All children will
experiment by walking on their “tippy toes” at some point during
development. So when then does this
playful experiment become something that should be looked into a little
further? Most experts will recommend
that if your child spends >25% of their walking time up on their toes and
are over the age of two they should be evaluated by a physician.
Toe
walking can occur for many reasons, and a thorough exam should be performed to
determine the cause and prescribe the most appropriate treatment. Your
physician should first rule out any serious neuromuscular or orthopedic
problems such as: cerebral palsy, injuries to the spinal cord, or paralytic
muscle diseases including muscular dystrophy, that could be causing this tip
toe walking pattern.
Idiopathic
toe walking is only diagnosed when your child demonstrates a persistent tip toe
walking pattern, and all potential neurologic, orthopedic and psychiatric
causes have been completely ruled out. This term implies that the toe walking
occurs in an otherwise healthy child and that there is no disease or
dysfunction creating the abnormal walking pattern. It is estimated that idiopathic toe walking
occurs in up to 24% of children, and that there is a family history of toe
walking in 30-71% of children diagnosed.
Studies
show that occasionally this diagnosis can be tied to language delays and
learning disabilities. If you begin to
notice any delays in your child’s ability to learn, communicate, or interact socially, requesting a developmental assessment from your physician
may be appropriate. A child with
idiopathic toe walking may also have some form of a sensory processing
dysfunction. This means that your child
may walk on his/her toes due to a hyper or hyposensitivity in their feet. Your child may not like the feeling of
different surfaces on their bare feet, causing them to rise up on their toes to
decrease the amount of contact their feet have with the floor. In this case, requesting a sensory
profile/assessment may be appropriate.
Idiopathic
toe walking first appears when the child learns how to walk. Often the child can walk flatfooted when
asked to do so, but quickly returns to the tip toe pattern as their preferred
method of movement. Over time, walking
in this position will result in tightness of the calf muscles and limited
motion of the ankle/foot. The longer the child walks in this position, the
greater the loss of motion. This not
only places your child at an increased risk for ankle injuries as a child, but
is also statistically tied to increased foot pain and pathology as an
adult. If the calf tightness is not
addressed early on, it can develop into a “muscle contracture”. This is when the muscle becomes physically shortened
after being too tight for too long and can no longer be stretched out by
conservative means.
Early
identification and treatment of children with idiopathic toe walking is needed
to prevent the development of calf tightness, limited motion of the ankle, and
development of permanent abnormalities in how they walk. Physical therapy is generally recommended to
address calf tightness, leg weakness, balance deficits, provide sensory
feedback and assess the need for orthotics.
When started early on, therapy has proven to be successful in correcting
toe walking. Older children with
idiopathic toe walking may not respond as well to physical therapy and may also
require a series of casts or night splints to help correct the problem. In severe cases, such as the development of
contractures, the use of botox injections or surgical intervention to help
lengthen the muscle tendons may be recommended.
For more information about this topic and others, contact your local physician or
physical therapist.
Physical Therapy Quick Tips:
·
Daily passive stretching for the calf
and hamstring muscles is recommended frequently throughout the day
·
Proper shoes are a must! Lace up tennis shoes will give your child
feedback about where their feet are and provide additional support for their
ankles, making it easier to walk with flat feet
o
Squeaky shoes may be helpful. These shoes make a sound only when your child
walks with his/her feet flat on the floor providing them with a squeaky sound
to encourage correct walking (Caution to parents: you will want to do this in
conjunction with the other tips as this sound may get a little too much too
handle on a long day)
·
Take time to SLOW DOWN and LOWER DOWN:
Your child’s little legs sometimes have a hard time keeping up with your pace,
causing them to rise up on their toes.
When this is combined with trying to hold your hand—which may be a big
stretch to reach for, it may be difficult to walk flat footed. Take the time to lower your hand and slow
your pace to help encourage a proper walking pattern
References:
1. Le Cras S, Bouck J, Brausch S, Taylor-Hass A; Cincinnati Children's Hospital Medical Center: Evidence-based clinical care guideline for Management of Idiopathic Toe Walking, Guideline 040, pages 1-17, February 15, 2011.
2.Eiff M, Steimer E; What is the appropriate evaluation and treatment of children who are toe walkers? The Journal of Family Practice. 2205; 55(5):1-3.
3. Englebert R et al. Idiopathic toe-walking in children, adolescents, and young adults: a matter of local or generalized stiffness? BMC Musculoskeletal Disorders. 2001. 12(61):1-8.
4. Zimbler S. Idiopathic Toe Walking: Current Evaluation and Management. Children's Hospital. 2009. 98-100.
