Toe Walking - Manitowoc, WI

My sons both have a developmental syndrome, Fragile X.
Low muscle tone may be the reason. I carried the syndrome
and toe walk, but was Magna Cum Laude in college. My mother
claims I never toe walked until I copied an older neighbor gal. (Looked like walking on high heels). I struggled to
relearn the proper method. May also relate to pronation
of feet (not much arch).

Hi A.,

I have a 6 year old son who walks on his toes, and it has been a frustrating process getting answers about the cause & best treatment for him. The place to start is a pediatric orthopedist (I don't know if you are in the Twin Cities area, but we saw Dr. Teresa Capello at Children's St. Paul & were extremely happy with her). Our (former) pediatrician didn't even look at my son's feet when I brought it up at a well-child check, but I insisted on getting a referral to an ortho & am very glad I did!

The things to look at are: has your child always walked on his or her toes? is it the same on both feet? (my son actually told me, "I can't put my heel down on this foot, it hurts too much.") if you ask your child to put his or her heels down, can he or she do it and walk with a normal gait? If the answers to those questions are yes, then it is most likely "idiopathic toe walking" (meaning no one knows why they do it), and there's a decent chance no intervention will be needed. In my son's case, he started walking normally & then started toe walking at age 2 or 3, and as I said, one foot is quite a bit tighter than the other, so we have seen a pediatric neurologist & ruled out lots of things. A developmental pediatrician is another option. Unfortunately, there isn't necessarily a diagnosis in these cases, but the best we can do with my son is call it mild cerebral palsy & go on from there.

If they decide that it is NOT idiopathic toe-walking, the best treatment is serial casting, where they position the child's feet very carefully, put on walking casts, and repeat weekly or every two weeks until they're happy with the position of the feet, and then custom braces at night until the child is finished growing (keeps those muscles that we worked so hard to loosen up from tightening back up at night, as they grow). The serial casting usually takes 4-8 weeks. They do not like to do "heel cord lengthening" surgery any more, as it is a one-shot deal, and does not address the tight muscles, just the tendons (or ligaments?).

As you can see from the length of my response, I have some experience with this issue! Please feel free to send me a message if you have more questions.

Good luck!

A.

Hi A.- I'm pediatric physical therapist and see many kids with the toe walking issue. Besides what Amy wrote, there are quite a few kids with sensory issues or integration disorders who walk on their toes as they are overstimulated or sensitive to their environment. Occupational therapy can help with these issues. There are definately the kids who are just idiopathic toe walkers, no explanation, where there can sometimes be a family history. These kids are sometimes serial casted as well if their muscles are tight or to break them of the habit. Your primary care doc could make an approp referral based on what you have told him/her.. a specialist, such as a neurologist or orthopedist can help with the diagnosis, as Amy said as they gather info on onset as well as motor milestones. If this is progressive, an MRI can rule out an issue in the spine...feel free to e-mail me directly as I could write a few more paragraphs of info that may or may not be useful depending on your situation.

Dear A.:

As a child I walked on my toes until I was in the fourth grade. I never was seen by a doctor for this problem. I am pretty sure it will go away, however, I was made fun of a lot when I was a child for this.

A.,
I am a preschool teacher and I work with children who have developmental delays. Toe walking can be a sign of some other developmental concerns. Be sure to discuss with your doctor your concern about this. Make sure the doctor asks you questions about your child's development. Are they meeting all their milestones? There are ways to break this.
An occupational therapist can do some different things to help. There are some special devices that can be worn which help the child keep their heels down.
Rachel

Hello A.!

How old is your child? Toe walking is often a result of a tight posterior muscle group in the lower leg... I would get it checked out by either a podiatrist or an orthopedist...

K.

A. everyone is different when it comes to toe walking. Don't be alarmed. My son walked on his toes, he grew out of it. I've seen a lot of toddlers walk on there toes and grow out of it. I've never heard of any child having to have surgery though, if so then I would think that maybe something else was wrong for that child to have surgery.Just my opinion.

I have heard conflicting sides for toe walking too. My daughter, now 8, was a toe walker. Several people told me I should take her to the doctor becasue it would cause problems in her feet and ankles later in life. I heard horror stories of children who never walked correctly due to the damage they caused. However, my daughter never had any problems. We discussed it with her doctor and she wasn't concerned, and we trusted her. Eventually my daughter stopped walking on her toes (before she turned two) and we never had any ramifications. I would see what your doctor says. Good Luck!

I have to agree with the "go to a children's ortho". Nothing against General Physcians, but that is exactly what they are. You wouldn't go to a General Dr. for a major heart problem. We had a friend whose daughter walked on her toes and she had to have casts on to stretch the hamstrings and she went through PT to correct the situation.

please consider getting child checked by a doctor...my niece's daughter did this until she was four and had to have surgery on achilles tendon to make it less tight which was causing the toe walking...it had to be casted and a few weeks of discomfort but now she is doing just great! good luck

Make an appointment with a pediatric orthopedist. This can be a long-term problem if not treated.

My son did toe walking also along with other quirky behaviors and was eventually diagnosed with sensory integration disorder (I think they refer to it as dysfunction of sensory integration now). We went to three years of OT starting at age 3 and now he has hardly any issues anymore (at age 9) - Google sensory integration and see if he has any of the other symptoms, if so get him evaluated by an OT that specializes in sensory stuff.

What answers have you gotten?? I have a 6 year old who still walks on his toes and I have always been told "he will grow out of it" I'm still waiting! We keep reminding him to walk on his feet and not his toes. I have a son in law who did the same and he did grow out of it.

M.
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As an Occupational Therapist I 100% agree with Jean's response below. Also, a friend's son is a toe walker. He has tight hamstrings AND sensory issues. Please get into Pediatric Rehab! Best wishes.