Let’s Not Tiptoe Around the Topic…
As humans, we explore our world in different ways as we develop; starting from immobile beings, moving to belly crawlers, to 4-point creepers, and eventually, upright walkers. These changes are challenging and take years for mastery. When learning to walk, many compensations can develop, one of which is toe walking. This compensation can occur for a variety of reasons, some of which are a lack of stability and balance or decreased muscle length. If not corrected at a young age, these compensations can carry over into adulthood.
It’s important to determine if a child is constantly moving onto tiptoes or if they are only doing so while trying to see onto the counter or look at something up high. If the tiptoe walking is consistent, a discussion with his or her pediatrician and an assessment by physical therapy is warranted.
During an evaluation, the physical therapist will assess range of motion and functional movements. He or she will develop a plan of care for PT sessions and provide the family with home exercises as consistency both in and out of the clinic is necessary for long-term changes to be made. Physical therapy sessions will work on developing lower extremity strength, improving single leg balance, increasing lower extremity muscle length and facilitating progress toward functional goals like jumping and running. The physical therapist will also provide resources and recommendations should he or she feel that additional interventions or referrals are necessary.
If hypermobility of the joints of the foot and ankle or hypotonicity of the muscles is the leading cause of impaired walking, ankle braces may be utilized. The braces most typically worn are ankle foot orthotics (AFOs) or supramellolar orthotics (SMOs). They help to provide stability to the joints of the foot and ankle which may be the cause of a child’s instability with walking. The consistent wear of a brace provides continual feedback to the child for appropriate foot placement while walking. If the length of the calve muscles are too short for the use of a brace, night splinting or serial casting may be necessary. Night splinting is the use of a fixed brace that is worn overnight to lengthen the calf muscles. Serial casting is a series of hard casts which progressively increase the amount of bend at the ankle which slowly increases the length of the muscles in the calf. Braces, splints and serial casts have the best outcomes when paired with physical therapy intervention.
If toe-walking is not corrected during development years, it is less likely that a child will grow out of the pattern entirely. The impaired gait mechanics a child develops can impact their strength and coordination gains, so it is best to address these findings as early as possible. At OMPT Specialists, we have a handful of physical therapists at our various locations who are trained in evaluating and treating pediatric gait mechanics. If you have any questions or concerns about your child, speak with your pediatrician and set up an initial evaluation appointment at OMPT Specialists.
By Paula Terenzi, PT, DPT, OMPT