Toe Walking and Braces: Let’s Talk About It!
Hey everyone, today we are talking about toe walking! Have you ever seen a toe walker? I bet many of you have. It's pretty common, especially in kids. Today, we’ll talk about what it is and how we can help kids walk more comfortably. So, let’s jump right in!
Toe Walking Basics
First things first: toe walking is when someone walks primarily on their toes or the balls of their feet without their heels touching the ground. This is pretty common in toddlers learning to walk, but if it sticks around past that age, it’s something to keep an eye on. It could be linked to various causes—some kids do it out of habit, others stem from sensory processing issues, and for some, it’s related to neurological conditions.
While some people might think it's cute or harmless, toe walking can actually create various future concerns. For example, you might think a toe walker has very strong calf muscles. But the truth is they have severely underdeveloped musculature. Think of it this way: Imagine doing a squat, but only going down 10% of the way down, then popping back up and repeating that over and over. Compare that to a full squat all the way down and back up. Well that's essentially what we are doing when we are toe walking, and subsequently toe walkers have very weak calves and ankles, making them very susceptible to injury. Not only that, but toe walkers often develop plantar flexion contractures, or tight Achilles tendons because their tendons are never fully lengthened always being in a contracted (or shortened) position. These contractures often result in the need for undesirable interventions like serial casting or tendon lengthening surgeries. NOT FUN! But don’t worry, we’ve got ways to help!
Toe Walking Interventions: Braces. Or AFO's and SMO's.
While physical therapy is always recommended for these kiddos as they often have muscular deficits to work through so they can walk heel-toe. Braces, or AFO's and SMO's can be therapy one wears to help develop good habits and muscle memory.
Which type of brace is right for your kiddo?
First off we need to consider 2 important things. 1- What is their available range of motion and 2- What is their cognition level? Functional range, or the range of motion to be able to walk with an efficient and normalized gait is about 5-7* of dorsiflexion (or 5-7* beyond 90*- toes going up towards the knee). And cognition, all we are really talking about is does the kid understand that the goal is to NOT toe walk and can do correct walking, but once distracted returns to the habit.
The Toe Walking SMO- For the kid that just needs a gentle reminder.
So let’s say we’ve got a kiddo who understands they shouldn’t be toe walking, and they’ve got decent range of motion in their ankles (maybe their range is a little tight, but they can still achieve the functional 5-7*), this is when we consider a Toe Walking SMO (Supramalleolar Orthosis).
The idea here is simple: they need a gentle nudge, a little cue to remind them to use their whole foot. The little posterior extension up the back of the calf just nudges them if they try to toe walk and its that simple! It can be made from thermoplastic or even 3D-printed—how cool is that? Another nifty option is the open-heel toe walking SMO, which comes with a silicone piece that provides extra feedback. When they hit the heel, they can feel it, helping to facilitate good proprioceptive feedback and proper muscle memory.
The Articulated AFO- For the kid that needs a true enforcer.
So this is for the kiddo that has adequate range, but may not understand that we are trying to stop toe walking. For example, a very young toddler, or a child with severe autism. In these cases we need to be a little more aggressive and provide a true STOP to the toe walking motion. This AFO allows for all ankle movement less than 90*, but will stop any beyond 90* (or toe walking).
The Wedged AFO- For the kid that does NOT have functional range of motion.
Now, what if we’ve got a child who has been toe walking for so long that their heels can’t even touch the ground? They may have developed a plantar flexion contracture, where their calf muscles are super tight. In these cases, we’ve got to adjust our approach and accommodate for that tightness. Enter the wedged AFO that helps support the foot while accommodating for that limited movement. We essentially bring the floor to the heel, so that we can get "heel contact" and start to get a proper stretch every step we take. And this will help the child walk in a more balanced, heel-to-toe fashion.
The Super Solid AFO- A unique approach for the challenging kiddo
What’s that, you ask? Well, it’s an AFO that doesn’t bend at the ankle or footplate—this thing is rock solid! The theory behind it is that many toe walkers have a weak posterior chain (the muscles at the back of the body), causing their center of mass to be too far forward. This brace helps shift that balance and build strength where it’s needed. This approach can be the game-changer for a lot of kids, but it is aggressive and needs to be done with specific physical therapy.
Wrapping It Up
Well there you have it! While toe walking might seem like a small issue, it can have a big impact on how a child moves and grows. Luckily, with the right tools—whether it’s an SMO, AFO, or the Super Solid Ankle AFO, talk to your PT and lets see if we can help your kid develop healthy walking patterns that set them up for success.
Until next time,
Dave and Polly
Comentários