Toe Walking is defined as the failure of the heel to contact the floor at the onset of stance during gait.
As a Pediatric Physical Therapist I have recently encountered a surge in the incidence of children who present with Idiopathic Toe Walking(ITW). As its name implies, Idiopathic Toe Walking refers to the manifestation of this gait pattern without a known underlying pathological cause. It is extremely important to categorize this diagnosis properly. In considering differential diagnosis, we need to rule out any neuromuscular or strictly orthopedic conditions. Always assess the child’s DTRs, muscle tone and range of motion to gain the best understanding of the underlying cause of the child’s presentation. Children who present with Idiopathic Toe Walking will always be bilateral and symmetrical, as opposed to a child with spastic hemiplegia who will demonstrate unilateral involvement.
A child with idiopathic toe walking may walk on his or her toes due to hyper or hyposensitivity. The child may not like the feeling of different surfaces on their bare feet causing them to rise up on their toes to decrease the surface of their foot in contact with the floor. We also need to consider the hyposensitive child. Toe walking increases the force of impact felt during ambulation, with the ground reaction force distributed through a smaller surface area at the metatarsal heads.
Weight bearing activities using a variety of textures will help provide insight, try sand, uncooked rice or beans, on an air cushion, or a tactile disk. A comprehensive history should be taken. Children who ambulate later or skip developmental milestones which limit weight bearing are often those who present later on with ITW. Does the child toe walk when wearing shoes? Is he/she able to achieve and maintain full range of motion at the ankle? Assess the child’s overall lower extremity biomechanics, from the position of the pelvis, to the knees and feet. Assess the child’s static vs dynamic arch formation as well as plantar intrinsics. Often times children with ITW will have weak intrinsic muscles, and use the toe walking to compensate.
Treatment Ideas to come….