Toe walking

Toe-walking is seen in many conditions such as cerebral palsy, muscular dystrophy,  and hemiplegia. In these conditions, it manifests as a consequence of spasticity and/or tightness of the calf muscles. However, toe-walking is also frequently seen in children with autism and sensory processing dysfunction.

There are 3 primary causes of toe-walking:

·         Spasticity and/or tightness of the tendo-achilles (tendon that attaches the calf muscle to the heel).

·         Decreased proprioceptive input through the calf muscles.

·         Idiopathy.

Toe-walking secondary to decreased proprioceptive input through the calf muscles is seen in the presence of hypotonia. In my clinical experience, I have observed a strong correlation between vestibular inefficiency, hypotonic muscle tone, and toe-walking.

Inefficient processing through the vestibular system consequently leads to poor proprioception since there is a close association between the two sensory systems. Toe-walking is a means of gaining proprioceptive input through the calf muscles when there is low muscle tone. 

Many children with sensory processing dysfunction do overcome toe-walking within a few weeks. However, if it persists over months and beyond the age of 03 years, it takes longer and becomes challenging to correct it through intervention. Since the brain adapts to any behavior that persists, toe-walking that persists over years during childhood then becomes a behavioral pattern of gait, i.e. the child becomes decreasingly aware of his/her heels on the floor. Hence  it becomes crucial to take corrective measures as earlier as possible.

Treatment for toe-walking

When spasticity is the underlying cause of toe-walking , the treatment approach is to reduce the spasticity and improve the muscle flexibility through appropriate neuro-developmental techniques, stretching, as well as possible use of braces.

When the underlying causes are decreased vestibular processing and hypotonia , therapeutic activities targeted toward the same become the treatment choice.  Some of these are as follows:

·         Propel the scooter board in sitting.

·         Backward walking.

·         Pushing forward a heavy stroller/ toy cart.

·         Box-skating or walking in shoe boxes.

·         Squatting in a vertically placed barrel.

·         Rubbing foam on heels actively by the child to encourage awareness of the heels.

·         Improving processing through the vestibular system warrants a multitude of activities.

An evaluation by a physiotherapist is essential for identifying the underlying cause of toe-walking, following which the appropriate treatment should be decided.

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