While toe walking is completely normal as children learn to walk, it should phase out by age 2. If children with cerebral palsy continue to walk on their toes past 2 years old, it’s most likely because spasticity in the calves pulls the heels up. If a child continues toe walking beyond age 2, spasticity may continue increasing, and toe walking may become a habit that’s very difficult to break.
To help you get a better idea of what toe walking is, this article will go over its:
What Causes Toe Walking in Children with Cerebral Palsy?
Toe walking in individuals with cerebral palsy is primarily attributed to spasticity, which refers to involuntary muscle contractions caused by damage to the brain. It can pull the limbs in abnormal positions and cause stiff movements.
Over 75% of individuals with cerebral palsy experience spasticity, which explains why abnormal gait patterns like toe walking are so prevalent among this population. Toe walking occurs most commonly in individuals with a type of cerebral palsy that primarily affects the legs called spastic diplegia.
If spasticity isn’t properly managed, the muscles will only become tighter. This can make toe walking even more challenging to reverse. Therefore, early intervention will help minimize chronic pain and correct form before the abnormal gait pattern becomes a habit. In the following section, we’ll discuss additional risks associated with toe walking.
Risks Associated with Toe Walking and Cerebral Palsy
Toe walking caused by cerebral palsy can range from mild to severe. While the brain damage that causes cerebral palsy will not worsen over time, secondary effects of that damage such as spasticity can.
The progression of spasticity in the calves can cause toe walking to become more severe and put children at risk for many other complications, including:
- increased risk of falling due to poor balance and stability
- chronic pain due to muscle tightness and excess pressure on the ankles
- poor posture due to altering center of gravity
- non-ambulation (inability to walk)
Early intervention is crucial to ensuring that spasticity does not harm your child’s growth and development. In the following section, we’ll discuss effective ways to correct toe walking.
How to Fix Toe Walking in Children with Cerebral Palsy
In order to correct toe walking in children with cerebral palsy, you have to treat the underlying problem: spasticity. Then, therapy will focus heavily on promoting neuroplasticity. Neuroplasticity refers to the brain’s ability to rewire itself and recover functions affected by brain damage.
The best way to activate neuroplasticity is through lots of repetition. By consistently encouraging your child to practice using correct form, they can develop better walking habits and overcome toe walking.
Below, we’ll discuss some of the most widely-utilized interventions to treat spasticity.
Physical therapy is one of the first treatments your child’s doctor will recommend for treating toe walking. A physical therapist will assess the severity of your child’s toe walking and create a personalized exercise regimen that focuses on lengthening tight muscles, strengthening underused muscles, and practicing correct form.
Many physical therapists use fun games and activities in addition to exercises to address toe walking and encourage carryover of skills learned in therapy to a child’s daily life. Some activities they may use to address spasticity in the calves include practicing various animal walks (such as the bear crawl) and trying to stay balanced on a wiggly surface.
Wearing orthotic devices like leg braces and casts help ensure that the joints in the foot are properly aligned. A leg brace or cast will keep the heel down and stretch the muscles in the calf so that your child can learn to walk correctly. If the spasticity is relatively mild and addressed early on, a child may be able to wean off of using the orthotic over time.
Botox injections are injected into overactive, spastic muscles to reduce tone. It can help temporarily reduce spasticity so that individuals with cerebral palsy can practice walking without spasticity.
Practicing walking with an improved gait pattern can help children develop new and proper walking habits, and can help keep spasticity in check even after the Botox wears off. However, Botox is only approved for children 2+, so if your child is toe walking before that, other treatments must be used.
Baclofen is a drug that can be taken orally, injected, or pumped into the body to relax spastic muscles.
However, the most popular and effective way is to get it pumped through intrathecal baclofen therapy, which involves surgically implanting a pump under the skin of the abdomen. It directly infuses baclofen into the spinal canal, so it can be delivered in smaller, safer doses.
Surgeries are often considered a last resort and are typically only recommended if all other treatments prove ineffective.
Selective dorsal rhizotomy is a surgery that involves cutting specific sensory nerves to permanently reduce spasticity in a muscle. When that nerve is cut off, it can’t grow back, so the muscle can no longer get spastic.
Manual muscle and tendon lengthening surgeries are also commonly performed to combat spasticity in patients with cerebral palsy.
Understanding Toe Walking in Cerebral Palsy Patients: Key Points
Minimizing spasticity is only the first step to correcting toe walking in children with cerebral palsy. Next, your child has to learn how to stand and walk correctly. It might feel weird or uncomfortable, but the more your child practices walking correctly, the easier it will get.
We hope this article helped you understand why individuals with cerebral palsy experience toe walking and how to correct it.