It describes the way of walking in which a child walks on the ball of their foot with little to no heel contact with the floor.
Toe walking is very common amongst toddlers learning to walk, however a normal heel to toe gait should develop soon after this stage. The majority of toe walking in children is idiopathic (reason unknown), sometimes it may occur due to an underlying condition.
If a child is still toe walking beyond age two, then the cause may be due to one of the following:
Sometimes children develop a habit of toe walking that they fail to grow out of, continued toe-walking can lead to a tightening of the calf muscles and/or achilles tendon as a result.
Toe walking can occur due to developmental muscle imbalances that sometimes occur in those with cerebral palsy.
Toe walking may occur in those with muscular dystrophy due to similar reason as above.
The signs that a child is toe walking are usually obvious to parents and carers as the child will walk on the balls of their feet, as though they are always walking on tiptoes. A child who toe walks will have very little or no heel-to-toe contact. They may complain of tiredness in the lower limb and struggle to keep up with other children.
Podiatry for toe walking in children would involve the taking of a thorough history, this includes medical and social. Podiatrists will then assess the child's foot and leg function and have a look at their walking, and whether they are able to actively flatten their foot to the floor when walking or assess if it is fixed. Many children that toe walk eventually grow out of it, a lot of the time it has no real reason for the cause. If a child's gait is not improving, or indicates an underlying medical condition then intervention may be advised. Treatment options will be discussed.
Treatment options for toe walking in children may include:
A consistent stretching programme may be suggested to try and conservatively lengthen the calf/achilles complex.
Children may have their foot and ankle casted to assist with stretching the calf and achilles to help gain heel contact. This is usually performed over a few weeks.
An ankle-foot orthotic may be advised with the aim to encourage the child's foot to reach a 90 degrees ankle in comparison to the leg, this is usually done over the course months.
Some patients, usually those with neurological conditions, a injection of botox into the muscle may be given to temporarily weaken the muscle and allow for casting or bracing.
A surgical procedure may be indicated to lengthen the achilles tendon. This is usually done on an outpatient basis requiring no overnight hospital stay, and the child will wear a cast for a period of time afterwards.
Benefits of podiatry include:
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