Tippy Toes

What is toe walking?

Toe walking is a bilateral gait deviation in which the heel strike is eliminated and weight load is solely on the forefoot (ball of the foot). Toe walking is actually believed to occur normally during development of heel-toe gait but a consistent heel-toe pattern develops at about 22.5 weeks after walking started, or by 24 months.

Reasons for toe walking

-Underlying diagnosis (cerebral palsy, muscular dystrophy, leg length discrepancy, autism)

-Idiopathic: no underlying cause or could be related to congenital Achilles tightness

-Sensory processing issues: deficits or overload

When to intervene?

-Early intervention is key because increased toe walking can lead to increased calf tightness making walking on heels more difficult which will then lead to more toe walking.

-Over the age of 2 and walking on toes greater than 50% of the time

-If the child is presenting other developmental delays.

Interventions

-Physical therapy evaluation and/or meet with your pediatrician

-Calf stretching and massage while watching TV, cuddling, or reading a book

-Encourage heel walking

References:

-Autism Research Institute: http://www.autism.com/symptoms_toe_walking

-The Prevalence and Course of Idiopathic Toe-Walking in 5-Year-Old Children. Pähr Engström, MD and Kristina Tedroff, MD, PhD. Pediatrics, 2012.

-Idiopathic Toe Walking. Journal of the American Academy of Orthopaedic Surgeons, 2012. http://www.jaaos.org/content/20/5/292.full.pdf+html