treatment
FAQs

Better known as having low muscle tone, hypotonia is a state in which your muscles have reduced their resistance to passive movements, making them more “floppy”. Rather than being a disease in itself, hypotonia is most 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, when we see hypotonia affecting the feet and legs, it can have significant impacts on a person’s independence, mobility and quality of life. Hypotonia can develop in both adults and children, as early as infancy, with some causes of hypotonia being present from birth. 

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 and effectively maintaining your posture. In hypotonia, the muscle fibres do not overlap in the same way, and more force and energy is needed to move your muscles (and therefore your body). This means that people with hypotonia often struggle with limited muscle weakness and reduced strength. There may also be problems in the transmission of signals from the brain to the nerves which tell the muscles when to contract, and by how much.

Signs And Symptoms Of Hypotonia

The primary symptom of hypotonia is reduced muscle tone, which may present differently at different stages of life. Signs of hypotonia may include:

• Floppiness, limpness or a “rag doll” appearance 
  
• Poor muscle strength and weakness
  
• Reduced resistance to passive movements
  
• Balance and coordination issues
  
• Joint hypermobility
  
• Flat foot posture
  
• Tiring quickly, as muscles must work harder to perform regular movements
  
• Poor reflexes, as it takes the muscles longer to react and move 
  
• Breathing or speech difficulties 
  
• Swallowing difficulties
  

In infants and young children, additional signs of hypotonia may include having little or no head control, as well as having delays in reaching physical milestones like sitting, crawling and walking, or grasping food or toys. Hypotonia in babies is often referred to as “floppy baby syndrome”.

Risk Factors: What Causes Hypotonia?

Hypotonia can be caused by damage to the brain, spinal cord, nerves, or muscles. This damage can be the result of injury, illness, environmental factors, or genetic, muscle, or central nervous system disorders. This can be broken down into:

• Genetic conditions: many genetic disorders are associated with hypotonia, such as Down syndrome, Prader-Willi syndrome, muscular dystrophy, and some forms of cerebral palsy.
  
• Central nervous system disorders: conditions affecting the brain or spinal cord, such as brain malformations, brain injuries, spinal cord compression, or infections, can result in hypotonia.
  
• Metabolic disorders: certain metabolic conditions, such as mitochondrial diseases or lysosomal storage disorders, can contribute to hypotonia.
  
• Neuromuscular disorders: diseases that affect the nerves or muscles, including spinal muscular atrophy, myasthenia gravis, or neuropathies, may cause hypotonia.
  

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

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.

Treating Hypotonia

It may be 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:

• Surestep SMO: the Surestep supramalleolar orthoses (SMO) has revolutionised the way that our clinic is able to manage and care for children with low muscle tone. Being a custom orthotic device that covers the foot and ankle, Surestep compresses the soft tissues of the feet with a patented design that offers significant stability and support. In its function, it is also not restrictive, so it does not interfere with a child’s natural development. The Surestep SMO can be worn as early as when children start to bear weight and cruise around the home. Together with the right Surestep footwear, it sets children up for success and enables them to have a new level of mobility and independence.
  
• Physical therapy (stretching and strengthening):  a gentle physical therapy programme that’s tailored to the person’s current symptoms and strength may be used, being careful not to overload muscles and instead incorporating useful, practical movements that are completed on a daily basis.
  
• Other ankle foot orthotics (AFO’s) or custom braces to help maintain a good alignment of the foot and ankle and promote stability and mobility, particularly for use in adults. We prescribe innovative, custom-designed braces like the Exo-brace to help with issues related to hypotonia like foot drop and ankle instability.
  
• 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. Custom foot orthotics are typically used in those with a milder form of hypotonia that do not need the same level of support and control at the ankle.
  
• 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
  
• Timely referrals: when working with patients with hypotonia, we often work collaboratively with other health professionals including occupational therapists and speech and language therapists, among others. If we identify an issue that you are not currently receiving care for, we ensure to refer you appropriately so you can continue to get the best care outcomes.
  

• Surgery: in severe cases of hypotonia, surgical interventions may be required to assist patients who have spinal deformities that significantly affect their quality of life, or experience frequent dislocations, joint weakness and slipping or subluxations.