Tip Toe walking in toddlers is common under the age of 3 and most of these children will grow out of this and adopt a normal walking pattern. If a child continues to toe walk they should be assessed by a podiatrist.
Causes of Toe Walking:
- Habitual or idiopathic toe walking, where the cause is unknown but the child is physically capable to stand flat footed, they have always just walked on their toes.
- Congenitally short or contracted Achilles Tendon.
- Muscle spasticity (I.E. Cerebral Palsy). Reflexes are increased and walking may be delayed.
- Paralytic muscle disease (I.E. Duchene Muscular Dystrophy). There will usually be enlarged calves and signs of muscle weakness. A serum blood test for a specific muscle enzyme level is recommended.
- Autism, as persistent toe walking may be an early sign of this condition.
- Hypersensitivity or sensory complications.
Diagnosis of Toe Walking:
- In depth medical history reporting and comparing the normal age for stage child milestone developmental accomplishments.
- Gait and range of motion assessment.
- Basic neurological assessment.
Treatment for Toe Walking:
- Depending on the cause of the toe walking, treatment may vary considerably.
- Idiopathic toe walking should be monitored to see if the child “outgrows” the condition, with passive stretching, massage and desensitisation with increased sensory feedback to the heels of the feet.
- Heel raises in the shoe that progressively reduce with a stretching regime and increased sensory feedback.
- Carbon fibre plates may also be use in the shoe to prevent tip toe walking in severe habitual cases.
- Night splints, AFO braces or serial casting may be used if there is a reduction in calf range of motion.
- Botox therapy is used in severe cases to paralyse the calf muscles to prevent resistance to stretching, most often used with serial casting.
- Surgical lengthening of the Achilles tendon may be necessary if conservative treatment fails. This is normally day surgery and done in conjunction with serial casting for 6 weeks and then a brace for the remaining numerous months.
- Toe walking caused by more serious neuro-muscular disorders should be referred to a specialist.
Well Heeled Podiatry has a range of treatment options for toe walker and can assess, diagnose and treat abnormalities of the lower limb, as well as ensuring you as a parent what is the appropriate age for stage developmental milestones.