Up On Our Tippy Toes (Part 2)

Posted on November 2nd, 2013 by Denise | No Comments

Up On Our Tippy Toes (Part 2)

By

Denise Koonce OTR

So what do you do if you have concerns regarding your child walking on their toes and how much is too much?  A reasonable guideline for determining if toe walking is outside the range of normal is, if your child is walking on their toes 50% of the time or more past the age of two.  It is also important to note or observe whether or not your child had been walking with their heel down, in a heel toe pattern, but switched to a toe walking pattern.  In addition, be aware if your child has begun to fall more.  If your child is demonstrating any of these, it could be a sign or symptom of an issue and you need to inform your child’s pediatrician or primary care provider about your observations and concerns.  Here are some recommendations or treatment options that may be recommended by your physician or physical therapist regarding the toe walking.

If the toe walking is present due to either a sensory defensive or sensory seeking reason you can provide additional sensory input to treat the underlying cause.  For instance, if your child is toe walking secondary to painful sensory feedback they are receiving from the soles of their feet, a good sensory diet would be helpful in desensitizing or normalizing their sensory system.  The therapist may recommend walking barefoot on different textures such as grass or sand and picking up objects with their toes from a bowl of rice or beans.  As part of a sensory diet, the therapist may also recommend vestibular or specific movement activities such as swinging and spinning.   If the child is toe walking to increase their sensory information by locking their knees and ankles in extension, then doing activities to address proprioception is required.  Examples of activities that address proprioception are jumping on a trampoline, or playing catch while standing on a soft dynamic surface such as mattress, bean bag, or balance pillow.  Have them crawl or play on a stack of pillows and couch cushions, or spend time at a nearby playground playing on playground equipment.    It is also beneficial to strengthen their core muscle groups such as abdominals (stomach muscles), gluteals (buttocks), and scapula (shoulder blade) muscles therefore providing them with a more upright posture and stronger balance.  If your child is toe walking due to a sensory system dysfunction other sensory areas may also need to be addressed, as is often the case.      

If the toe walking appears to be idiopathic and present for unknown reasons, then stretching the lower leg muscles, also known as calf or gastroc muscles is helpful.  This can be accomplished by having the child stretch their calf muscle or by you stretching it passively.  A therapist or physician may also recommend a simple orthotic that will slip into the shoes they wear.  For more severe situations the physician may recommend serial casting or surgery to lengthen the muscle.  However, it is important to verbally remind your child not to walk on their toes, cueing them to stop when you see them doing so.  Encourage heel toe gait by providing them with light up shoes, and stay away from shoes that have a raised heel in girl fashions. 

If the toe walking is due to a diagnosis of cerebral palsy or muscular dystrophy then further evaluation and treatment should be recommended and your child should be seen by both medical specialists and therapists. 

Toe walking is a natural part of a child’s development but it is important to be aware of when it is no longer within the normal range and should be addressed.  By addressing it early on you can decrease the habit and therefore the vicious cycle produced by idiopathic toe walking, address the sensory system, and rule out other underlying diagnoses.   So if your child is, past the age of two and still toe walks more than 50% of the time, be empowered and have them evaluated.  If you have experienced this situation please share with us your insights and story.

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