When children start walking for the first time, it’s always an exciting (yet stressful!) time. From those first awkward steps, over the next few months their style of walking evolves as they get stronger and more confident. By the average age of two, most children are established walkers.
Around this time, we can start to sit back and assess the way our children are walking. Occasionally it may seem they may be doing something that seems a little peculiar to us. Sometimes your maternal child health nurse may pick up on something and refer you to get your child assessed.
You may have noticed that your child walks up on their tippy toes quite frequently. Not just if they are dancing or running around, but just in their normal day to day walking. This is known as “Toe Walking”. It is where your child may walk around on the balls of their feet without their heels making regular contact with the ground. It can be very noticeable when they are walking in bare feet, and sometimes appears to be better when they are walking in their shoes. To ensure that you can implement the right treatment strategies, we recommend an assessment with your podiatrist.
The importance of the assessment is to distinguish whether the toe walking is idiopathic (no known cause with the absence of a medical issue) or pathological (caused by an underlying medical reason). This being said, most cases do end up being idiopathic and treated conservatively.
Your podiatrist will assess your child by doing multiple types of assessments. None of these are invasive or painful for your child. These assessments are as follows:
Medical History – An in depth medical history will be taken about your child and circumstances around their birth. For example, if there were any pregnancy complications, if the birth was premature and if there were delays in reaching developmental milestones. They will also ask about if your child complains of any pain or discomfort.
Physical Assessment – This would entail a gait assessment (watching the child walk) as well as a non weight bearing examination where range of motion tests would be conducted on the lower limb. They would also assess whether the issue was unilateral (one side) or bilateral (both sides).
Neurological Assessment – The podiatrist would check for any issues with their reflexes, sensations or muscle strength testing.
In some cases, there may be some concerns with the results and further testing may be required. This could be with a paediatrician, physiotherapist or neurologist. In these cases, your podiatrist can point you in the right direction and write a referral letter with detailed assessment results.
If there are no major concerns, your podiatrist may recommend conservative treatment. This will be dependent on the age of your child and their assessment results. This may include stretching, bracing, casting, footwear or just observation. They will review your child regularly and reassess to see if progress is being made.
In some cases where progress is not being made, or there is a physical restriction which will not respond to conservative treatment, surgery may be indicated.
Although this information may be daunting, just remember that most cases are idiopathic and only need conservative treatments. But it is especially important for your child’s health that you are guided in the right direction. So, if you are concerned that your child may be a toe walker, please ensure to make an appointment for an assessment with your podiatrist.