Idiopathic toe walking is when a healthy child keeps walking on their toes even after attaining the age where they should be walking on a heel-toe gait. Though common in younger children who are learning to walk, overtime, the children tend to outgrow the condition and walk normally.
Several cases can lead to idiopathic toe walking. When children grow older with persistent toe walking, they begin to embrace it out of habit. The muscles and tendons of the toes also take shape and become rigid, which makes it a little hard to correct in old age.
The earlier you start dealing with toe walking, the faster you will achieve normal walking in children. Otherwise, for persistent toe walking, you need to be braced for periods of casting and correctional interventions.
Take your child to a medical professional immediately you suspect a case of toe walking. The doctor will determine the best course of action, whether treatment is possible, and any other concern. There are cases when parents raise concerns only to realize the children are slow in growth.
This article will look into the causes of the idiopathic toe walking and some of the possible interventions.
Causes of Idiopathic Toe Walking
In most cases, idiopathic toe walking is caused in children when they learn how to walk. In some cases, though, there can be underlying conditions that can lead to the abnormally. Some of the possible causes include;
· Cerebral Palsy – Brain controls all the body functions, body movements, posture, and muscle tone inclusive. Injury to the brain can cause abnormal growth of the foot. Cerebral palsy can lead to stiff muscles and unsteady walking.
· Autism – Studies have revealed a correlation between idiopathic toe walking and autism spectrum disorders.
· Muscular dystrophy– There is the possibility of genetics having an impact on idiopathic toe walking. A child might start walking, and over time, the muscle fiber weakens due to genetic diseases.
· Short Achilles tendon– Tendon connects the back of the heels and the lower leg muscles. A short tendon prevents the heels from touching the ground.
· Spinal cord abnormality– Abnormalities in the spinal cord like when it attaches to the spinal column and spinal mass can lead to toe walking.
There is also a risk factor in idiopathic toe walking due to genetic composition. There is a high likelihood that toe walking runs in families.
While the consequences of untreated idiopathic toe walking are still unclear, there are several actions to help to alleviate it. For now, it is believed that persistent idiopathic toe walking can lead to susceptibility to falling and tripping. It can also lead to other cosmetic and social impacts.
At the moment, studies are still underway to determine the best means to go about curbing it. So far, there are several ways through which you can help a child’s ankle becoming a limitation.
Some of the best interventions include:
Physiotherapy is a proven way through which children can successfully overcome idiopathic toe walking. You need a qualified pediatric physiotherapist to examine and ascertain the extent of the child’s condition. The professional monitors the child when partaking several tasks like walking, running, or moving around the floor. The physiotherapist will then recommend the right treatment based on the child’s movement and strength.
It is the assessment report that informs every other proceeding physiotherapy session.
The first step in the treatment is stretching. Even though it is known to provide the least results, most professionals use it to keep a desirable range of motion (ROM).
Some of the techniques involved in medical therapy include orthotics, stretching, chemodenervation, and casting. The doctors will use these options depending on the severity and the underlying teitology.
2. Active Range of Motion
You need to get your child active and working on different surfaces to help correct the idiopathic toe walking. Some of the options to choose is letting the child stand on a surface without shoes. Use a wobble board, dyna-disc, Naboso Mat or incline wedge surfaces for this activity.
The child needs balance to stand on the surfaces. To keep the balance, they will experience an intense stretch of the toes muscles, which leads to correction of the condition.
Other than just standing on the surface, let the child walk on it without shoes. Walking activates the intrinsic plantar muscles as the feet stretches to cover the ground. These muscles are essential in keeping balance and will let the whole feet stretch.
To remove monotony on the regime, you can play up the standing and walk with animal walks. The bear walk involves the child having both hands and feet on the floor. The more the child makes the movements, the more the muscles stretch. You can also opt for crab where the child moves with the hands and feel for propulsion with the back facing the ground. Frog jumping requires full foot contact with the ground when making the jumps, just like penguin walk, which ensures the heels are in connection with the floor.
While it might be all games and jumps, the more the child stretches the muscles, the better the correctional chances.
3. Sensory Integration Activities
In addition to the above intervention for idiopathic toe walking, you can include everyday practices to help your quest. Get the child to try out exploration of different sensory surfaces barefoot regularly. The type of shoes your child uses can also help alleviate idiopathic toe walking. You need shoes that fit well and allows the child to step on the ground entirely. Heavier shoes with ankle caps will come in handy in controlling foot movement and alignment.
Insert other materials in the shoe for alignment. Such materials include tactile simulation methods and other vibrating cushions. Naboso Neuro Insoles is one of the of the simple, non-invasive interventions doctors use in managing idiopathic toe walking. These textured insoles have demonstrated efficacy in reducing a toe-walking gait.
A study established that whole body vibrations improve the number of heel strikes, ankle range of motion and gait. The vibrations can be used as easy and accessible home treatment option.Trigger point release exercises using foam rollers and massage balls can help release the tension in the foot muscles to ease toe walking. The sustained pressure on the foot helps ease the trigger points that can shorten muscles or cause pain. You can also use night splints by letting the child wear ankle-foot orthosis to help stretch tight muscles while the child is asleep.
4. Orthopedic Surgery
Surgery might not be the first option to consider, except in cases of severe idiopathic toe walking. It is also not administered during the early stages of the child's growth. You must monitor the child for some time before deciding on the surgery. During the early stages, monitoring should be done every 3 – 6 months and take note of changes. In the case of no improvements, you will introduce physical activities and exercise.
It is only when this option fails that you introduce the surgery. By this time, the child would be around 3 years old. It is also necessary only when the child feels discomfort and functional limitations due to the condition. These patients, in most cases, tend to have underlying muscle or neurological abnormality.
The surgery involves lengthening the patient’s ankle equinus to increase the patient's gait. The process can either be percutaneous or open technique. There are different surgical procedures like the heel-cord lengthening on patients with paralytic muscle diseases. Selective gastrocnemius length is preferred when the process is to bring the ankle to a neutral with the knee.
It takes around 4 -6 weeks after the surgery for the patient to heal. Taking care of a child during the post process can be a little hectic. Therefore, you need to ensure the child’s comfort for proper healing. You can raise the child’s legs for around 2-3 days during the early periods when acute swelling is rampant.
Even though most orthopedic surgeries are successful, report any case of abnormalities to a medical doctor. Take note of cases of wounds, nerves, and any other injuries that might occur.
Interventions for idiopathic toe walking is not a destination but a journey. Whatever you do, make sure you are helping the kid step on the ground. You should integrate daily fun activities that will not seem to be work. Only go for surgery if all the options fail to work and in older children.