How is toe walking treated?

Toe walking is a relatively common concern in children, and it is important to address it as early as is possible to prevent potential long-term issues with gait and posture. Treatment for toe walking depends on the underlying cause, which can range from physiological factors like tight Achilles tendons to psychological factors like sensory-seeking behaviours in children with autism spectrum disorders. The identification of the cause of the toe walking is important. When toe walking is associated with an underlying condition such as cerebral palsy or developmental delay, it is essential to address the primary condition as part of the treatment plan. Comprehensive care may involve a combination of physical therapy, occupational therapy, and medical management to optimize the child's mobility and function.

One of the primary treatments for toe walking is physiotherapy, which focuses on stretching and strengthening the calf muscles and Achilles tendons. Physical therapists can design specific exercises to improve range of motion and correct muscle imbalances. Stretching exercises, such as heel cord stretches, can help lengthen tight Achilles tendons and promote heel-to-toe walking. Orthotic devices, such as ankle-foot orthoses (AFOs), are often prescribed to children with persistent toe walking. AFOs provide support and help maintain the foot in a dorsiflexed position, encouraging proper heel-to-toe gait. These devices are typically custom-made to ensure a proper fit and can be particularly effective for children with tight Achilles tendons or muscle imbalances. In mild cases rigid footwear can help and the footwear can be made firmer with carbon fiber plates. These rigid carbon fibre inserts prevent bending at the ball of the foot and apply a force via a bigger lever arm to get the heel down to the ground. Serial casting is sometimes used. Serial casting involves applying a series of casts to gradually stretch the Achilles tendon over time. Serial casting can be an effective treatment option for children with severe tightness in their Achilles tendons. In cases where muscle spasticity is contributing to toe walking, Botox injections may be recommended. Botulinum toxin is injected into the calf muscles to temporarily reduce muscle activity and spasticity, allowing for a more typical heel-to-toe gait pattern. Botox injections are typically used in conjunction with other therapies and are not a standalone treatment. For children with autism spectrum disorders or sensory processing difficulties, sensory integration therapy can be beneficial. This therapy aims to address sensory-seeking behaviors that may lead to toe walking. By providing sensory input in alternative ways, such as through tactile and proprioceptive activities, therapists can help children develop better sensory regulation and reduce the need for toe walking. In cases of habitual toe walking, behavioral interventions can be effective. This involves working with a psychologist or behavior therapist to identify triggers and reinforce alternative walking patterns. Positive reinforcement, such as rewards for walking with flat feet, can be a helpful component of these interventions.

Regardless of the treatment approach, regular monitoring and follow-up are essential. Children grow and develop, and their treatment plans may need to be adjusted accordingly. A team approach involving parents, pediatricians, physical therapists, podiatrists, and other specialists can ensure that the child receives comprehensive care and ongoing support.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.