Toe-Walking

What is toe walking? Why does my child walk on their toes? What can I do about it?

Kids start to cruise (walking along furniture) and learn to walk around 12-18 months of age. When children begin cruising they often rise on their toes and return to a flat-footed posture. Some will take a few steps on their toes and some steps flat-footed. By 24 months of age, most children should be walking with their feet flat. By the age of 3, they should be walking using a heel-toe pattern.  

Common Causes of Toe Walking:

Tight calf muscles or shortened tendons  

A symptom of neurological disorders (ex: cerebral palsy)

A symptom of muscular dystrophy

A dysfunctional vestibular system; autism

Idiopathic (no underlying cause)

Sensory processing disorders

How is toe-walking treated?

Physical therapy: Your physical therapist will help stretch your child's calf and foot muscles. They will show you exercises and stretches that can help your child increase their foot and ankle range of motion.  

Serial casting: This approach involves a series of walking casts over several weeks to stretch and lengthen your child's calf muscles and tendons. Continued physical therapy is beneficial after serial casting to work on strengthening and balance activities. 

Ankle-foot orthotics (leg braces): Your physical therapist or orthotist may fabricate a plastic leg brace that keeps your child's foot stretched or positioned to 90 degrees to lengthen their calf muscles and tendons while they are walking throughout their day.  

Observation: Your child’s provider may recommend a “wait-and-see” approach to see if the condition improves on its own. It is generally not recommended to wait more than 6 months.

Botulinum A toxin (Botox®): Your child's doctor might recommend Botox injections which help to relax the calf muscles to allow for muscles to be lengthened. This is sometimes used along with serial casting or ankle-foot orthotics.  

Surgery - if your child has not made significant improvements with other treatment techniques, your doctor might recommend surgery to loosen and lengthen the calf muscle and Achilles tendon.  

Please reach out for a consultation/evaluation if you have any concerns with how your child is walking!

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Home-based physical therapy