Three years ago, I wrote here about my daughter who is a toe walker. She saw a pediatric orthopedist and had several physical therapy sessions at age 5. Today, Megan is 8 years old and still walks on her toes.

A Recap of Our Family’s Experience with Toe Walking

In my initial post about my toe walker, I explained how Megan walked with a normal gait as a toddler, but shortly after her fourth birthday, she began walking on her tip toes more and more frequently, until she was continually up on her toes. Constant toe walkers can end up shortening the tendons in their legs so much that they lose the ability to stand flat with their heels on the ground.

Megan doesn’t have cerebral palsy, muscular dystrophy, or autism, which are conditions that are sometimes tied to toe walking. Our pediatrician referred us to a pediatric orthopedist who diagnosed Megan with tight heel cords. Megan was considered a habitual idiopathic toe walker, meaning it was simply a habit and there was no known reason for the toe walker behavior.

The orthopedist prescribed a few weeks of physical therapy to stretch Megan’s tendons, because her muscles were so tight she had difficulty standing up straight when we asked her to stand with her heels on the floor.

If physical therapy didn’t work, the orthopedist told us to return and they would do serial casting, in which a series of casts are placed on the child’s feet and lower legs that force the feet into the proper position and are supposed to retrain a child to walk with a typical gait.

Megan went to six sessions of physical therapy over four weeks. During that time, she increased her range of motion and gained more flexibility, but she still walked on her toes unless we frequently reminded her to get down on her heels. The physical therapist told me Megan would outgrow her toe walker behavior, that it was a habit that took time to break, and that eventually kids grow big enough and heavy enough that they get down on their heels.

We were only a few weeks out from that last physical therapy session when I first wrote about our toe walker experience.

What Happened After Physical Therapy

We continued doing Megan’s physical therapy exercises and stretches at home three times a day. It helped her maintain range of motion so she could stand correctly when we asked her to, but we never saw a decrease in the toe walking. Also, Megan didn’t like taking time to stretch three times a day, and it felt uncomfortable to her.

Because it didn’t seem to be making a huge difference, we became less consistent about stretching her three times daily. When she began kindergarten and was in school full time, we had her stretch only once or twice a day, usually before school or before bedtime. I asked her teacher whether she qualified for physical therapy through the school district, but she did not qualify because her toe walking did not impact her ability to learn.

Based on advice we read online, I bought some strap-on ankle weights designed for exercise and had Megan try wearing them around the house. She still walked on her toes.

I also bought Megan a pair of high-top Nike tennis shoes and several pairs of fashion boots in hopes that they would make it harder for her to get up on her toes. They did not have the desired result.

Toe Walker: Where We’re at Today

Megan still walks on her toes. She’s not always high up on her toes, but her toes are the first part — and often the only part — of her foot to hit the ground when she walks. She has a bounce in her step. If her heel does make contact with the ground, it’s usually with a toe-to-heel gait or she slaps her foot down flat instead of walking with a heel-to-toe gait. We can give verbal reminders to walk correctly and she will do so, but seconds later, once we’re not nagging her, she’s back on her toes.

We could have returned to the orthopedist, who suggested serial casting if physical therapy didn’t work. When I researched casting, though, I learned many children eventually revert back to walking on their toes after going through the treatment. Serial casting didn’t sound pleasant to us either. Children typically spend one month to 12 weeks walking around with large casts on both feet and legs, with no swimming, a lot of itching, and taking measures to prevent the cast from getting wet while bathing. I wasn’t sure I wanted to put Megan through casting – and potentially pay a lot of money for it – if the long-term results were uncertain.

There simply don’t seem to be any magic-bullet treatments for toe walking, whether it’s physical therapy, braces, or casting. Some doctors recommend Botox injections or surgery to cut the leg tendons, but I’m not a fan of those invasive treatments.

My husband and I have had several years to develop some unofficial theories as to why Megan walks on her toes. We half joke that it started when she took a liking to princess dress-up dresses as a young preschooler. It seemed it was impossible for her to walk normally in a frilly, fluffy dress, and instead she frolicked, fluttered, danced, and tiptoed all over the house. Whether that was the beginning of a bad habit, we’ll never know.

Realistically, Megan may have some mild sensory issues. Over the years, it was common for her to dig her toes into the couch or push her toes hard against my husband or me when we sat together on the couch. She seems to seek extra stimulation for her toes.

I’ve also been told anecdotally that it may be hereditary. My grandmother told me my mother walked on her toes as a child and eventually stopped.

Some doctors believe toe walkers may have subtle neurological conditions that doctors don’t yet know how to recognize or diagnose. In the back of my mind, I sometimes wonder if Megan’s diagnosis of mild isolated ventriculomegaly while I was pregnant with her has anything to do with her toe walking. The ventricles in her brain were mildly enlarged, and if they continued to grow they might have put pressure on the brain and caused damage. An ultrasound a day after her birth indicated her ventricles were a normal size, and that was the end of our concerns, and Megan is a smart and healthy child. It’s perhaps a farfetched theory to explain her toe walking, but I sometimes wonder.

In the meantime, Megan’s core muscles in her stomach are strong because of all the time she spends on her toes, and she excels on the bar in her gymnastics class. On the other hand, her teacher reminds her to touch her heels to the mat at appropriate times when she does floor and beam exercises.

At this point, we tolerate the toe walking and believe it’s simply part of who Megan is. We continue to have Megan stretch and do physical therapy exercises periodically so her tendons remain loose and she doesn’t lose her ability to get down on her heels, but we don’t ask her to do those things every day anymore. We have a happier relationship with Megan when we aren’t hassling her daily about stretching, and it wasn’t fixing the problem anyway.

We learned that we can’t make her stop. If Megan is going to stop toe walking, she will have to be the one to make that decision and put in the effort to change.

Doctor’s Advice We Can Follow

What really helped me feel better was Megan’s annual well-child doctor visit this past winter. We saw a different pediatrician in the office, one whom we hadn’t seen since the toe walking began. I mentioned Megan’s toe walking and said we periodically stretch her to maintain range of motion.

Then the pediatrician confessed that she is a toe walker herself.

“You used to walk on your toes?” I asked.

“I STILL walk on my toes,” she said.

She showed me her shoes, which had a slight raised heel, and explained how she feels most comfortable in shoes with a bit of a heel. She admitted she isn’t a fan of serial casting because the weeks-long process of wearing casts can be invasive and emotionally traumatic for a kid. She also believes that for many kids and even for herself, toe walking is a sensory thing; it just feels good or natural to walk that way.

She encouraged us to keep doing what we’re doing: Make sure Megan stretches occasionally to retain her range of motion, and don’t worry about the toe walking.

Those are doctor’s orders we can follow.

Photo credit: Flickr.com

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Category: Health

Tags: pediatric orthopedics