Did you know?
About 2% of children still toe-walk by the age of five, and this is typically a developmental and neurological immaturity issue that your child should not face. At an early age, it is quite normal, but it should not be extended beyond the age of 2. Most of the cases can be treated with the right guidance and treatment.
So, before choosing anything for your child, let’s understand what toe walking is in children, when it is normal, and when you should worry.
What is Toe Walking?
It is a condition in which your child starts to walk on their toes and the balls of their feet and is unable to touch their heels to the ground.
Why is this common in children?
In the learning stage of walking (by age 2), it happens that children walk on their toes. This is their process to build strength and coordination, and by the time they transition from heel to toe, they do so by age two. In some children, it becomes a habit, and doctors find no medical or physical reason behind this issue; this is called idiopathic toe walking. But the question is, how to know whether my child is having a toe-walking issue or it is just idiopathic walking?
The simple answer to the question is,
If your child started to walk normally when they were distracted or asked, then you don’t have to worry about anything. It is just a habit, and your child will start walking normally after some time.
Common causes of Toe Walking
- Idiopathic toe walking-as you know now, ITW is a condition in which a child habitually walks using their toes without any neurological, mental, or orthopedic issue. Almost 7% to 10% of children may develop this; this is completely normal. But if this is not corrected promptly, your child may develop improper bone growth, joint discomfort, and muscle tightness.
- Neurological disorders-due to differences in the proprioceptive and vestibular systems, the disruption happens in communication between lower limb muscles, the brain, and the spinal cord. This directly compromises muscle tone, motor control, and sensory processing. Let’s discuss every challenge that might happen due to neurological challenges-
- Muscular dystrophy-although it includes over 30 genetic disorders that conclusively weaken the muscles over time, it prevents heels from touching the ground while walking.
- Hereditary spastic paraparesis-when stiffness and spasticity happen in the lower limbs of your child, it makes it difficult for them to drop their heel. It directly affects their calf muscles.
- Cerebral palsy-one of the biggest symptoms of cerebral palsy is toe walking. When brain damage causes involuntary muscle tightness in the calf and Achilles tendon, it impacts posture and movement.
- Spina bifida- due to nerve damage, a tethered spinal cord, and muscle imbalance affects the lower legs.
- Compensatory gait-due to weakness in the anterior shin muscle (which is responsible to lift foot upwards), the primary muscle becomes degenerate or suffers nerve damage.
- Developmental disorders- around 20% to 45% of children exhibit persistent toe walking because, while walking on their toes, they seek sensory input from muscles and joints, and this leads to the issue. Remember, autism spectrum disorder does not lead to toe walking. As this is a developmental condition, most of the time it is mistakenly ignored by the parents, and it often become toe walking issue.
- Physical condition-conditions like a shortened Achilles tendon, heel pain, and musculoskeletal issues can cause children to experience difficulty touching their heel to the ground. It is a structural issue, limiting the range of motion in the ankle and forcing the child to walk on their toes.
When to see a Pediatrician?
If your child passes age 2 and is still walking on their toes, then your child should not wait any longer; have their habit analysed. There is a possibility that they might be able to walk normally on their own. But if not, it can lead to long-term challenges. Taking them to Cradle Children’s Hospital is the right decision that you can make for your child. A pediatrician can help you understand the exact issue and start treatment.
Remember that early intervention is the key to long-term healthy living.
Diagnosis and Treatment
How to test it?
- One of the simplest tests to see whether your child has toe-walking issues. It is called the Silverskiold test. Let’s go through it step by step-
- Sit your child on a chair or at the edge of the bed with their feet dangling.
- Start pushing (gently) their toes towards the shin. If their ankle can bend more than 90 degrees, their Achilles tendon is completely normal.
- The next step is to let them lie on their stomach, with their feet hanging on the edge of the bed.
- Gently push their toes upwards to the shin. If they are able to move more than 90 degrees but not sit, then their Achilles tendon is tight.
Treatment
- Physical therapy:A physical therapist can provide exercises to strengthen calf and foot muscles. This helps to release tension in the muscles and increases the range of motion. It includes heel walking or duck walking, calf stretches, squat play, walking on a curb, and seated toe taps.
- Ankle-foot orthotics:It is more like a leg brace that stretches and strengthens tendons and calf muscles by stretching the foot at a 90-degree angle.
- Botox (botulinum toxin): These are injections placed in the weak joints and muscles. It helps to smooth the stretching part. It is a combination of Botox and physical therapy. You may start to notice results within two to three weeks.
- Serial casting-it is a series of lightweight below-the-knee casts that are used to gradually strengthen the tight muscles and improve ankle flexibility. Don’t worry, this is a non-surgical process, and the whole procedure lasts up to 4 to 8 weeks.
- Surgery- this is the last option, which even most of the doctors also avoid. If the other treatment options fail, then this is chosen. Through surgery, doctors lengthen the muscles and tendons of the lower leg.
Conclusion
Now you know when you should be worried and when not. In the early stage, when they are learning to walk, toe walking is completely normal. But as parents, it is your responsibility that, you need to make sure that your child doesn’t get the habit of walking on their toes. But if this is not habitual, and they experience pain while using their heels, then it is time to book a consultation.
Cradle Children Hospital’s doctors are well-experienced to let you know the exact condition behind this issue. Through their guidance, you can ensure that your child does not develop this issue. Apart from that, if you are concerned about your child regarding any condition, then they are our best choice.
So, don’t wait, and book the consultation today.
