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Toe Walking

Posted on November 18, 2010 by admin No Comments

Why Is My Child is a Toe Walker?!!

Child Toe WalkerThere are a few questions pediatric physical therapists get all the time and this is one of them.  But first let’s determine if your child is a toe walker. To figure it out answer this question:  Is your child up on their toes all the time or does your child just occasionally walk on their toes?  All children will try out walking on their toes during their development.  If you see your child walking flat footed more than 25% of the time chances are they are experimenting with walking on their toes.  If your child is walking on their toes most of the time but stands flat footed you can consider them a toe walker.  There are many reasons for toe walking.   It is important to discuss any concerns with your pediatrician but these explanations will give you some of the most common causes.

First, a short discussion on the ankle.  The ankle has many degrees of freedom, meaning it can move in many directions at the same time.  Without controlling these movements, the ankle is a very unstable thing to be standing on!! (This is why it is so easy to twist and sprain your ankle).  So your smart child might have figured out a way to beat this problem.  The ankle blocks many of the movements when you are on your toes due to the congruency of the bones in this position.  This is the reason we land on our toes when we jump or leap.  So if your child feels like his ankle is very wobbly he is going to rise up on his toes.  Now you may ask why other kids don’t use this trick.  It may be because they have tighter ligaments or more proprioceptive input (WHAT?!?!) giving them feedback more quickly to activate a muscle to prevent the instability.

Proprioceptive input.  HUH? When your joints move, a ligament or tendon is stretched.  Receptors in the ligaments and tendons respond to the stretch by sending a message to the brain.  Your brain then sends a message to the appropriate muscle to control that movement.  If someone has “loose ligaments” sometimes that feedback doesn’t get to the brain in time and the person will stumble or fall before the muscles are activated to prevent it.   As a result some children will avoid the stumbling by walking on their toes.
Children may walk on their toes for another reason – because they have tightness in their calf muscles (the Gastroc Soleus complex in particular).  This can happen as a result of keeping their feet plantar flexed (toes pointed) or because the bones are growing faster than the muscles during a growth spurt.  If the Gastroc is tight, it pulls the heel upward toward the back of the knee making it difficult to get the heel on the ground, especially while you are also trying to use the muscle to walk.  Here’s the good part: you can stretch the Gastroc and resolve the issue.  The hard part is to break the habit of walking on the toes.

Another reason for walking on the toes is that the child has sensitive feet.  The tactile input from the feet (sensations they feel from the receptors on the bottom of their feet) can be significantly bothersome to certain children making them prefer to walk on their toes to decrease this input.  A child with tactile input issues may be up on their toes on some surfaces or when their shoes are off but may be flat footed on other surfaces.  However, they may be up on their toes all the time.

So how do you resolve these issues?
1.     No matter what you think the origin of the problem is, you should stretch the Gastroc.    If a child is in the habit of walking on her toes the Gastroc will shorten slightly but can easily be stretched. Talk to a pediatrician or a physical therapist on how to do this safely on a child.

2.    Talk to your pediatrician or a physical therapist about getting an orthoses (usually one that just slides in the shoe like a Pattibob) which will help with the proprioceptive input problem.  An orthoses will give the child tactile input which can assist or replace the proprioceptive input necessary for good balance.

3.  Tactile desensitization.   By massaging the bottom of the feet or trying to step on different items you help them to desensitize their feet.  You can try sand, dirt, scarves, sand paper, smooth pebbles, mulch, pillows, or other items that don’t cause pain but are just different from a smooth floor or rug.

4.   Sometimes simply reminding the child to put his heels down when he walks is enough to stretch the muscles and retrain the brain.
5.    Occasionally there are more serious issues associated with toe walking so it is important to consult your pediatrician on any concerns you have with your child’s development.

Consult a doctor:

If you notice that your child has stiff movements throughout their legs or in one leg and one arm or throughout the extremities.

If you child falls a lot and has trouble getting up off the ground.

If your child started walking on flat feet but now is up on his/her toes (bear in mind that standing on flat feet then walking on toes is different)

If your child has trouble with appropriate social responses or has extreme reactions to changes and disorder.

Of course, you should always consult a physician with all your concerns.  Trust your instincts!  Feel free to contact us at referrals@atoztherapies.com

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