If my child is still toe walking past toddlerhood — does she need professional help?
My oldest daughter often doesn’t walk correctly. On any given day, you’ll spot Megan traipsing around high up on her tippy toes. Sometimes my husband and I get comments about her future as a ballerina, but this is not how I’d like for her career as a dancer to begin.
The toe walking began last spring or summer. I was the first to notice and express concern. I once worked at a preschool for special needs children and saw a lot of toe walkers. It’s common for children to walk on their toes when they first learn to walk, but they generally stop toe walking by the end of their toddler years. Toe walking is often associated with children on the autism spectrum or children with cerebral palsy or muscular dystrophy, but Megan is not autistic nor does she have a muscular or neurological disorder.
Sometimes toe walking is a proprioceptive or tactile issue, too. I don’t know whether any science backs it up, but my grandmother claims my mom was a toe walker, leading us to wonder if it may be hereditary. After a little Google research, I suspected Megan was probably a habitual or idiopathic toe walker, meaning there is no known cause and no other health problems. It’s just a habit.
What’s the big deal with toe walking?
The problem with habitual toe walking is that over time it can shorten the tendons in the back of the leg, down low in the calves and even up in the hamstrings. If the muscles get too tight, it can be difficult or impossible for a child to walk properly or stand with her heels on the ground. Treatment ranges from physical therapy to more aggressive options like leg braces or serial casts – a series of casts worn for several weeks or months – that force the foot into a correct position. Some children also have surgery to cut and lengthen tight tendons.
We monitored Megan for several months. The toe walking became more frequent, and we often reminded her to walk on her heels. The toe walking didn’t bother her, but it irritated me. The way Megan walked was … different. It looked so extreme when she perched as high as she could get on her toes and bobbed around all day like that. I nagged her to get down on her heels. We had her practice walking consciously in a heel-to-toe pattern. We had her stand with her toes on a thick book while her heels touched the floor. It was a stretching exercise for toe walkers that I’d found on the Internet, recommended by a physical therapist.
By October or November of last year, we decided to seek professional help. I’m not the type of parent who takes her children to the doctor for every little sniffle or bump, though, so I was hesitant to make an appointment with the pediatrician just for toe walking when nothing else was wrong. Megan’s birthday is in January, so I waited and brought it up at her annual checkup.
Our pediatrician referred us to a pediatric orthopedist. The orthopedist took an x-ray from Megan’s hips to her toes and declared that everything looked fine. She saw no curvature of the spine and no problems with Megan’s hips, legs, or feet. She gave Megan’s feet a quick look and asked her to walk and run down the hall. She diagnosed Megan with tight heel cords and prescribed physical therapy to “loosen her up.” If physical therapy didn’t work, we were encouraged to come back in three months to talk about serial casting.
Megan had six physical therapy sessions over four weeks. She was so tight on the first day that when the therapist had her stand with her heels flat on the floor, she bent slightly at the hips to ease the pull on her leg muscles. We were given a set of exercises to do three times a day at home to stretch Megan’s calves and hamstrings. One of the most effective ones is the towel stretch. I also got stretching ideas while watching Megan’s physical therapy sessions. Who knew that kicking a soccer ball, walking on a balance beam, doing the crab walk, or walking down steps could be so helpful?
Our last physical therapy session was a few weeks ago. Our therapist used a device that looked like a hinged ruler to measure Megan’s flexibility and range of motion in her ankles and legs on the first and last days of therapy, and she showed improvement. The therapist was confident we would continue to make progress with a home therapy program and didn’t need further visits to the therapy gym (and $25 copays every time!). Both the orthopedist and physical therapist reassured me that most children eventually stop walking on their toes because it becomes uncomfortable as they grow heavier.
We are continuing our stretches at home. Some days it’s hard to squeeze three sessions in, especially on mornings when we’re on a schedule and headed off to preschool or church. Megan doesn’t like to be bothered with stretching, and it feels uncomfortable to her.
She continues to walk frequently on her toes, especially when she’s distracted by people or an activity and is not thinking about her feet. She loves keeping her toes pointed so much that she also has a tendency, when she’s standing in one place, to keep one foot flat while she bends her other leg so her toes are the only part of her foot touching the ground. I bought her new white dress shoes for Easter and the toes are already scuffed. (Grr.) We also ask Megan not to sit on her knees because it allows her to point her toes. Instead, she sits criss-cross applesauce.
We know that at least we’re helping her retain her range of motion by keeping her muscles stretched. Megan is wobbly when she’s on her toes, and we worry some about the long-term effects on her posture. We also know Megan’s gait may stand out when she starts kindergarten this fall, although in my online research I haven’t come across any stories of toe walkers being teased for being different. I’ve also noticed Megan’s 17-month-old sister experimenting with walking on her toes and worry that she may be copying her big sister and picking up the habit, too. She’s still young enough she may outgrow it, though.
I found some reassurance when I stumbled across the blog of another parent of a toe walker. This writer’s daughter, Lydia, has been a toe walker from the start and was still doing it at age 7, at the time of her last update on their toe walking adventures. Lydia had physical therapy, braces, and serial casting over the years, with varying degrees of success. The serial casting, a treatment possibility Megan’s orthopedist discussed with me early on, worked wonders for Lydia until she got back into the habit of toe walking a few months later. She finally saw an orthopedist who suggested some kids are “just toe walkers.” The orthopedist suggested that if it wasn’t bothering Lydia, they
ought to just “let it be.” And so they have, more or less.
There are no quick or easy fixes for toe walking. Our physical therapist said breaking a toe walking habit is a process and not an overnight cure. We’ll continue to work with Megan, stretching her legs and reminding her to “walk on her heels.” We’ll also continue to love her. The way she walks is only part of who she is, and it shouldn’t obscure how beautiful the rest of her is.
Let’s connect on social media too:
Tags: pediatric orthopedist