Pediatric toe walking occurs when a child walks on their toes without placing their heels on the ground. While this can be normal in toddlers learning to walk, it becomes a concern if it persists beyond age 3, as it may signal an underlying issue.
Types of Toe Walking
- Neurological Toe Walking: Associated with conditions like cerebral palsy, autism, or other neurological disorders that affect muscle tone and control. Early diagnosis and management are crucial in these cases, typically involving a combination of therapies and daytime bracing, such as SMOs (Supramalleolar Orthoses) or AFOs (Ankle-Foot Orthoses).
- Structural Toe Walking: Caused by physical restrictions like a short Achilles tendon or anatomical variations in the calf. These issues prevent the child from placing their heels on the ground while walking and often require nighttime bracing or, in some cases, surgical intervention.
When to Worry
If toe walking continues past age 3, or if it causes discomfort, imbalance, or difficulty walking, it’s essential to seek a specialist’s opinion. Persistent toe walking can lead to complications like muscle tightness, calluses, and structural changes in the feet and legs, making early intervention crucial.
The Silfverskiöld Test
A critical diagnostic tool, the Silfverskiöld Test helps distinguish between neurological and structural causes by assessing the ankle’s range of motion. In neurological cases, the ankle typically has a normal range of motion, while structural cases show limited movement, indicating a need for more targeted treatment.
How to Perform the Silfverskiöld Test at Home
The Silfverskiöld Test is a simple way to check for tightness in the calf muscles, which can affect your child’s ability to walk with their heels down.
Step-by-Step Guide:
- Position the Foot: Have your child lie down, and gently move their foot into a neutral position.
- Check with Knee Extended: Straighten your child’s knee fully. Try to gently push the foot upwards (toward the shin). If it doesn’t move much, note this.
- Check with Knee Bent: Now, bend the knee about 30 degrees and try pushing the foot upward again.
What the Silfverskiöld Test Results Mean:
- If the foot moves better when the knee is bent: This indicates tightness mainly in the gastrocnemius muscle (upper calf). This type of tightness may respond well to treatments like the Pediatric Toe Walking Brace, which can help stretch the muscle and improve walking.
- If the foot doesn’t move much in both positions: This suggests tightness in both the gastrocnemius and soleus muscles (lower calf). The Pediatric Toe Walking Brace is likely to be especially effective in this scenario, as it targets the areas of tightness that contribute to toe walking.
- If the foot moves well in both positions: This typically suggests that muscle tightness is not the issue, and the cause of toe walking might be neurological rather than structural. In such cases, the Pediatric Toe Walking Brace might not be effective, and it would be advisable to consult a specialist for further evaluation and treatment options.
The Pediatric Toe Walking Brace
For children diagnosed with structural toe walking, the Pediatric Toe Walking Brace offers a non-invasive treatment option. Worn at night, this custom-fitted brace gently stretches the calf muscles and Achilles tendon, promoting a natural heel-to-toe walking pattern. Consistent use over several months can lead to significant improvements, helping to correct the gait without the need for surgery.
Virtual Consultations with Dr. Jarman
Dr. Mikkel Jarman, a leading expert in pediatric foot and ankle care, offers virtual consultations to help parents understand their child’s condition and explore treatment options. Whether you are local or out of state, Dr. Jarman provides expert guidance to determine the best course of action for your child’s specific needs.
Learn more about virtual consultations with Dr. Jarman
If you’re concerned about your child’s toe walking, don’t hesitate to reach out for a consultation. Early diagnosis and treatment are key to preventing long-term complications and ensuring your child develops a healthy, natural gait.
