Toe walking can seem cute, at first. But if it persists after a child is about 20 months old, it can be a problem.
Toddlers develop a heel-toe walking pattern about 20 weeks after they begin walking alone and no longer should 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.
CHILDREN’S GRAND ROUNDS: New evidence in toe walking
At her daughter’s checkup 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.
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 generally is shorter. She has treated patients as young as 18 months and as old as 13.
“We want to get these kids in earlier,” she said. “By the time they’re 6 or 7, they can have structural damage to their foot.”
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 retrain 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, he or she 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 also is 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, McGrane said. She met with Nicole for physical therapy for about 10 months.
“We were amazed at how quickly the process went,” McGrane 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 retrain 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 available multi-planar ankle motion, 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 retrain their gait pattern to allow for a consistent heel-toe walking pattern.
Children’s research in toe walking
We compared outcomes in treatment of toe walking gait with carbon-fiber-orthotic intervention and serial casting. Children were enrolled in this study, and results have shown good outcomes. The research study offers financial assistance as well as a team approach in the treatment of a child’s toe-walking pattern.