Toe Walking-can physiotherapy help?

You may never have noticed, but some children tend to walk up on their toes, rather than keeping their heels down. This is referred to as “toe walking”. But why do they adopt this position?

 
In many cases, the reasons are never known why a child may start to walk on their tip toes. Some walk like that from very early on-as soon as they are on their feet. Others develop their walk in this position as they get older. Many children choose to walk on their toes for some of the time, as a game or to avoid a cold floor for example. But toe walking refers to children who walk up on tip toes for most of the time and often struggle to correct their position by keeping their heels down.

A child in a toe walking position.

A child in a toe walking position.

Toe walking can be very common and many toddlers grow out of it. However it can be associated with other conditions, such as cerebral palsy (CP). Children with CP may have tight Achilles Tendons due to spasticity (rigidity) in their muscles and this causes them to have to walk up on their toes. Some children who seek sensory feedback (for example children on the Autistic Spectrum) may adopt a toe walking position as a sensory strategy.

 
But for many there can be no definite reason for toe walking-this is known as idiopathic toe walking. Most children who are idiopathic toe walkers end up with some degree of tightness in their Achilles Tendon and calf. This is because the calf does not get a full stretch when in a pointed position, as it is when toe walking. But part of toe walking can also be attributed to habit…and this is often the hardest part to rectify. Therefore early intervention can be extremely beneficial.

 
For children who toe walk there are several methods of physiotherapy treatment that may help. Firstly a full physiotherapy assessment would be carried out. The Therapist would look at muscle length, particularly around the calf and Achilles Tendon. They would also assess muscle strength, especially the muscles of the lower limb and core (back, hips and abdominals). They would then provide an exercise programme that targets muscle lengthening and strengthening. For younger children this may involve parents being shown how to stretch certain muscle groups and encourage activities that help to strengthen particular muscles. For older children, it may be more appropriate for them to be taught how to stretch and strengthen themselves. They may also use a stretching wedge to specifically stretch the calf muscles.

 
Regular, daily stretching is important in order to gain some length in the muscles and therefore allow your child to be able to put their heels down more easily. However, for some children, stretching alone may not be enough. These children may require further intervention that can include serial casting (regular plaster casts being applied to the ankles over a period of 4-6 weeks to gain a consistent stretch), splints (made of plastic, they hold the ankle in a certain position, therefore preventing toe walking) or in very severe cases surgery.

 
If you have any concerns about your child toe walking or would like some advice, please contact Therapy Stars on info@therapystars.co.uk or 07813 764938.