Pediatric Foot & Ankle

Toe Walking in Children - Is There Reason For Concern?

March 23, 2021 Dr. Mikkel Jarman Season 1 Episode 2
Pediatric Foot & Ankle
Toe Walking in Children - Is There Reason For Concern?
Show Notes Transcript

 Toe walking is a walking pattern in which the child walks on their toes or the balls of their feet and there’s no contact of the heel to the ground. For children 3 years and younger, toe walking is very common. However, for children ages 3 and up toe walking may be associated with a medical condition. Fortunately, over 90% of these cases can be treated with conservative treatment options.

In this audio track, Dr. Jarman with Pediatric Foot & Ankle in Arizona, discusses toe walking in children and when there is reason for concern and when there is not.

Read more: Toe Walking in Children - Causes, Concerns, & Treatment
Watch full video: Toe Walking - What Every Parent Should Know

Dr. Mikkel Jarman:
Hello, I'm Dr. Michael Jarman here with Pediatric Foot & Ankle, and today I'd like to discuss toe walking, a condition that is visually obvious to parents and easily diagnosed when you see it. The struggle for a parent is what can be done to stop it. Toe walking is a walking pattern in which the child walks on their toes or the balls of their feet, and there's no contact, or severe balance between the heels and the ground.

Most children as they begin or start walking around 12 to 15 months may start to walk on their toes, but by the age of 24 months should be walking with their feet flat on the ground. By the age three children should be walking with a relatively normal heel to toe pattern. I'm often asked when as a parent, should I be concerned? The other doctors and the internet say my child will outgrow it. But when does my child need surgery? If I just wait longer will they eventually just start walking on their toes?

Tip toe walking can be normal in children, but after the age of three it is not. Let your intuition be the guide on this one. Any child after the age of three who walks on their toes needs to be evaluated by a specialist. As the child grows into adulthood they will develop other foot and ankle problems.

Here my clinic I'm evaluating several specific factors. Does the child have any underlying neurological disorders such as cerebral palsy, muscular dystrophy, brain, spinal cord injuries, autism or other sensory processing disorders? In these children toe walking can be normal? Can the child walk normal with the feet flat down a hallway? What is the child ankle range of motion with a leg extended? Will it flex past 90 degrees on X ray? Are there any bony abnormalities of the ankle or foot that would block this motion? What are the conservative care has been offered? And has your child responded to any of it?

The reality is that 90% of these children will have an excellent outcome with conservative care while the latter will require surgery. Conservative care is extremely effective if and only if there is strict compliance to the protocol. We find physical therapy lay casting orthotics, Botox injections, taping strapping stretching, even special shoes tend to fail these children or just not effective enough. There is a method of nighttime splinting that is very effective but must be implemented correctly and consistently by the parent for a minimum of one. But sometimes two years. This method is preferred and children over the age of three under the age of three we find this method to be difficult to implement, and often recommend a daytime brace with normal shoe gear that can help stretch and encourage a flat foot position. The mass majority of children who walk on their toes have idiopathic Aquinas, which is a tight or short Achilles tendon and when severe do not have the ability to stand flat. Because the muscle and tendon cannot physically lengthen enough, it is actually painful for them to walk flat, conservative cares that means to slowly and steadily lengthen this tendon muscle group, but it takes time and cannot be achieved overnight. If you think of braces on your teeth, they're applying pressure to your teeth 24 seven, and eventually they start to move. The correct method of splinting at night is no different. If we can gently and correctly brace these children for six to eight hours every night, I guarantee you, you will see results.

Surgery is a last resort but is an effective and direct way to stop toe walking in children that have failed conservative care, or just not candidates for conservative care. Lengthening is a surgical procedure in which a tight Achilles tendon is lengthened to allow proper range of motion and function of the ankle joint. When I surgically correct these children, there is an immediate resolution to the problem. Once the first leg has been lengthened the others lengthen three months later. This allows complete correction of even the worst toe walkers in a matter of months. It can be very frustrating for parents to watch their child toe walk and how it is dismissed, ignored or undertreated by many health care providers. We can provide answers and a treatment plan that will change their lives. If you'd like to have your child evaluated, or if your child is just not responding to current treatment. Please let us help and call our office today. I'm Dr. Michael Jarman. Thanks for watching.