Toe walking is very common in children as they learn to walk. While many children outgrow the habit, persistent toe walking can itself lead to broader mobility issues, pain, and can be indicative of more serious issues. Toe walking can be a result of several diagnoses such as cerebral palsy, muscular dystrophy, hypotonia, autism, or other diseases of the nerves and muscles. It can also be idiopathic, meaning there is no formal diagnosis and/or the toe walking is from habit. Idiopathic toe walking can also have a genetic link in families. In any incidence, it is best to treat toe walking as early as possible.
It is very important to encourage children to walk with “flat feet” and address the cause of toe walking in order to limit the potential tightening of the heel cord. The heel cord is made up of the tendon from two different muscles found in the calf: the Soleus and Gastrocnemius. Children who toe walk often have tight heels cords due to overworking of the muscles and tendons. Tight heels cords can lead to multiple mobility problems such as frequent tripping and falling. Physical therapy can help treat toe walking with great success. During physical therapy, we focus on stretching the heel cord and associated muscles, balance, proprioception, overall leg strength, and gait training. Your physical therapist will give you exercises to do at home with your child and tips to help your child walk with the foot flat position as much as possible. It is common for children who toe walk to temporarily receive braces while undergoing physical therapy in order to help facilitate the feet’ flat position when walking and to help stretch the heel cord. Another intervention is called serial casting, where the child’s foot is placed in a hard cast in order to achieve and maintain a stretch for an extended period of time. Each week the cast is changed in order to continue to stretch and lengthen the tendon to improve the child’s ankle range of motion. Achilles tendon lengthening surgery is usually performed as a last resort. In cases where surgery is required physical therapy is typically recommended in order to maintain the new length of the tendon and to help strengthen the muscles. With early and persistent physical therapy the child can achieve an appropriate gait pattern and full ankle range of motion consistent with age-appropriate mobility.
If you think your child would benefit from physical therapy for toe walking, please contact Sensory Solutions, LLC to set up a time for an evaluation.
Katie Jaschek PT, DPT