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Ask the Baby Expert: Question #23: Toe Walking: Truths and Myths and When To Be Concerned

May 13, 2018
Toe Walking: Truths, Myths, When to be Concerned, when to see a PT, how to prevent it - everythingbabies.org

Toe Walking is a hot topic!

“My former 28-weeker [preemie] is a year and a half and he started walking on his tippy toes…”
“My daughter is a toe walker and also delayed in speech. This is based on early on PT. They did suggest a shoe with high arch support.  What is the best type of shoe? They didn’t give us an exact brand.  Also, should we be requesting additional PT? I’m starting to get a lot of anxiety with her delays as she’s getting older.”

 

Having so many parents of blooming babies in my Facebook group has taught me a lot about my profession and how important it is that I’m sharing my expertise and experience on the internet!

 

Here are some very common myths about toe walking that I’ve seen online (and in my practice) from professionals:

 

“They’ll grow out of it. If they’re still doing it at 3 years old, then we’ll address it”.

“It’s not a concern. He’s ‘just exploring'”

“It’s because he has tight heel cords. [Lacking range of motion in his ankles.] There’s nothing a PT can do about it. We’ll do surgery when he’s 4 if he’s still doing it.”

 

And then there are parents offering their well-intended, anecdotal* advice:

“I walked on my toes until I was 13. There’s nothing wrong with me.”

“Their calves are really strong…she’ll be a good sprinter when she grows up!”

Ugh…I’m pulling my hair out!

Please, get a referral for PT if your child cannot walk consistently with flat feet.

 

Here are the truths about toe walking:

  1. Children do not “grow out of it” if they are not able to walk flat-footed at all.
  2. It’s not a lack of range of motion. It’s the brain’s error in programming, telling the foot that it functions best at a certain degree of plantarflexion (toe-pointing). The height of the heel may be different for each kiddo. The lack of range of motion is a consequence of constant toe walking when the heel cords (Achilles tendons) don’t get fully stretched by more normal, heel-toe gait and squatting with heels on the floor.
  3. It’s not a sign of calf strength.  It’s actually a compensation for weakness in the abs and gluts (core).
  4. It is strongly correlated with sensory processing dysfunction and vestibular issues. This means it is often a compensation strategy for poor balance and proprioception (the brain’s awareness of the joints and body parts in space)
  5. It is strongly correlated with speech delays. Which means it is not typically a problem in the feet but in the brain.
  6. It is very difficult to treat, even when you are treating the other related issues (speech, balance, sensory.)
  7. Foot/ankle orthotics (braces) can help “cure” toe-walking if prescribed correctly and are worn consistently. Some pediatricians and specialists (ahem…surgeons) don’t think they help, but I have never seen orthotics make toe walking worse, so it’s worth trying if the PT knows how to prescribe them correctly and the parent/child is compliant with the home program.
  8. Taping, soft tissue work, balance training, verbal cueing, prescribing heavy shoes with good arch support, and duck walking are also common types of treatments in physical therapy.

 

In 14 years I have never worked with a toe-walker that didn’t have one of the above issues (co-morbidities.) That’s why it’s so misunderstood, complex, and difficult to treat.  That’s why they call it “idiopathic” toe walking.

Idiopathic: “relating to or denoting any disease or condition that arises spontaneously or for which the cause is unknown.”

 

So, how do I know if my child needs PT for toe walking?

  1. If your child is walking on their toes more than 50% of the time, ask for a referral
  2. If your child is toe walking more than 25% of the time and has any of the above risk factors, ask for a referral for PT and to address the other issues like speech, developmental delay, and sensory processing.
  3. If your child’s heel cords are so tight, they cannot get their heels on the ground or squat to 90 degrees with their heels down, get a referral to PT.

If you suspect your baby is toe walking or is at risk of toe walking…I can help!

Join the Preemie Power Facebook group for videos and tips on preventing or minimizing toe walking! (You don’t have to be a preemie parent to join, 90% of the information in that group also applies to full term babies.)

Schedule a one-on-one video consultation with me!  Send me a video of your baby in action and we will chat “in person” about strategies and techniques specifically for YOUR child’s individual situation. The first 30-minute consult is free! 

(Click the image below or go to: https://everythingbabies-wendyrohin.youcanbook.me/)

 

Ask the Baby Expert! Free 30min consult with Wendy Rohin, pediatric PT at everythingbabies.org

 

How do I prevent  my child from toe walking?

How to prevent it? That’s easy! Don’t let them walk on their toes! 😉

OK, it’s not that easy. There are other things you can do (and not do) to prevent it.

Jump over to this article to learn how to prevent toe walking before they are off and running!

“Prevent toe walking with these 5 simple tips and tricks”

 

But first, here are some risk factors that increase the likelihood of a child becoming a toe walker.

 

RISK FACTORS FOR TOE WALKING

  1. Prematurity (Read this post)
  2. Developmental delays (Read this post)
  3. Neurological diagnosis (ie cerebral palsy, lack of oxygen at birth, brain bleed at birth)
  4. Sensory processing disorder (ie autism spectrum disorders, over-stimulation, poor sensory regulation)
  5. Overuse of “containers” (ie jumpers, walkers, exersaucers or any baby sitting device that limits the amount of time a baby in on the floor working on gross motor development, especially tummy time!

The subject of baby containers warrants more discussion and is a whole separate blog post on its own.

But the basic connection to toe walking, besides lack of floor time, is the artificial support provided by the container’s seat in jumpers, walkers, and exersaucers. This decreases the input to the feet and often the heels never touch the ground. Then the repeated jumping and springing off the toes falsely wires the brain to using the feet abnormally when it comes time to standing and walking independently.  Does that make any sense? Comment below if you’d like more clarification.

 

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CLICK HERE to learn more! 

 

 

And before you go…here is a valuable quote and an even more valuable warning…

 

“I did then what I knew how to do…Now that I KNOW better, I DO better.”  Maya Angelou

 

You should not feel an ounce of mommy guilt for not knowing everything! ♥

 

And now a “soap-box” public announcement warning from Everything Babies!

Please be careful taking advice from other parents.  Parents are the worst when it comes to anecdotal evidence. (Please don’t take offense…I only say this to HELP you and your child. I have no other motive!)
If someone says, “I slept on my tummy, and I’m still here” that is anecdotal evidence and has NO BEARING on the importance of Back to Sleep in the prevention of SIDS.
Anecdotal evidence: Evidence collected in a casual or informal manner and relying heavily or entirely on personal testimony. “Anecdotal evidence is based on hearsay rather than hard facts.”  (Quote is from vocabulary.com)
My favorite one, which actually came from a member of our state early intervention program, “My best friend’s child started showing signs of autism just hours after he got his 12-month vaccines.” {Insert very dramatic eye roll here…}
THIS IS ONE PERSON’S PERCEPTION OF THEIR CHILD’S DIAGNOSIS, BASED ON ONE STUDY OF 12 CHILDREN IN 1998 THAT WAS FRAUDULENT AND FUNDED BY LAWYERS LOOKING FOR LAWSUITS, BUT BELIEVED AND CHAMPIONED BY A CELEBRITY …but I digress….

Knowledge is far superior to fear.  Accurate knowledge moves you forward and allows you to reach your goals! ♥

Cheers! everythingbabies.org

Toe Walking: Truths, Myths, When to be Concerned, when to see a PT, how to prevent it - everythingbabies.org

Toe Walking: Truths, Myths, When to be Concerned, when to see a PT, how to prevent it - everythingbabies.org

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1 Comment

  • Reply Sonya G. October 30, 2020 at 1:55 am

    Hi there.

    My daughter will be 26 months old in 9 days.

    She is a 50-60% toe walker when she has no shoes on and is walking on a smooth surface indoors, maybe 30-35% with shoes that are flexible, and about 5-10% with thick high-top shoes.

    Additionally, she is also speech delayed at about 6-7 months.

    However, we had an evaluation done by a series of developmental professionals who determined the she had no autism spectrum disorder red flags due to the following reasons:

    (1) she has always had great eye contact since before she was 2 months old,
    (2) was able to sit up straight without support at 6 months,
    (3) began actually babbling consonants starting at 6 months,
    (4) began walking at 10.5 months,
    (5) began waving at 11 months,
    (6) began pointing right after 16.5 months,
    (7) has joint attention,
    (8) began smiling at 2 months
    (9) plays with a diversity of toys,
    (10) plays pretend games (pretends to feed her dolls/stuffed animals),
    (11) she enjoys the company of other children and the people in her life,
    (12) and she has good receptive language in 2 languages (she is being raised bilingual.)
    (13) Loves to dance
    (14) Blows kisses to people
    (15) Can follow a number of 1-step instructions, if not 2-step instructions.
    (16) Has some expressive language that is appropriate for her age

    To date, she has a word bank of 57 single words. HOWEVER, some of them are mere approximations and some of them are just sounds she uses to identify the object. For example, she calls forks/spoons “ba.” When I ask her where the fork or the spoon is, she can differentiate the two, but will refer to both of them as “ba.” Additionally, she pronounces “monkey” as “buckey” and “more” as “moe” and “door” as “doe.” Also, “light” is “law.” “Arm” is “uhm” or “amma.” “Nose” is “nooo.” “Ear” is “eaaah.” This is just an example.

    To date, she has not rolled her Rs, produced any S sounds, F sounds, or a string of consonants in a word.

    And she just began combining words at 25 months. So far, we had 12 instances of word-combining within her 57-word bank with some of the incorrect pronunciations and word replacements.

    On top of that, for several action words, she prefers gestures rather than words, even words that she actually can say. She nods her head for “no.” She motions to her mouth to eat. She puts her head on the palm of her hand to indicate she wants her blanket or wants to go to sleep.

    She will be receiving BOTH physical therapy and speech therapy. In the meantime, is there any knowledge or anything we can do to help her overcome both her toe walking and speech delay outside of the therapy if, in fact, it is neurological in nature.

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