Toe Walking
When a child walks on their toes with no contact between the floor and the child's heel is called Toe Walking. It can be observed frequently in children under the age of two years. But, if a child continues toe walking even after 3 years of age, that needs to be examined.
This pattern of toe walking may be related with certain illnesses, trauma, or neurogenic factors. Sometimes kids toe walk during play activities for a period of time and that is completely fine; however, if children walk on their toes for prolonged periods of time, intervention is essential.
Why is toe walking a concern?
Bones expand in response to stress, and since kids develop so quickly, frequent toe walking could cause irreversible injury. Contractures (Permanent muscle and joint tightness) and a chronic shortening of the calf muscles (present at back of lower leg) and achilles tendon (Heel to calf connecting tendon) are the results of persistent equinus positioning (upward bending of ankle is limited)
Common conditions associated with toe walking:
Autism
Cerebral palsy
Muscular dystrophy
Lower limb injuries
Developmental delays.
Causes:
Short Achilles Tendon - also known as equinus or Achilles contracture, is a condition where the Achilles tendon is shorter than normal. This tendon connects the calf muscles to the heel bone in the posterior aspect of the leg. This condition can restrict full range of motion in the ankle joint, and affects walking and mobility.
Flat Feet - also known as pes planus, is a condition where the feet arches are less or completely absent. It leads to problems with balance & coordination.
Muscle Tightness- Tight calf muscles and tight achilles tendon can lead to toe walking. Due to the tightness, children will face pain and discomfort when they keep their foot down.
Sensory Perception - Children with sensory and proprioception issues may find walking on toes more comfortable as it provides a sense of stability and provides feedback.
Neurological Abnormalities - Conditions like cerebral palsy, muscular dystrophy and autism spectrum disorder can lead to toe walking.
Idiopathic Toe Walking - Some children toe walk without any underlying medical condition. This is known as idiopathic toe walking. It often resolves on its own after a period of time.
Effects of toe walking:
Muscle Tightness: It can cause the Achilles tendon and calf muscles to become tight and shorter, which reduces range of motion and flexibility.
Muscle contractures: If not treated at the right time, tight muscles can lead to muscle contractures.
Foot Pain: Toe walking for a prolonged period of time can lead to pain and discomfort in the feet.
Balance and coordination: It may affect balance and coordination, and result in risk of fall. These challenges can arise due to the changes in muscle length and strength as well as the adjustments needed for a new gait pattern.
Joint Alignment: It may eventually cause the ankle, knee, hip, and foot joints to become misaligned.
Delay in milestones: Sometimes, Toe walking can delay gross motor milestone developments.
Strategies for Toe walking:
Physiotherapy/Occupational Therapist: A physiotherapist will assess the child's gait and muscle tone, and provide exercises and interventions to improve muscle flexibility and strength and stop toe walking. An occupational therapist helps improve functional mobility and address underlying sensory or motor issues in children who toe walk.
Encourage Active movements: Animal walk, balance on one foot, squats, stomping and push & pull boxes filled with objects.
Stretching : Stretching plays an important role in addressing toe walking, especially when kids have tight calf muscles and Achilles tendons.
Sensory Integration Therapy: For children with sensory issues, sensory integration therapy can help address the underlying sensory processing difficulties.
Orthotics: Custom orthotic devices or shoe inserts can help correct foot alignment and encourage heel-to-toe walking.
Conclusion:Children can develop toe walking for a variety of reasons, and the key to an effective intervention is to find out the underlying cause. Through interventions like physiotherapy, occupational therapy, orthotics, and sensory integration techniques, children can improve their gait pattern and reduce the long-term effects of persistent toe walking. Early intervention and ongoing support play a vital role in promoting healthy development and mobility in children.