Children who walk on their toes can develop tight calf muscles and weak ankles. Their health-care provider may recommend treatment to prevent problems with balance and strength.
Research into genetic causes of toe walking have found that patients displaying this gait abnormality exhibit changes on genes including MORC2, DHTKD1, FGDA, PRX, SBF2, SH3TC2 and GDAP1. These patients typically have motoric problems such as a bilateral foot drop (pes cavus) and poor muscle strength.
Stretching
Often, children who walk on their toes will develop tight muscles in their calves on the front of their legs. Stretching these muscles can help loosen the tightness and improve your child’s ability to walk with a heel-to-toe pattern.
Have your child lie on their back on a comfortable surface such as a bed with their knee straight and leg supported. They should then bring their foot upward toward their head bending the ankle, hold this for 15-30 seconds and then bring their foot back to the normal position and repeat 10 times daily.
Another stretching exercise is to have your child stand with their feet together and then place one foot in front of the other, like walking on a tight rope, without touching each other. The goal is to see if your child can walk with the front foot without the heel touching the floor before the toes of the back foot, this helps strengthen the muscles on the front of the leg.
Some studies affirm that toe walking can lead to changes in the structure of the foot, shortened Achilles tendon and may contribute to problems such as callouses on the skin, muscle strain, stress fracture of the feet or lower legs, poor balance, tripping and falling1. However, these problems are usually short-term and toe walking resolves in the majority of children by their first decade of life1. Treatment options include physical therapy, a series of casts (serial casting), plastic braces or botulinum toxin injections to the calf muscles in addition to a daily program of stretching to improve the walking pattern.
Strengthening
Children who continue to walk on their toes past the age of five often develop tight calf muscles and weak muscles on the front of their legs. These problems can lead to a lack of ankle movement, difficulty walking with a heel-to-toe pattern and/or pain in the ankles, knees or hips.
Daily exercise and stretching are important for improving these muscles. Have your child stand with their feet flat and positioned shoulder-width apart. Encourage them to do a deep squat (bend at the knees and hips but keep their chest upright). Make it fun by placing puzzle pieces on the floor for them to pick up with their toes! They should repeat this exercise 10 times.
Other strengthening exercises can include marching on the spot, walking uphill and/or on uneven surfaces, and heel walking. It is also helpful for your child to jump like a frog or use a balance pad and tactile spots to increase their strength during more dynamic movements.
Idiopathic toe walking may also be caused by a short Achilles tendon (the tendon that connects the lower leg muscles to the back of the heel bone). It can be difficult for these children to walk on their heels because they are unable to move their shin bones up to their feet. Treatment options for this condition include serial casting, which involves the child wearing a cast that is slowly stretched out over a period of weeks as their leg moves into a more normal position, and physical therapy.
Shoe Inserts
Children who toe walk may benefit from the use of carbon foot plates. These are orthotic inserts that stiffen the sole, restricting the child’s ability to extend through their MTPJs (metatarsal heads). This prevents the child from being able to stand on their toes and helps them to be unable to subconsciously revert back to their toe walking habits.
The KidSole Toe Walking Wedge is an adjustable, clinically-approved brace that can help correct toe walking. It starts out fully stacked and gradually removes layers every two weeks or as directed by your clinician, allowing the body to naturally adapt to a corrective walking pattern. The wedges also improve stability by providing heel contact, helping to alleviate a child’s sensory and coordination difficulties. They can be used by children with flat feet and those with short Achilles tendons (a condition that affects many toe walkers). Occasionally, health conditions like peripheral neuropathy or corns/calluses may trigger toe walking.
In young children who toe walk out of habit, treatment is often not needed. It’s most common in toddlers who are just learning to walk, and usually goes away on its own. However, toe walking can be a symptom of some neurological conditions. If a physical exam suggests an underlying condition, referral to a pediatric orthopedic surgeon is recommended for further evaluation.
If there’s an underlying condition, treatment will typically include physical therapy, leg braces and serial casting. The goal is to progressively lengthen the tight calf muscles and Achilles tendons. PT may also involve other treatments to help with balance and coordination, such as ambient prism lenses or special shoes called neurodevelopmental footwear.
Several studies have shown that toe walking resolves in the majority of children by 10 years of age. Although persistent toe walking can cause calluses on the skin, foot/calf pain and contribute to tripping and falling, no major long-term problems have been scientifically documented. Typical treatment includes a 3-6 month course of daytime articulated ankle-foot-orthoses (plastic braces that are removed during school and gym) or night time solid stretching plastics braces to remain in place throughout sleep, along with daily physical therapy. Some children might benefit from serial (multiple) below-the-knee casts that are changed every 2 weeks to progressively increase the range of motion in the calf muscles.