What is Toe Walking?
Toe walking is a condition where a person or a child walks on the toes or the ball of the foot. Toe walking is commonly seen in children who are just learning to walk. Many of the children outgrow the habit of toe walking. Children who continue toe walking, even after crossing their toddler years, usually do so out of their habit. If the child's growth and development is normal, then toe walking alone is not a cause for concern.
Sometimes toe walking can be due to some medical conditions, such as muscular dystrophy, cerebral palsy and other generalized diseases of the muscle and nerve. Children suffering from autism can also walk on their toes or the balls of their feet.
Causes of Toe Walking
Usually, toe walking is a habit, which a child develops when he/she learns to walk. In some cases, toe walking can occur due to some underlying medical conditions, such as:
- Toe Walking Caused Due to Cerebral Palsy: Cerebral palsy is a disorder of movement, posture or muscle tone, which occurs as a result of injury or abnormal development in certain areas of the undeveloped brain, which is responsible for controlling the muscle function; due to which cerebral palsy can cause toe walking.
- Toe Walking Caused Due to a Short Achilles Tendon: Achilles tendon connects the muscles of the lower leg to the back of the heel bone. If the Achilles tendon is very short, it may prevent the heel from touching the ground.
- Toe Walking Caused Due to Autism: Autism is a condition consisting of complex array of disorders, which affects a child's ability to communicate and interact with others. Toe walking has also been associated with autism.
- Toe Walking Caused Due to Muscular Dystrophy: Muscular dystrophy is a genetic disease where the fibers of the muscles become very susceptible to damage and become weakened over time. Toe walking can sometimes occur in muscular dystrophy. Toe walking due to muscular dystrophy is more likely if the child has initially walked normally before starting to toe walk.
- Idiopathic Toe Walking: This is where the child toe walks out of habit and this can also run in families.
Signs & Symptoms of Toe Walking
Toe walking is a condition where a child walks on the toes or on the ball of the foot. This normally happens when the child is learning to walk. If the condition persists even after the toddler years, i.e. after 2 years of age, then medical attention should be sought. If the toe walking is accompanied with tight leg muscles, lack of muscle coordination and stiffness in the ankle's Achilles tendon, then also medical attention should be immediately sought, as toe walking can also occur as a result of some medical disorder.
Investigations for Toe Walking
A physical exam can detect toe walking. In-depth gait analysis or electromyography (EMG) can also be done. During an EMG exam, a thin needle consisting of an electrode is inserted into a leg muscle. This electrode measures the electrical activity in the affected muscle or nerve.
Further neurological testing or exams are done if an underlying medical condition, such as autism or cerebral palsy is suspected to look for developmental delays.
Treatment for Toe Walking
Treatment for toe walking is not needed if the child is toe walking out of habit, as the child is likely to outgrow this habit. In such cases, the doctor will monitor the child's gait during office visits. If there is a physical problem, which is contributing to toe walking, then treatment comprises of:
- Leg braces or splints to the leg help in promoting a normal gait.
- Physical therapy consisting of gentle stretching of the muscles of the leg and foot also help in improving a child's gait.
- Serial casting. If the above treatment options, such as leg braces or physical therapy are not beneficial, then a series of below-the-knee casts are recommended, which progressively improve the ability of bringing the toes toward the shin.
- Surgery for toe walking is done if all the above conservative measures fail. Surgery is done to lengthen the tendons or muscles at the back of the lower leg.
- If the toe walking is caused due to medical conditions, such as autism, cerebral palsy or other health problems, then treatment is done according to the particular underlying medical condition.
Exercises to Stop Toe Walking
The type of exercises or physical therapy for toe walking depends on the cause behind it. A doctor or a physical therapist should be consulted before starting any exercise program. The following exercises can help in correcting toe walking.
Exercises to Stop Toe Walking #1: Standing on a Pillow- This is a method to improve the child's balance and sensory awareness by having him/her to stand on a pillow when doing his/her regular activities. Doing this will force the child to be aware of the position of the legs and feet and accordingly balance himself/herself.
Exercises to Stop Toe Walking #2: Calf Raises- Sometimes, toe walking can occur due to tightness in the calf muscles. These muscles can be stretched by having the child stand up an incline plane, and slowly rise up onto the toes. The child should then slowly lower down using the calf muscles to control the downward movement. This exercise helps in lengthening the calf muscles.
Exercises to Stop Toe Walking #3: Mouse House - Activities which help with motor control will improve the child's control of the specific movements of the body, such as which muscles to move and in which direction and how fast. There is one such exercise named Mouse House which helps with this. Stand straight with weight distributed evenly across the feet. Slowly raise up the arch muscles on the internal edge of the feet, which will create more space under the feet, like a room for a mouse. The weight should be evenly spread to avoid the feet from rolling in toward the middle.