Toe Walking in Children
What is Toe Walking?
Toe walking is the inability to walk with a heel-toe pattern of walking. It is considered a typical walking pattern of movement in children under the age of 2 years. Toe walking is relatively common – around 5% of the population (which is as common as Asthma!).
Why does it occur?
There are many reasons that children may walk on their toes including diagnoses such as Idiopathic Toe Walking, Autism, ADHD, Cerebral Palsy, Congenital or Neurological Conditions. There is also some research to suggest children who use infant-walkers also have a slightly higher risk of toe walking.
Most Children who walk on their toes are given the diagnosis of ‘Idiopathic Toe Walking,’ which is the given when there is no known reason for why children walk on their toes. It is considered a diagnosis of exclusion and is only given when all other reasons for toe-walking are ruled out. For this reason, it is important to assess children who toe walk for more than 30% of the day by a physiotherapist or other health professional.
Children with a diagnosis of Idiopathic Toe Walking have been shown to have reduced coordination of their calf muscles when walking which impacts upon their ability to heel-strike. This is considered a ‘software’ problem rather than a ‘hardware’ problem – as in – the muscles and nerves are structurally sound, however the ability to coordinate the activation is reduced.
How is it managed?
Physiotherapists are involved in the assessment of toe walking to determine the possible cause and to implement a treatment plan, if required, to reduce the amount of toe walking. They can also help to advise if there is a need to investigate further with a Paediatrician, Orthopaedic Surgeon or Neurologist.
Treatment options that should be considered is strengthening, motor planning exercises, casting, footwear advice and surgery. There is new research emerging to suggest that calf muscle stretching in the presence of toe walking is not hugely beneficial.
Does it resolve on its own?
In reality, most children who toe walk will have spontaneous resolution by 10 years of age. This most often occurs when children walk on their toes for short intervals throughout the day but are able to demonstrate a heel-toe pattern of walking easily and often.
Children who toe walk for most of the day or who struggle to demonstrate a heel-toe walking pattern should be assessed by a Paediatric Physiotherapist.
Summary:
Idiopathic Toe Walking is a diagnosis of exclusion.
There are many theories as to why children toe-walk, but the evidence is still unclear on the specific cause.
Spontaneous recovery occurs in most children by the age of 10 years.
Children who toe-walk for more than 30% of the day should be assessed by a Paediatric Physiotherapist.
If you are concerned about your child’s toe walking, please get in contact to book an assessment.
