The Truth About Toe Walking

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.

Shoes, Shoes, Shoes!!

Shoes, Shoes, Shoes!!

Let’s talk shoes!  I will admit, I’m a shoe girl, even the ones I know aren’t good for me.  BUT when it comes to my daughter’s footwear, I’m pretty strict with what I put her in.  Why?  Because her foot is still developing, the foot that will support her for the rest of her life.

When we are born, our bones are soft and malleable, and over the first two years of life the bones harden, until we have a firm foot.  But wait!  My kiddo is older than 2 and I’m still fussy about what shoes she wears…why?  Our foot, and gait (walking pattern) continues to develop up until 7 years of age when we have our adult gait pattern.  So, she has a few years yet before I will stop being picky about her shoes.

So, what do I put her in?

First let me say that the recommendations that will follow are for typical children (no neurological, sensory or developmental diagnosis) with NO foot or gait abnormalities.  *Look for future blog posts talking about atypical kiddos and abnormal gait patterns such as toe walking.

When we think that about our foot changing and maturing through until 7 years old, obviously our development and what we are doing is quite different throughout those years.  Therefore, our shoe recommendations change depending on what stage we are in.

Pre-walkers, ie babies and crawlers, do not need shoes.  They need booties or pre-walking shoes that do not bind their feet.  The shoe should be flexible rather than providing a rigid support, and it’s very important that the shoe be shaped like the child’s foot.  The function of a shoe at this age is warmth and protection

Toddlers, who tend to use a lot of energy walking, should have a lightweight flexible shoe. A leather or canvas tie shoe is more secure, will stay on the foot, and will fit fat little feet better.  I think this is a bit of change from what kiddos have worn in the past.  I know my first shoes were very stiff, firm leather high tops and I have had lots of comments from the older generations about not putting my child in “supportive” aka stiff shoes.  When we are learning to walk, we learn a lot from feeling the floor under our feet, so flexible is key!  Toddlers should have flat heels on any shoes and they ideally should go barefoot in a protected environment such as indoors.  I know this isn’t always possible – my daughter goes to a daycare where they are required to wear indoor “shoes”.  So she is that kiddo who is still wearing leather Robeez inside all day.

For school aged kiddos, style and shoe fit is important with the main function being shock absorption and protection.  At this age, they can choose from a variety of options, including athletic shoes, sandals, hiking shoes, etc.  It is very important to wear the right shoes for the right activity to prevent injury.  Look for reasonably priced, flexible, well-ventilated shoes that allow plenty of room for growth.

The American Academy of Pediatrics has some overarching recommendations on what to look for when buying shoes.  Shoes should be lightweight and flexible to support natural foot movement with a stable base; they should be made of leather or mesh to allow the foot to breathe and they should have good shock absorption with durable soles as children get into higher impact activities.  They shouldn’t be stiff or compressive, as this may cause deformity, weakness and loss of mobility. In general, base your shoe selection for children (*typical children) on the barefoot model.

I do get questions on what specific brands I recommend.  I honestly think it depends on the stage of development and what fits your child.  Robeez and Momobaby are great for infants and toddlers.  Pediped; Stride Rite; Keen; ASICS; New Balance and Saucony all have some great options for children.

If you have any concerns about your childs foot or walking pattern I urge you to speak to your paediatric physiotherapist as soon as possible. We want to ensure your child has the best foundation (their feet!) to support the rest of their development.