Toe Walking...They don’t always grow out of it!

Today's blog is from a pair of guest bloggers, Jessica Edwards-Perrin and Tina Borchers. They are both physical therapists at Preferred Physical Therapy and have helpful tips on toe walking. (Note: Any views or opinions expressed are solely those of the author(s).)

 

Toe Walking...They don’t always grow out of it!

Toe walking is a common gait pattern in children who are learning to walk.  They are trying different patterns to find an easy way to get around. It is not common for children to continue to toe walk after the age of two however. This will create strength issues down the road.  Toe walking commonly is associated with children who have weak core and weak hip musculature.  This will create tightness in their calf and hamstring muscles at the same time. This gait pattern will continue to cause abnormalities as they get older.

If you notice this in your child, it is important to have your physician evaluate the child first to rule out any other problems the child may have. Once these are ruled out, typically, the diagnosis of Idiopathic Toe Walking is made.  (Idiopathic meaning "of unknown origin".)

Common Patterns seen:

• The "W" sitting position is common in these children as they do not have to use their core while playing on the floor in this position.
  
• Running pattern:  Usually, the child does not flex their hip as high and they use their hamstrings more.  This may cause difficulty when they are trying to run for prolonged period of time or running on unsteady surfaces. There are other compensation patterns when the hip does not flex like his should, such as rotating their leg and foot out to the side to clear the floor. 
• Falling often:  The child may appear to be clumsy and uncoordinated.  They trip often due to their limited hip flexion.
• Tightness:  The child begins to develop tightness in the hamstrings and calves at an early age.  Then, when they go through a growth spurt, they seem to have more gait problems and an increase in tightness/pain 
• Struggle to keep up:  Due to their poor gait and running pattern the child may struggle to be able to keep up speed and demonstrate the same patterns as their peers. Due to the muscle tightness and weakness they fatigue quicker.  Compensation patterns may become worse as they try to increase their speed.

What is the treatment?

As stated before, toe walking can lead to a loss of ankle range of motion and tightness of the calves and Achilles tendon. Sometimes, bracing, or casting in severe cases, will be indicated, which would be discussed with your physician. Like any habit, the longer it persists, the harder it is to break. That is why it’s very important to have the child evaluated by his/her physician and a skilled Physical Therapist to start intervention as soon as possible.

It should be noted that there may be other contributing factors to the toe walking, such as an increased or decreased sensitivity of the feet, poor tolerance to tight clothing, disliking certain foods/textures, or even language delays. If these are seen as well, comprehensive evaluation by an Occupational Therapist and a Speech Language Pathologist is also recommended.

In Physical Therapy (PT), the child will be started on a stretching and strengthening program. PT will work on the walking pattern, balance, and posture. PT should always include a home exercise program that the parent and child can do on their own in between PT sessions.

Some examples of PT activities/exercises for Toe Walkers:

1. Stretching exercises

• Calf stretching
• Hamstring stretching
  

2. Abdominal Strengthening

• Sit-ups
• Planks
• Superman's

3. Balance Activities

• Standing on one lower extremity
• Standing on uneven surfaces
• Sitting on a ball

4. Postural Exercises

• Avoid "W" sitting
• Sitting and standing with correct posture
• Abdominal and shoulder blade strengthening will help with posture as well

**These are some common exercises, but as always, it is important to have your child evaluated so that exercises can be given that are specific to the child’s needs. No child is the exact same.

About the authors:

Jessica has worked in a variety of pediatric settings including clinic, school, home and daycare. She enjoys working with infants all the way to up to teenagers. She has worked the last 4 years with birth to 3 year olds with Missouri First Steps. She focuses on developmental delay, torticollis, gait abnormalities and orthotics. She enjoys learning more about disorders such as autism, cerebral palsy, downs syndrome, and many more unique diagnoses.

Tina has worked in the outpatient PT setting for 4 years. She has a special interest in Craniosacral Therapy for infants and young children dealing with sensitivities of the nervous system, spastic muscles, and/or chronic pain. She has treated children and adolescents of all ages for torticollis, gait abnormalities, and athletic injuries.