What is Toe Walking?
Toe walking is a condition where someone walks on their toes or their forefoot (ball of the foot). and their heels do not, or rarely, make contact with the ground.
Children will adopt different walking styles as they develop and explore, however, toe walking generally does not continue after the age of 2-3.
What Causes Toe Walking?
Often, the cause of toe walking is classed as ‘idiopathic’, meaning that the cause is unknown.
It can be caused simply by tight posterior leg musculature. Toe walking is often associated with various medical conditions, such as cerebral palsy and muscular dystrophy.
There has also been a link discovered between autism and family history of toe walking.
There is evidence to suggest that it is more common in babies born prematurely. When babies are in the womb, they will push against the lining of the womb to stretch out. This allows for stretching of the calves and movement of the ankle joints. Babies born prematurely may not have the opportunity to do this and therefore may have tighter posterior leg musculature or reduced movement through their ankles.
Does it Only Affect Children?
Toe walking is predominantly seen in children under the age of 2. However, it can be prevalent in adults if it is not managed well as children, or if they have other medical conditions associated with toe walking.
Why is Toe Walking Problematic?
Our feet are designed to walk in a heel to toe motion. This allows for proper pressure distribution and efficient movement to be able to put one foot in front of the other.
Toe walking places excessive pressure on the forefoot, which is not built for these forces.
This can also lead to pain in the forefoot and toes, as well as development of callus and corns.
The achilles tendon and calf muscles are another area of concern when it comes to toe walking. This is because Toe Walking can be caused by tight calves, but it can also cause tight calves. This can lead to injury of the achilles through the teen and adult years, particularly if they play sport.
When Should I Take My Child See a Podiatrist?
Early intervention is always best, so it’s important to have your child’s walking assessed as soon as you notice this gait pattern. This allows us to intervene if necessary.
If your child continues to toe walk after the age of 3, it is important to visit a podiatrist for an assessment.
Children may toe walk occasionally, however, if it becomes their preferred method of walking, we need to address the cause of this.
It is also important to see a podiatrist if your child is in pain, avoids physical activities and play, or seems to be more clumsy than their peers.
What Are The Treatment Options for Toe Walking?
Stretching
A gentle stretching regime can be implemented to help reduce the tightness within the achilles tendon and posterior leg.
Heel Lifts
These are small inserts that can be placed into shoes to take pressure off the achilles and calves. They can be worn in most shoes.
Orthotics
Orthotics can assist with taking pressure off both the achilles/heel and the forefoot. They can also help to promote heel to toe walking.
Gait Retraining
This involves encouraging your child to adopt a heel to toe walking pattern. This can be implemented at home or when in care. The more that this is implemented, the more it will become a habit. This will help to reduce strain on both the forefoot and the achilles.
Discourage W Sitting
Some children will sit on the floor with their hips and legs in a W formation. This not only puts excessive pressure on the hip joint, it can also result in knee pain and tightness within the calves. If you notice your child is W sitting, it is important to discourage this.
Referral to Surgeon
In severe cases, a referral to an orthopaedic or podiatric surgeon may be required. This may involve procedures such as achilles lengthening or botox injections.
My Older Child Has Started Walking On Their Toes All of a Sudden, Should I Be Concerned?
If your child aged between 8-14 years old begins to walk on their toes, it may not be simply toe walking. It may be due to a condition known as calcanea apophysitis, or Sever’s disease. You can learn more about this in our article “Heel Pain in Kids – What Does it Mean?“.
If your child is showing signs of toe walking or experiencing any pain or discomfort in their feet and/or lower limbs, come see us at Watsonia Podiatry. We’re here to help! Book your appointment by calling us on 03 9432 2689 or book online here.