Idiopathic Toe Walking
By Staff Writers
Children typically experiment with walking on their tip toes between one and two years of age – after they first begin walking. However, if a more mature walking pattern, which includes placing the heel first and pushing off with the toes, has not developed by about age three, there could be cause for concern.
“When looking at young patients, physicians should make sure that the child’s toes can still come up and that there is not a strong push response,” says Pam Dahm, a physical therapist with LifeScape’s Idiopathic Toe Walking clinic. “Checking of the reflexes can show if there is a strong reflex. And, of course, if they are just constantly up on their toes, it’s a sign they may need to be evaluated.”
While there can be many reasons for idiopathic toe walking (ITW), one cause can be abnormal bone growth. Another can be weakness in in the child’s abdominal and/or leg muscles. Walking on the toes allows the child to lock the ankles, knees and hips in a straight position and reduces the work that the muscles do. Toe walking can also be one of the first signs of a sensory integration disorder. If uncorrected, toe walking can lead to pain, imbalance, weakened muscles, and growth abnormalities.
“If a child is up on his toes, for whatever reason, the balance is naturally going to be thrown off,” says Dahm. “If this is mild and short-lived, it may not be a problem. But it you walk on your toes for a lifespan, it can lead to contracture of the ankles, pain in the joints because of extra strain, and can also limit balance and affect bone growth and gross motor development.”
Evaluation of ITW at LifeScape, begins with a family history and an assessment of the movement in the foot and ankle and observation of the child’s walking pattern by a physical therapist. Children with signs of sensory problems are referred to an occupational therapist.
A physical therapist who specializes in ITW may use stretching and strengthening exercises along with gait activities to promote a typical walking pattern. Serial casting may be utilized when other therapy activities are not successful. Supportive orthotics may be recommended to help maintain improved gait in conjunction with idiopathic toe walking treatment. Early interventions like these can often help patients avoid more invasive orthopedic surgery later in life.
“The interdisciplinary aspect of the toe walking clinic here at LifeScape is one of the most important aspects,” says Therapy Supervisor Melissa Carrier-Damon. “Sometimes the problem turns out to be sensory in nature, sometimes it’s a tone problem, sometimes we never know exactly why it’s happening. The wide variety of expertise that we have here to diagnose and treat it is a real advantage.”
To refer a patient or for more information on the evaluation process, call the LifeScape Rehabilitation Center at 444-9700.