Our podiatrists here at Riverside Podiatry understand that children’s walking patterns vary greatly from early childhood to adolescence. These changes can sometimes be concerning for parents, particularly when comparing to other children of a similar age. It is important not to worry, but to seek professional medical advice from our podiatrists if you are concerned with your child’s foot or walking development.
Toe walking describes walking on the balls of the feet (forefoot), without the heel making contact with the ground. Toe walking is more commonly known as tip-toeing. While it is considered normal for toddlers to begin walking on their toes as they experiment with different walking styles, it should not persist for long periods and past the age of three. Sometimes there can be an underlying reason as to why a child may toe walk and these can be investigated by our podiatrists to help correct any issues from an early age.
When is toe-walking a problem?
When your little treasure is starting to discover and build confidence in walking, toe-walking may be a normal part of becoming comfortable with their gait (walking). Typically, this is up to the age of three and doesn’t last for very long (or occurs intermittently). Occasional toe-walking isn’t problematic, but if toe-walking is their only or primary method of walking, or occurs very regularly past the age of two, then it’s best to book your child into our podiatrists to understand what’s going on.
Why is toe-walking a problem?
Our primary concern with persistent toe-walking is that the Achilles tendon and calf muscles tighten and contract, therefore staying in a shortened position during gait. As this happens, your child’s flexibility through their calf muscles can decrease and it will then become more comfortable for your child to remain on their toes while walking instead of adapting a heel-to-toe movement. Your child may feel tightness and/or pain at the back of the heels and legs when their heels touch the ground.
What causes toe-walking?
- Habitual or idiopathic (unknown cause) – the truth is, some children may simply see toe-walking as being fun or a game which may become a learned behaviour. In this particular case, the child is physically capable of standing flat footed. All other causes of toe-walking must be ruled out before deeming your child’s toe-walking as habitual.
- Sever’s Disease – irritation or inflammation of the growth plate of the heel, whereby it is painful to put the heel on the ground.
- Congenitally short or contracted Achilles tendon.
- Muscle spasticity – some conditions such as Cerebral Palsy can cause the calf muscles to tighten and therefore prevent the child from physically being able to touch the ground with the heels. This may be unilateral (one side) or bilateral (both sides).
- Congenital Muscular Dystrophy or Global Developmental Delay – this patient will typically have large calf muscles and signs of muscle weakness.
- Hypersensitivity – sensory processing issues or children who are more sensitive to touch may cause a child to toe walk.
- Autism – it has been proposed that autism may be linked to toe-walking, but no clinical evidence has been found to date.
How can we help toe-walking?
There are many different treatment options available for toe-walking in children which is determined by the cause and its severity.
Where toe-walking is encouraged by tight calf muscles and Achilles tendon, our podiatrists will work with you and your child to gently loosen the muscles while helping to support their feet and ankles. This may involve:
- Monitoring for idiopathic toe walking to see if a child “outgrows” the condition
- A gentle stretching program
- Soft tissue therapy of the calves and Achilles tendon
- Heel raises in the shoe that progressively reduce with a stretching regime and increased sensory feedback
- In-shoe devices, such as orthotics
- Carbon fibre / polypropylene / subortholen plates, if necessary.
In more severe cases, treatment options may include a referral for Botox therapy, surgical lengthening of the Achilles tendon and/or serial casting, or referral to a specialist for serious neuro-muscular disorders.