and Addressing Toe Walking in Toddlers: A Guide for Parents

Q: and Addressing Toe Walking in Toddlers: A Guide for Parents

Hello： In response to your question, there are five possible reasons why a child may prefer to walk on their toes： 1. <br>Congenital： Such as clubfoot, where the shape of the foot is not normal and can usually be identified visually. <br>2. <br>Neurological： Such as in cases of c

Pediatric Gait Abnormalities

Dear Dr.
Li,
Hello.
My daughter is currently 2 years old.
Since she started walking, she has been walking on her tiptoes.
Even now, she still walks on her tiptoes and runs a little that way, but she does not do it when standing still.
We often correct her walking posture, and she can walk slowly using a typical walking style, but she quickly reverts to walking on her tiptoes.

I would like to ask how we can improve this situation.
Does she need rehabilitation? Thank you very much for your response.
Sincerely,
Cai Wei-Jing

Cai Wei, 30~39 year old female. Ask Date: 2003/11/29

Dr. Li Wenlin reply Orthopedics

Hello: In response to your question, there are five possible reasons why a child may prefer to walk on their toes: 1.
Congenital: Such as clubfoot, where the shape of the foot is not normal and can usually be identified visually.
2.
Neurological: Such as in cases of cerebral palsy or infantile paralysis.
3.
Muscular physiological: Such as muscular dystrophy.
4.
Psychological: Such as hysterical toe walking.
5.
Unknown causes: This is the most common reason, often due to gastrocnemius muscle spasm, followed by peroneal muscle spasm, and least commonly, accessory soleus muscle involvement.
Clinically, if the ankle can dorsiflex (toes pointing up) when the knee is bent but cannot dorsiflex when the knee is straight, it may indicate gastrocnemius muscle spasm.
Conversely, if the ankle cannot dorsiflex regardless of whether the knee is bent or straight, the likelihood of peroneal muscle spasm is higher.
Generally, toe walking caused by gastrocnemius muscle spasm is the most common, and rehabilitation treatment options are limited.
Casting may lead to recurrence, while surgical treatment (lengthening the gastrocnemius or Achilles tendon) is a more effective method.
Online consultations without direct observation can lead to assumptions; please seek medical attention promptly.
Wishing you well.

Reply Date: 2003/11/29

More Info

Hello, Mr. Tsai. Thank you for your question regarding your daughter’s toe walking. This is a common concern among parents, and I appreciate your proactive approach in seeking guidance.
Toe walking, or walking on the toes without the heel touching the ground, is often observed in toddlers and can be a normal part of their development. Many children go through a phase of toe walking as they learn to walk, and for some, it resolves naturally as they grow older. However, persistent toe walking beyond the age of 2 or 3 may warrant further evaluation.

Understanding Toe Walking
1. Normal Development: Many toddlers exhibit toe walking as they explore their mobility. It can be a sign of excitement or a way to balance themselves as they develop their motor skills. In most cases, children will outgrow this behavior as their walking patterns mature.

2. Possible Causes: If toe walking persists, it may be due to several factors:
- Muscle Tightness: Tightness in the calf muscles (gastrocnemius and soleus) can lead to toe walking. This is often referred to as equinus gait.

- Neurological Factors: In some cases, toe walking can be associated with neurological conditions, such as cerebral palsy or autism spectrum disorders, though this is less common.

- Sensory Processing: Some children may prefer toe walking due to sensory preferences, finding it more comfortable or stimulating.

Addressing Toe Walking
1. Observation: Continue to observe your daughter’s walking patterns. Note if she walks normally at times and if there are specific situations where she prefers toe walking. This information can be helpful for healthcare providers.

2. Encouragement: Gently encourage her to walk flat-footed. You can make it a fun game or use positive reinforcement when she walks correctly.
3. Footwear: Ensure she wears supportive shoes that encourage proper foot placement. Avoid shoes that are too flexible or lack support, as they may contribute to toe walking.

4. Physical Therapy: If toe walking persists or if you notice any signs of discomfort, it may be beneficial to consult a pediatric physical therapist. They can assess her gait and provide exercises to stretch the calf muscles and strengthen the foot and ankle.
5. Medical Evaluation: If toe walking continues beyond the age of 3 or if you have concerns about her development, it may be wise to consult a pediatrician or a pediatric orthopedic specialist. They can rule out any underlying conditions and provide tailored recommendations.

Conclusion
In summary, while toe walking can be a normal part of development, persistent toe walking should be monitored. Encouraging flat-footed walking, ensuring proper footwear, and considering physical therapy can be effective strategies. If concerns persist, seeking professional evaluation is advisable.
Thank you for your inquiry, and I wish you and your daughter all the best as you navigate this developmental phase. If you have further questions or need additional support, please feel free to reach out.

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