The trouble with toe walking

Toe walking seems cute, at first.  But if it persists after a child is around 20 months old, it can be a problem.

Toddlers develop a heel-toe walking pattern about 20 weeks after they begin walking alone and should no longer be toe walking, said Nicole Brown, DPT. If left untreated, toe walking can lead to future injury or pain in your child.

“I think with little ones everyone thinks it’s adorable because you don’t know if it’s causing problems,” said Sara McGrane, whose daughter Molly started seeing Brown when she was 5 years old.

At her daughter’s check-up when she was 3, the primary care physician told her parents they needed to encourage her to stop walking on her toes, McGrane said. When she was 4, the parents were told again to keep working with Molly. It was at her visit when she was 5 that her primary care physician noticed she was toe walking and referred her to the Children’s Rehabilitation Clinic in Minnetonka.

“When she was little, it was cute,” she said. “She had always been a toe walker.”

Often, Brown doesn’t see patients until they’re 6 or 7 years old. There’s a misconception that kids will grow out of toe walking, she said.  Those who are seen at 2 or 3 years old have a better prognosis, and treatment time is generally shorter. She has treated patients as young as 18 months and as old as 13.

“We want to get these kids in earlier. By the time they’re 6 or 7, they can have structural damage to their foot,” she said.

Treatment varies and depends on the severity of the condition. If Brown can see a patient before there’s limited range of motion, she can re-train the child to resume a normal walking pattern through physical therapy, which on average lasts six months, she said.

If there’s limited motion in the ankle and the child is consistently toe walking, the child is put in serial casts or carbon fiber braces, she said. The serial casts are like a typical fiberglass cast for a broken leg. They’re taken off every week and put back on to accommodate the new range of motion that was achieved. Once a child’s motion improves, Brown uses ankle braces. Physical therapy is also part of the prescription and on average lasts about a year.

In Molly’s case, her heel cord was tight enough that she required bracing, Sara said. She met with Nicole for physical therapy for about 10 months.

“We were amazed at how quickly the process went,” Sara said. “We are big believers in the program.”

What is toe walking? Toe walking is a diagnosis in which a person walks with bilateral toe-to-toe walking pattern.  There may be a medical cause or it may be idiopathic in nature.

How does Children’s treat patients who toe walk?

  • We offer serial casting, orthotic intervention, and physical therapy treatment for treatment of toe walking.
  • Serial casting has been proven to be an effective intervention for toe walkers in treatment of tight heel cords to increase the range of motion and to also weaken the heel cord muscle to allow us to re-train the child’s walking pattern.
  • Children’s and Orthotic Care Services have designed a new type of solid ankle foot orthotic that mimics serial casts for treatment of toe walking.
  • The orthotic brace is a two-pull carbon fiber solid ankle foot orthotic.  The carbon fiber on the outer shell decreases the amount of multi-planar ankle motion that is available which mimics the effects of serial casting through increasing range of motion through the heel cords as well as weakening the heel cords but allows the child more flexibility in that they can take off the brace to shower or participate in certain activities.
  • After serial casting or carbon fiber bracing intervention has been completed, children are then placed in a two-pull plastic ankle foot orthotic to re-train their gait pattern to allow for a consistent heel-toe walking pattern.

Research in toe walking is underway at Children’s. We’re comparing outcomes in treatment of toe walking gait with carbon fiber orthotic intervention and serial casting.  Children are being enrolled in this study, and results have shown good outcomes.  This research study offers financial assistance as well as a team approach in the treatment of a child’s toe walking pattern.

If you would like more information about your child’s toe walking gait or to see if your child qualifies for this research study, please contact Nicole Brown, DPT at 952-930-8685 or by email at Nicole.Brown@ChildrensMN.org.

 

 

 

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