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Fancy Foot Work

Do you find your child doing all sorts of fancy footwork on his or her toes?  If so, there may be more than a future Julliard or Nutcracker star to be considering.  Children who walk on their toes (toe walkers), especially at young ages, as their main mode of walking may be at risk for abnormal development of the structures in their feet.  Critical developmental ages for children’s feet occur before the age of 2.

There are a few reasons as to why children may walk on their toes: muscle weakness of the lower leg, tightness of the calf muscles, abdominal/core weakness, sensory processing issues, and being born premature.

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Weakness: With weak muscles, sometimes children are unable to get their muscles to function to help perform the typical heel-toe pattern we, as adults, commonly use during walking.  To address this issue, you can have children perform some of the following activities: walking on their heels like a duck, walking in swimming flippers, or squatting to roll a ball or to play with toys.  The most important part of playing in the squat position, is that your child’s heels remain as close to the floor as possible.  This helps to strengthen specific muscles that are commonly weak in toe walkers.

Tightness: Often times, tightness of the calf muscles may occur due to the constant and prolonged toe walking.  This may occur with or without muscle weakness.  All of the following stretches should be held for 20-30 seconds, 3 times, and performed 2-3 times each day.  It is easy to remember to stretch if you pair it with meals (especially if you love food as much as I do).  For example, stretch with breakfast, lunch, and dinner. To stretch with an older child who can follow pictures or “Simon Says” you can perform the following:

  1. Standing at a wall with the back leg straight and front leg bent as shown gently lean into the wall.
  2. Sitting with both legs straight out in front, and back straight, wrap a towel or belt around one foot at a time and pull up towards your face.  For older children you can tell them, “pull your toes towards your nose,” you may also assist your children with these stretches.

With younger children, you can stretch their feet into the “toes towards nose” position by placing your hand in the middle of their foot and pushing up slowly until you feel resistance.

Core Weakness:  Core or abdominal weakness can also contribute to toe walking.  I’m not saying your child needs to have a “6-pack” abs, but core stability is extremely important for balance and walking.  If your child toe walks, he or she is practically in a “controlled fall” meaning his or her weight is constantly shifted forward.  You may notice your child walking more quickly on his or her toes in comparison to children who do not toe-walk; this is because your child’s weight is shifted too far forward.  Increasing core muscle strength will help assist the child with balance and hopefully bring their center of mass backward.  This improvement in stability will then encourage more heel-toe walking vs. just toe walking.  Some exercises to help with core strengthening include:

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  1. Having your child sit on a couch cushion on the floor with their legs in “crisscross” position or with their feet together, have them reach for a toy in all directions up, down, sideways, behind.
  2. Start with your child laying on his/her back and then sit up to reach a toy or give a hug to mom or dad.  Try doing this with minimal use of the child’s arms.
  3. The “Superman.”  If your child is older, have your kiddo lie on their tummy and imitate a superhero pose with arms and legs up.  If your child is younger, hold him or her on their tummy in the air and try to get them to pull their arms and legs up into the superman pose.
  4. Swiss ball strengthening.  Check out the following site for a list of good activities for your children! http://nspt4kids.com/parenting/10-ways-to-use-an-exercise-ball-to-help-your-child-grow/

Sensory:  Children who have a sensory processing disorder are often toe walkers.  There are a few theories as to why these children walk on their toes.  One is that walking on the toes provides extra input that sensory seekers strive for.  Another theory is that since the bottom of the foot is so sensitive, children walk on their toes to avoid touching certain textures such as grass, carpet, etc.  To address some of these issues, you can expose your child to all sorts of different textures on the bottom of their feet.  Have them walk through the grass, on the carpet, on cement, through shaving cream, putting their feet in cool water one night then warm water another night…just about anything that you would put your hands in, you can put your feet in!  If your child avoids certain textures with their hands as well, it may be worth seeking the advice of an Occupational Therapist for some sensory integration techniques.

Prematurity:  Being born premature also has a correlation to toe walking.  As children grow in utero, the space in the womb begins to shrink and they push on the uterine wall with their feet.  This places a stretch on the calf muscle because the toes are automatically in the “toes towards the nose” position.  When a child is born prematurely, he or she misses out on the input and the stretch on the calf muscle.  If your child is premature, it is recommended during their feeding to place a stretch through both of their feet to mimic the position in utero.

If your child spends increased amounts of time on his or her toes, it may be worth seeing a local physical therapist (PT) or occupational therapist (OT).  PTs and OTs can help further assess your child and assist them with developing the appropriate skills for achieving a more natural heel-toe walking pattern.  PTs and OTs work with you and your child using a play-based setting to acquire necessary skills.  Therapists will also provide parents with a customized home exercise program including fun and playful strengthening and stretching activities as appropriate.   Lastly, PTs also have the ability to refer your child on to an orthotist (if needed) who will assist with braces to help further correct your child’s walking pattern.  Please contact any of the physical therapists at PTC for more assistance; we are happy to help!

Katie Collin, PT, DPT

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