Tip Toe walking is used to describe a walking pattern seen in children where the heels are raised off the floor in stance phase of gait. Tip Toe walking can be a feature of a number of type of childhood disorders including:
Cerebral Palsy (CP)
Increased neurological tone and/or spasticity in the lower limbs is a cause of toe waking. The spasticity in the legs can cause the calves to tighten and reduce in length, forcing the feet into a plantar flexed (pointed position). The tightness in the calves reduces child’s ability to rest heels on the ground. In addition children with CP often have very weak muscles in the lower limbs making walking with the correct muscles very difficult. Sometime the child will use the increase tone to their advantage by way of using the toe walking as a adaptive walking pattern. Tip toe walking is an adaptive walking pattern to allow the child to loco mote despite weak pelvis muscles and tonal changes.
Hypermobility Disorders
Children with hypermobility often have ligamentous laxity in the hip/knee/ankle joints. In association with this it is quite common for the proximal muscles (core/pelvis/hip) to be weak and the longer distal muscles (hamstrings /calves ) to be strong. They are unable to stabilise or control movement efficiently due to weakness around the pelvis and thus overuse the calf muscles as an adaptive mechanism to facilitate walking.
Autism Spectrum Disorders (ASD)
There is a higher incidence of hypermobility and ligamentous laxity in the ASD population in comparison to the normal population. Like the hypermobile group, weakness in the trunk and and pelvis predispose child to overuse of the calves and hamstrings and thus tip toe walking.
Signs and Symptoms in Tip Toe Walkers
• Child walks on tip toes with heels raised off floor
• Gastroc-soleus (calf muscles) muscles often look well developed
• Decreased length of gastroc-soleus +/- hamstrings
• Foot changes due to abnormal weight bearing ( fan shaped forefoot or flat over pronated foot or pes cavus)
• Weakness in hip and bottom muscles
• Often have weakness in core muscles
• May complain of calf or shin pain
• +/- increased tone in lower limbs ( in cases of cerebral palsy)
Non-Surgical Management Options
• Stretching of tight muscles groups
• Strengthening of pelvis muscles (especially gluteus medius and quadriceps) and core stability muscles
• Botox ( in cases where increase tone is a cause)
• Spiral Thigh Brace™ for gait retraining
• +/- Orthotics from a podiatrist to reduce overuse of ankle foot and stabilise foot so that child is encouraged to use hip muscles to control movement and balance as opposed to using tip toes
A child who has tip toed since they started to walk and has maintained the pattern for years, often has no memory or concept of what it feels like to walk in a different or more normalised pattern . The
Spiral Thigh Brace™
is a fantastic biofeedback tool to facilitate motor learning and development of new motor memories to help the body and brain to learn to walk in a more normalised pattern. Like an exoskeleton, the Spiral Thigh Brace™ is body hugging and allows freedom of movement while controlling the direction of movement.