Orthotic Treatment for Idiopathic Toe-Walking in Kids

Parents often ask us “how to stop toe-walking in children”? When toddlers first learn to walk, they may walk on their toes. However, toe walking usually reduces over time and is not of any concern.

However, if you’re concerned about your child’s development, you should consult your GP, pediatrician, or pediatric physiotherapist to determine the cause and possibly get braces for toe-walking.

In this blog, we explain the common causes, symptoms, and treatments, as well as discuss available orthotics for toe-walking. And remember, if you need custom pediatric orthotics in Albuquerque and Las Cruces, we can help!

What Is Idiopathic Toe Walking?

Idiopathic walking describes a gait pattern where an otherwise healthy child continues to walk on tiptoes beyond three years. Young children walk on their toes and the balls of their feet when they're learning to move and tend to walk normally with a heel-toe pattern as they grow older.

If your child continues to walk without their heels making contact with the ground after age two, it may signal an underlying medical condition and the need for special orthotic braces to stop toe walking.

Toe Walking with Autism

​​ASD children are more likely to walk on their toes than children without the disorder.

Since there's no direct link between autism and toe walking, the causes are unclear. It could be that tightened heel muscles limit your child's ankle range of motion, or it may also be sensory-related.

There is a high prevalence of vestibular dysfunction in children with autism. The vestibular system provides feedback to your brain about motion, position, and spatial orientation and may be responsible for toe walking. However, the role of sensory processing in developing toe walking in children with autism requires further research.

Tip Toe Walking in Adults

Occasionally, people walk on their toes in adulthood. They may have tried correcting the problem as a child but never outgrew it, or the treatment did not work.

Sometimes adults begin walking on their toes for unknown reasons. Health conditions like corns, calluses, and peripheral neuropathy may also cause toe walking.

The Anatomy of Toe Walking

Two major muscles make up the calf; the gastrocnemius and soleus. They merge at the base of the calf, where they become the Achilles tendon. When walking, the calf muscles and Achilles tendons help lift the heels.

It is possible that the muscle-tendon combination in some children who toe walk is shorter at birth, or shortens over time, thus making it impossible for them to touch their heels to the ground and walk flat-footed.

Causes of Idiopathic Toe Walking

The most common reasons why children toe-walk are:

• Flat Feet: children with flat feet have difficulty balancing and coordinating, and raising their toes to counteract this. Toe walking enhances the arch, creating a more stable foot (base) and temporarily improving the child’s balance and stability. However, this is not normal and walking on toes causes incorrect muscle balance development.
• Short Achilles tendon: a short Achilles tendon can prevent a child’s heels from touching the ground.
• Sensory perceptions: some kids benefit from increased sensory input when they push up on their toes. Interestingly, kids at the opposite end of the spectrum can also toe-walk. As a result of reducing the amount of foot contact with the floor, they receive less input. Basically,  a child simply may not like the feeling of cold tiles or a shaggy carpet, which exaggerates toe-walking symptoms.
• Muscular dystrophy: in this genetic disease, muscle fibers are unusually vulnerable to damage and weaken over time, resulting in toe walking. Toe walking might be more likely to be caused by this diagnosis if your child initially walked normally before starting to toe walk.
• Neurological abnormalities: children with cerebral palsy or spinal cord abnormalities may also experience toe walking.

Toe Walking Symptoms

​​A child who walks on their toes rather than together with their heels is the most obvious symptom. Others include:

• Impaired balance and coordination
• Frequent falls
• Difficulty wearing shoes
• Problems participating in sports or other recreational activities
• Complaints of pain
• Heel cord tightness

Toe Walking Diagnosis

Your doctor will first ask a series of questions about your child to understand their general health and walking abilities and then conduct:

• Physical examination: during a physical exam, your doctor will observe your child walking and check their feet and limbs for abnormalities.
• Neurological examination: these tests determine whether nervous system abnormalities are contributing to your child's toe walking.
• Other tests: specific tests such as X-rays, CT, and MRI scans may also be necessary to exclude other diagnoses.

What Are the Long-Term Effects of Toe Walking in Adults?

If left untreated, the long-term impact may include:

• Muscle tightness
• Achilles tendon tightness
• Foot pain
• Inability to stand/walk flat-footed (which can require surgery)
• Wearing a toe-walking brace

There is also no guarantee your child will outgrow walking on their toes. Some parents take the "wait and see approach," but the longer the condition lasts, the harder it is to break.

How to Stop a Baby Walking on Tiptoes: Treatment Options for ITW

Treatments include physical therapy, AFO bracing for tip-toe walking, as well as surgical procedures.

Nonsurgical Tip-Toe Walking Treatment

Treatment depends on your child's age and ability to walk flat-footed. Initial treatment is always nonsurgical for children between the ages of 2 and 5 who can walk flat-footed:

• Observation: your doctor may suggest monitoring your child with regular office visits for a while. If the behavior is habitual, your child may stop on their own.
• Serial casting: a series of short-leg walking casts can gradually stretch and lengthen the muscles and tendons in the calf and discourage toe-walking.
• Bracing: an ankle-foot orthosis (AFO), also called tip-toe braces, can stretch and lengthen muscles and tendons while holding the foot at a 90° angle.
• Botox: patients with neurological abnormalities may receive an injection of botulinum A toxin (Botox®) to relax their calf muscles temporarily.
• Night splints: night splints hold the foot in a stretched position and keep the feet with the toes pointed up.
• Physical Therapy and stretching: gentle stretching of the leg and foot muscles might improve your child's gait.
• Bracing: tip-toe walking braces with hinges allow the foot to move up but prevent it from pointing or plantarflexing. Because it's difficult toe-walk in idiopathic toe-walking braces, this is often the most effective treatment option.

Surgical Toe Walking Treatment

Children over the age of 5 may have very tight calf muscles and Achilles tendons, making it impossible to walk flat-footed. In such cases, the doctor may recommend surgery to lengthen the Achilles tendons to improve the range of motion and ankle function.

With this toe-walking treatment, your child will be better able to tolerate AFOs and walk in a flat-foot position. Where the tendon is lengthened depends on whether your child's foot can be positioned flat at the ankle with the knee bent. As such, a variety of techniques are available.

Surgical toe walking treatment is an outpatient procedure. As soon as the tendons are lengthened, a short-leg walking cast will be placed on your child's legs while he or she is still asleep. Usually, these casts are worn for between four and six weeks.

Orthotic Options for Idiopathic Toe-Walking

Rigid carbon foot plates and Ankle-foot orthoses are the two most popular orthotics for kids who walk tippy toe.

Carbon Foot Plates for ITW

Low-cost, lightweight, minimally invasive carbon foot plates offer a low-cost solution to idiopathic toe walking. Carbon foot plates are like insoles for toe walkers. These orthotic inserts for toe-walking stiffen the sole, preventing a child from standing on their toes since they limit their ability to extend through their MTPJs.

The concept behind treating ITW children with FOs and carbon fiber foot plates is that by supporting the foot and ankle complex with a custom molded foot orthotic and restricting toe walking with the full-length footplate, the child will be unable to toe walk and/or will not subconsciously revert to doing so, since the foot orthotic itself supports the foot and ankle complex.

Supramalleolar Orthosis (SMOs) for Toe-Walking

Designed for children with sensory or stability difficulties., SMOs (supramalleolar orthoses or ankle braces) are thin, flexible orthotics that promote natural development while providing support. These braces for toe-walkers offer more support than shoe inserts and are less bulky than AFOs (ankle and foot orthotics).

By using compression and a posterior tongue extension, they help facilitate heel-toe gaits. There is no restriction on kids' ability to continue to develop their speed and gross motor skills, which require plantarflexion (pointing the foot downwards).

Does SMO Hurt?  

While an SMO for toe-walking will take some time to get used to, it should not be painful. However, it is not uncommon to feel some initial discomfort.

The break-in period should be roughly two weeks. If your child experiences skin rubbing or blisters, or discomfort after this time, then book an appointment with your orthotist immediately.

Toe-walking SMOs are best for kids with sensory issues and instability, as well as habitual toe-walkers. Unfortunately, an SMO orthotic for toe-walking is unsuitable for kids with spasticity and high muscle tone.

Ankle Foot Orthoses (AFO) for ITW

In persistent cases, an AFO brace for toe-walking (AFOs) may be required. These custom ankle-foot orthotics, covering the foot, ankle, and leg, and finish just below the knee.

Hinged AFOs allow the foot to move up and backward but prevent it from pointing, or plantarflexing, making it very difficult to toe-walk in AFOs.

AFOs can be used for several purposes, including controlling alignment, increasing mobility and independence, assisting rehabilitation, and/or reducing pain. Your child's needs determine whether their ankle-foot-orthosis for toe-walking should be hinged (able to bend at the ankle) or solid (unable to bend at the ankle).

Let Our Experienced Orthotics Team Help Your Child Today!

Now that you know how to stop your kid from walking on their toes, you can improve their gait pattern and change their biomechanics of toe walking with our adapted AFOS. Primecare’s orthotists work with parents and pediatric patients to create custom foot orthotics for toe-walking. Guaranteed, we’ll get the right orthotic help for your child.