Toe walking is when your child walks on balls of their feet and no contact of the heel to ground. Toe walking is common in children when they are learning to walk. After the age of 2, however, most children's toe walking will disappear and begin planting their heels to the ground.
Toe walking after the age of 2 may be a sign of an underlying medical condition. In most toe walkers, the reason remains unknown. Older children who continue to toe walk may do so simply out of habit or because the muscles and tendons in their calves have become tighter over time.
Calf muscles and Achilles tendons work together to help lift your heels when you walk.
In toe walkers, this muscle-tendon combination may be shorter at birth, or may shorten over time. This prevents the child from touching their heels to the ground and walking flat-footed. However, in most cases, the muscle-tendon combination is long enough that the child is able to but may need to be reminded to do so.
Most young children who walk on their toes are able to walk flat-footed when asked to do so. However, many older children who continue to toe walk (usually those over the age of 5) are not able to walk with their heels down. These children may complain about problems wearing shoes or participating in sports or recreational activities that involve wearing roller skates or ice skates.
Some children who toe walk have no specific complaints, but their parents are still concerned about the impact their walking pattern may have on their future function as teenagers and adults.
For children who are 2 to 5 years old and able to walk flat-footed, initial treatment is conservative. These options may include:
- Observation. The Chiropodist may recommend monitoring your child with regular office visits for a period of time.
- Serial casting. The Chiropodist may recommend a series of short leg walking casts to help stretch and lengthen the calf muscles to break the toe walking habit.
- Bracing. Wearing an ankle-foot orthosis (AFO) can help stretch and lengthen muscles and tendons. An AFO is a plastic brace that extends up the back of the lower leg and holds the foot at a 90 degree angle. An AFO may need to be worn for a longer period than serial casts.
- Botox therapy. For certain patients—usually those with a neurologic abnormality that leads to increased muscle tone—an injection of botulinum A toxin (Botox®) may also be given to temporarily weaken the calf muscles. This will allow the muscles to stretch more easily during casting or bracing.
Most patients improve over time and are able to participate in normal activities and sports. However, studies show that some children will continue to toe walk—even after serial casting or surgery.
Give our office a call at 905-209-8000 or book an appointment through our online portal if your concerned about your child's feet.
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