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Toe Walking in Children












What is it?


Toe walking refers to the preference of a person to walk on their toes or on the balls of their feet instead of using their entire foot. It is a common behaviour in young children who are just learning to walk and usually it is quickly outgrown.


However, children who continue to walk without touching their heels to the ground for more than three months after they’ve learned to walk may have a gross motor function deficit known simply as “idiopathic toe walking.”


Causes:


Toe walking may be caused by a congenital contracture of the Achilles tendon, Cerebral Palsy or paralytic muscular disorders such as Duchenne Muscular Dystrophy. Toe Walking may be associated with developmental disorders such as Autism or other myopathic and neuropathic disorders but can also manifest seperate to these conditions and in these cases is known as idiopathic toe walking.


Toe walking may be linked to hypo or hypersensitivity. Some children may not like the feeling of some surfaces on their bare feet, which cause them to rise on their toes to avoid having the full surface of their feet contacting the floor. On the other hand, some children are seeking more input. For these children toe walking increases the force of impact felt during gait, as the ground reaction force is distributed through a smaller surface area at the metatarsal heads.


Toe walking may lead to pain and future foot and ankle problems from the shortening of the Achilles tendon and only certain joints accumulating load during the gait cycle.


Possible Treatment Ideas:


Passive Leg Stretching




Stretching the child’s Plantar flexors, Hamstrings and Gluteal Muscles can help with the tightness at the back of the ankle.



Active Ankle Stretching













Walking up a ramp, crab walks and frog jumps all require a flat foot to complete the movement






















Strengthening



Hurdles, Tea Towel Pickups, Balance Boards/ Balls, Jumping variations strengthen the intrinsic muscles of the foot whilst requiring the entire foot to be in contact with the floor


Gait retraining drills






Silent heel to toe walking, High knee marching, Bottom kicks,Trolley/Pram Pushes, Backwards walking













Sensory Strategies



Vibrating orthotics, Barefoot play on different surfaces, Joint compressions, Ankle weights


Takeaway


Promoting your child to use the entire foot throughout these exercises will cause motor learning. The cortex will absorb this information and use this to its own benefit and replicate this in daily life.


Interested to know more about Shanti Physiotherapy




References:

  1. Le Cras S, Bouck J, Brausch S. Evidence based clinical care guideline for management of idiopathic toe walking. Cincinnati Children’s Hospital Medical Center. 2011.

  2. Sobel E, Caselli M, Velez z. Effect of persistent toe walking on ankle equinus. J Am Podiatr Med Assoc. 1997 Jan; 87(1):18-22.

  3. 1. Schoenecker P, Rich M. Chapter 28: Idiopathic Toe-Walking. In: Morrissy , Weinstein , editors. Lovell and Winter's Pediatric Orthopaedics. 6th edition. Lippincott: Williams & Wilkins; 2006. pp. 1204–1211.

  4. 2. LeCras S, Bouck J, Brausch S, Taylor-Haas A. Cincinnati Children's Hospital Medical Center: Evidence-based clinical care guideline for Management of Idiopathic Toe Walking. 2011:1–17. Guideline 040

  5. 3. Harris EJ. In: Chapter 37: An approach to toe-walking: Appropriate decision making. Pediatric Foot ∧ Ankle Surgery. Richard M Jay., editor. W.B. Saunders Company; 1999. pp. 284–303









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