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SHOES TO PREVENT TOE WALKING - CAN FOOTWEAR HELP?

In general, a particular shoe or style of shoe is not considered a treatment for toe walking (aka tip toe walking.) However, there are some considerations for shoe fit which we’ve listed below. 

Toe walking is a gait pattern often observed in young children. It usually resolves on its own as the child develops and becomes stronger and more coordinated. Let’s take a closer look at what tip-toe walking is all about.

What is toe walking aka tip-toe walking?

Toe walking, also known as tiptoe walking, refers to a walking pattern in which a person walks primarily on their toes or the balls of their feet, with minimal or no contact between the heels and the ground. This gait pattern is often observed in young children who are learning to walk, and it typically resolves on its own as they develop and gain strength and coordination.

However, for those who toe walk beyond a certain age or into later childhood, it can sometimes be a sign of an underlying condition. Some of the possible causes of persistent toe walking include:

  • Idiopathic toe walking: This is the most common cause, where no underlying medical condition is identified. It may be associated with tightness in the calf muscles or a habit that has developed over time.
  • Muscle or neurological conditions: Certain conditions, such as cerebral palsy, muscular dystrophy, or Charcot-Marie-Tooth disease, can lead to toe walking. These conditions affect the muscles, nerves, or motor control, leading to altered gait patterns.
  • Autism spectrum disorders: Some children with autism may exhibit toe walking as part of their sensory-seeking behavior or motor abnormalities.
  • Structural abnormalities: Structural issues like leg length discrepancy, tight Achilles tendons, or foot deformities can contribute to toe walking.

How to address tip-toe walking

If toe walking persists in children it is important to consult with a healthcare professional, such as a pediatrician or a physical therapist. A doctor or specialist can assess the situation, identify any underlying causes, and recommend appropriate interventions or further evaluations if necessary. 

Treatment options for toe walking may include physical therapy, stretching exercises, orthotic devices, or addressing any underlying medical conditions.

What a doctor’s examination will consist of

During a doctor's examination for toe walking, the healthcare professional will typically conduct a thorough assessment to determine the underlying cause and appropriate treatment options. The examination may involve the following steps:

1. Medical history

The doctor will ask questions about the child's development, including:

  • Age of onset: When did you first notice your child walking on their toes?
  • Duration: How long has your child been toe-walking? Has it been a constant pattern or does it come and go?
  • Developmental history: Did your child meet their developmental milestones on time, such as crawling, standing, and walking? Were there any delays or concerns in their motor development?
  • Family history: Has anyone in the family, including siblings or close relatives, experienced toe walking or other similar issues?
  • Associated symptoms: Are there any other accompanying symptoms or concerns, such as muscle weakness, clumsiness, pain, or difficulty with balance?
  • Environmental factors: Has there been any recent change in the child's environment, such as new shoes or surfaces they walk on, that may be influencing their gait pattern?
  • Previous interventions: Have you tried any interventions or strategies to address the toe-walking? If so, have they been effective?
  • Behavior and play patterns: Does your child engage in any specific behaviors or activities that may be related to the toe-walking? For example, do they walk on their toes more during certain situations or while engaged in specific activities?
  • Medical history: Are there any known medical conditions or diagnoses in the child, such as neurological disorders or muscle-related conditions?
  • Other observations: Is there anything else that you have noticed about your child's walking pattern or overall development that may be relevant?

These questions help the doctor gather important information about the child's history and symptoms, which aids in the evaluation and identification of potential underlying causes of toe walking. They may also inquire about any family history of similar issues.

2. Physical examination 

The doctor will conduct a physical examination to assess the child's gait, posture, and muscle tone. They will observe the child walking to evaluate the extent of toe walking and may also look for any other associated signs or symptoms.

3. Neurological assessment

The doctor may perform a neurological examination to evaluate muscle strength, reflexes, and coordination. This can help identify any neurological conditions that may be contributing to the toe-walking.

4. Range of motion assessment

The doctor may assess the child's range of motion in the ankle joint and check for tightness in the calf muscles (Achilles tendon). A limited range of motion or tightness in the calf muscles can contribute to toe walking.

5. Additional tests or referrals

Finally, the doctor may recommend additional tests or refer the child to a specialist. These may include X-rays to assess bone structure, genetic testing, or a referral to a pediatric orthopedist, neurologist, or physical therapist for further evaluation or intervention.

The specific steps of the examination may vary depending on the healthcare professional and the individual case. It's important to consult with a qualified healthcare provider who can provide a comprehensive evaluation and appropriate guidance based on the child's specific circumstances.

Treatment options to help children who toe walk 

The treatment options for toe walking depend on the underlying cause and the severity of the condition. Here are some commonly used interventions:

Observation and reassurance

In some cases, toe walking may resolve on its own without intervention, especially in young children who are still developing their coordination and balance. Observation and regular monitoring may be recommended to ensure that the condition does not persist or worsen.

Physical therapy

Physical therapy plays a crucial role in addressing toe walking. A physical therapist can provide exercises and stretches to improve muscle strength, flexibility, and range of motion. They may also use techniques to promote a more typical heel-to-toe walking pattern.

Orthotic devices

Orthotic devices, such as ankle-foot orthoses (AFOs), can be used to support the foot and ankle in a proper alignment and discourage toe walking. AFOs are custom-made or prefabricated braces that provide stability and promote a more normal gait pattern.

Stretching exercises

Stretching exercises, particularly for the calf muscles and Achilles tendon, can help alleviate tightness that contributes to toe walking. The doctor or physical therapist can demonstrate appropriate stretching techniques to be performed regularly at home.

Serial casting

In cases of severe and rigid toe walking, serial casting may be employed. This involves applying a series of casts to gradually stretch and lengthen the calf muscles and Achilles tendon over time.

Botox injections

In some instances, when tight calf muscles are the primary cause of toe walking, botulinum toxin (Botox) injections may be considered. Botox injections can temporarily weaken specific muscles, allowing for an improved range of motion and a more typical gait pattern.

Surgery 

In rare cases where conservative measures have been ineffective, surgical intervention may be considered. Surgery aims to lengthen the Achilles tendon or address any structural abnormalities that contribute to toe walking.

It's important to note that the treatment approach will vary depending on the specific underlying cause, the age of the individual, and the severity of the toe walking. Consulting with a healthcare professional, such as a pediatrician, physical therapist, or orthopedic specialist, is crucial for a proper evaluation and to determine the most suitable treatment options for each individual case.

Can a specific style of shoe help stop toe-walking in children?

While there is no specific style of shoe that can definitively discourage toe walking, certain shoe features may be beneficial in promoting a more typical gait pattern. Here are some considerations when selecting a proper shoe for a child who toe walks:

Firm heel counters

Look for shoes with a firm and supportive heel counter, which is the back part of the shoe that wraps around the heel. A firm heel counter provides stability and helps prevent excessive ankle movement, encouraging a heel-to-toe gait.

Arch support

Adequate arch support can help maintain proper foot alignment and promote a more natural walking pattern. Look for shoes with built-in arch support or consider using orthotic inserts if recommended by a healthcare professional.

Flexible sole

Shoes with a flexible sole allow for natural movement and flexibility of the foot. This can help the child develop a more normal walking pattern and engage the muscles of the foot and ankle appropriately.

Proper fit

Ensure that the shoes fit well and are neither too loose nor too tight. Shoes that are too loose can lead to instability, while shoes that are too tight can restrict proper foot movement and cause discomfort.

It's important to note that shoes alone are not a primary treatment for toe walking. They can complement other interventions, such as physical therapy or orthotic devices, but the underlying cause should be addressed and managed appropriately. Consulting with a healthcare professional, such as a pediatrician or a physical therapist, can guide shoe selection based on the specific needs of the child.

For children who will naturally outgrow toe-walking, certain features “gamify” how your child walks and encourage them to walk with flat feet instead of on their toes. (i.e. their feet flat on the ground rather than on their toes, not to be confused with fallen arches.)  For example:

Squeaky shoes

Squeaky shoes produce a sound with each step, which can provide auditory feedback to children and potentially encourage a heel-to-toe walking pattern. The sound can help children become more aware of their footsteps and may aid in the development of a more typical gait over time. (Though buyer be warned: They may drive you nuts!)

Light-up shoes

Light-up shoes have LED lights embedded in the soles that light up with each step. These shoes can be visually stimulating for children and may add an element of excitement and fun to their walking experience. While they do not directly impact toe walking, they can encourage children to engage in physical activities and enjoy the process of walking.

What if toe walking does not resolve on its own or through medical treatment?

Toe walking itself may not typically cause pain or limit activity in the absence of an underlying condition. However, if toe walking persists and is associated with an underlying issue or structural abnormality, it can potentially lead to complications that may cause discomfort or limit certain activities. Some possible complications include:

Muscle imbalances and tightness

Prolonged toe walking can lead to imbalances in the muscles and tendons of the lower leg, particularly the calf muscles and Achilles tendon. These imbalances can result in tightness, discomfort, or even pain in the calf area.

Decreased ankle range of motion

Persistent toe walking may contribute to a decrease in ankle joint range of motion, limiting the ability to fully flex or extend the ankle. This can impact activities that require a full range of ankle motion, such as running, jumping, or squatting.

Stability and balance issues 

Walking on the toes can affect balance and stability, potentially increasing the risk of falls or accidents during activities that require a steady and balanced gait.

The social and psychological impact

Chronic toe walking may also have social and psychological effects, particularly as the child grows older. They may face challenges in participating in certain sports, activities, or social interactions due to their atypical gait pattern.

Because of these possible complications, it is important to consult with a healthcare provider if you notice your child is toe-walking. By identifying and managing any underlying causes or contributing factors, it may be possible to prevent or minimize potential complications and improve overall function and comfort

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