Why Toe Walking Is NOT Idiopathic

For far too long, therapists andphysicians have been getting it all wrong when it comes to toe walking in children! The cause is notshort muscles; the solution is notstretching. Itis notidiopathic andthere is a reason... we just havent looked in the right places!

Toe walking is not a foot or ankle problem - its a movement disorder. So, tight heel cords are merely a symptom of a pathological movement pattern. Decreased muscle length is actually the resultoftoe walking, instead of the cause. Traditional interventions such as serial casting, orthoses, Botox, surgery, and stretching only focus on symptomatic treatment. The reality is that multiple body systems are involved in walking and theyallrequire consideration. If all the impaired systems arent effectively addressed, the likelihood of long-term resolution is low.

Why Aren't Traditional Interventions Working?

Eachof theconventional approaches has some problems:

• Serial castingcausesweakness and fatigueresulting in further dysfunction

• Orthotics often do not address correct biomechanics andrestrict joint function

• Botoxlimits motor training potential

• Surgery causes additional soft tissue immobility

• Stretching does not improve muscle function

What Is Missing?

Inthe traditional approaches, some important factors are left out of the picture:

• Postural control - necessary for optimal balance

• Base of support - essential to rehabilitate gait

• Correct lower extremity alignment - crucial for long term resolution

• Contributions of 3 primary body systems - vestibular, visual, and proprioceptive

• Reflexes - often retained in children who toe walk

Both families and therapists are often disappointed with treatment outcomes for toe walkers. It is common to have poor results andeven a return of the toe walking after a few months. There is, however, a different way to assess and intervene withthe condition a way that makes sense of why the child is toe walking! It looksbeyond the "tight heel cords" and examines how all the above factors contribute to this movement disorder.