Some children tend to walk on their toes, or on their forefoot, while others tend to alternate between forefoot walking and walking with heels on the floor. The physiotherapist will be able to find out the reasons for this, provide you with a treatment plan, and refer you to other professionals if necessary.
The cause could be neuromuscular, sensory, or habitual. The neuromuscular causes may be cerebral palsy, dystonia, spina bifida, or Duchenne muscular dystrophy, whereas sensory causes can include autism, hyperactivity, and learning difficulties. Some children are observed to walk on their toes on certain occasions, but can walk with their heels down, meaning muscle tightness is unlikely to be the cause. When no cause is identified, it is called idiopathic toe walking.
The management of toe walking depends on its cause, age, and severity. A thorough examination will be conducted to rule out spinal disorders, hip problems, limb length discrepancy, foot deformity, and abnormality with tone. The physiotherapist will observe your child standing and walking to assess their tone, strength, and pattern of movement. A tailored treatment programme consisting of stretching and strengthening exercises for improving flexibility and muscle control will then be provided.
Stretches are usually provided to the calf and hamstring muscles while simultaneously strengthening the opposite muscle groups (front of the leg), as in some cases they are found to be weak. Most children who toe walk have poor core stability, hence trunk strengthening exercises will also be provided as part of the programme. Proprioceptive exercises, which include balancing on one leg, jumping, and hopping, are found to be helpful in toe walking due to sensory problems.
Although rare, serial casting is used when the problem persists after the above exercises as it provides a sustained stretch to the calf muscles. Depending on the cause and severity of toe walking, some children might be referred to the orthopaedic surgeon for opinion on botox or further intervention. They might also be referred to orthotics for the provision of appropriate footwear.
Some cases are resolved with growth, whereas others are not. There is a risk that tightness in the muscles of the legs could increase as your child grows. This is particularly true in neuromuscular conditions, such as cerebral palsy. Some of the secondary effects that may arise in the future are back problems, postural malalignment (as the body tries to compensate), balance impairment, and foot disorders which, if severe, can cause problems with the knees.
Most cases of toe walking in the absence of any pathology are resolved with physiotherapy, although it can take a while for them to learn the normal pattern of walking.