The Truth About Toe Walking

Let’s talk about toe walking!  I recently went to a course solely focused on toe walking and was super excited to go.

Why?

Because I had been finding that these kiddos were hard to treat, I often wasn’t getting the gains I had been hoping to, and, when I did, they didn’t always last.

Let me tell you, this course changed EVERYTHING!

I will honestly admit I had been doing it wrong all along!  I had been taught in school (like most physios) that toe walking was the result of tight calf muscles.  So, we did things like stretches, night splints and surgery.  What we now know is that tight calves is the consequence, rather than the cause.

Idiopathic Toe Walking

It isn’t uncommon for children who toe walk to be diagnosed with idiopathic toe walking.  Idiopathic means that there was no known cause, but what has happened over the years is that is has morphed to people thinking there isn’t a cause.

NOT TRUE!

There is always a cause.

Toe walking is super inefficient, and the only reason your body will do it is to meet a greater need.

Toe walkers of today are different then the toe walkers of previous generations.  We are using more equipment with our kids than we used to and more supportive toys when learning to walk.  We have more kids with sensory needs and/or autism.  All of these things make for fundamentally different toe walkers.

Which means that the assessment and treatment of these kids needs to go beyond looking at the calves!

Wait and See

I have come across some families that tell me they were informed that toe walking is normal and not to worry, as they will grow out of it.  Toe walking is NOT a normal part of development – if your child has just learned to walk in the last week or two and you see them up on their toes and then they go back down to the soles of their feet, and this happens less and less, then you likely don’t need to be concerned.  But studies show almost all 18 month olds step with their heel first.

Did you know our balance strategies during walking are developed by 3 years old and the bones in our foot are solidified by 4 years old?

AND it is possible for walking on the toes to actually deform the foot bones!

It’s a challenge to make changes to both of these things after that point.

Lastly, our adult walking pattern is solidified by 7 years old, so how a kiddo walks at 7, is how they will walk as an adult.

That’s why earlier is better to try to address these issues BEFORE our foot, balance and walk are all solidified!

Toe Walking as a Marker

Earlier in this post I talked about how toe walking is inefficient and that the only reason someone will do it is to meet a greater need.  A new study has shown that there’s a correlation between speech difficulties, learning disabilities and toe walking.  This likely explains the underlying reason the child is toe walking in the first place.  Because children typically start walking before they have much speech, toe walking can be a marker for other concerns that haven’t yet emerged, but should be monitored.

Long Term Consequences 

You may be thinking, what is the big deal?  Is it THAT important that my kiddo is up on their toes – they are walking, right?!

Wrong!

There are long term consequences!

Some long term consequences of toe walking include increased frequency of injuries, knee instability, difficulty finding shoes and early arthritis and joint pain.

But what about those kids that can, when asked, put their heels down?  A recent study found their calf strength and overall endurance was significantly less then their peers, which means they have a harder time keeping up!

There is an interesting video/interview here talking about the long term repercussions of toe walking.

So, the long and short of it is that toe walking is a complex issue, much more than most physiotherapist and doctors ever thought.  Treating it is possible without drastic measure such as night splints, botox or surgery.  However, as with most things, the earlier the issue is addressed, the better the likelihood of results.  So, if you have concerns regarding your child’s toe walking, book an appointment with a physiotherapist who has training in toe walking and will take a wider approach than  simply looking at their calves!  If you are in my area feel free to reach out to me at erin@newhorizonsrehab.com or (519) 291-5402.

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