What is "toe walking" in kids, and why does it happen?
This is not medical advice.
Firstly, most of these kids aren’t really walking on their toes. These kids are really walking up on their forefoot, or the ball of their foot. Not their toes. That would be like ballet dancers on point. They are having to use their toes for more balance. There are several different reasons this happens, and the rate of incidence is not clear, partially because there may be many different causes, and this may be hard to define as a “condition.”
The first assumption when I started working was, “well this kid’s calves must be very tight, and we need to stretch them!” and stretch, and stretch, etc…
Sometimes their calves were tight. They were unable to physically stand flat footed. That ankle does need serious range of motion. Which can be extremely difficult. Check out my previous article on stretching and kids. Some surgeons may suggest “lengthening'‘ ( a cute way of saying cutting.) I’m not suggesting this never happen either. There may be circumstances where the range is so poor, that the child is unable to function, or stand. That’s a tough decision that a family makes with the medical advice they receive.
What about the ankles that aren’t tight, and the kid is still walking on their forefoot?
This is where the theories get more interesting. A muscle is strongest 1/2 way through a contraction range. So what if some “toe walkers” are up on the forefoot, because the calf is weak?
If the calf is weak, and we keep stretching it passively, we may be making it even weaker. Which isn’t helping.
The other part of this equation is that the kids are not used to putting their heel on the ground. This requires some feedback and motor control. The skin on the heel may be overly sensitive. It’s probably not calloused like the rest of us.
Therapy for that might involve walking down inclines, where it’s easier to approximate the heel to the surface.
What if they’re right and we’re wrong? If I have to walk barefoot while we’re camping, I’m walking on my forefoot also. I’m not planting my heel on sticks and rocks. What if we were evolutionarily (is that even a word?) built to walk barefoot, on our forefoot. That theory has become very prevalent in running. Not sure that this theory is as prevalent in walking.
One thing I don’t think that works is telling the kid to stop “walking on their toes.” They probably don’t have the motor control or sensation to achieve that. It can be practiced in a fun manner. Play that is arranged to plant the heel at the same time is the best therapy.
I think most of us take things for granted in our bodies’ design. The Achilles tendon is only 1/2 inch wide. Yet it’s capable of holding our entire body weight if we stand on one forefoot. It’s no wonder it gets “tight”, and would require some extra strengthening. This is true in the majority of the adult population, not just the “toe walking” kids.