Toe Walking
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Written by Stephen M. Edelson, Ph.D.

Toe walking is quite common in young children, age 3 and younger; but toe walking, especially in children 5 years and older, is often associated with neurological immaturity. Many parents and professionals are not aware of the various interventions used to treat toe walking. The following interventions are listed from least to most invasive.

Physical exercises are sometimes used to stretch out the tendon in order to reduce toe walking, but this treatment has had minimal success.
A dysfunctional vestibular system, a common problem in autism, may be responsible for toe walking. The vestibular system provides the brain with feedback regarding body motion and position. It may be possible to reduce or eliminate toe walking by providing the person with therapeutic vestibular stimulation (e.g., being swung on a glider swing).
Toe walking may be directly or indirectly related to a visual-vestibular problem. I have conducted several research studies with Melvin Kaplan, O.D. at the Center for Visual Management in Tarrytown, New York. While conducting these studies, I observed four individuals who were toe walkers. In each case, their toe walking was eliminated within seconds after the child began wearing prism lenses.

Description of program. Prism lenses displace the person’s field of vision up, down, left or right. Dr. Kaplan and other developmental optometrists have developed nonverbal assessment procedures to determine the correct direction and degree of displacement for the prism lenses. Unlike other interventions for autism, changes in attention and behavior are observable immediately after the person begins to wear the lenses. The use of prism lenses is part of a ‘vision training’ program. The program typically lasts for one year and involves wearing prism lenses and performing daily visual-motor exercises. After the program is completed, the person no longer needs to wear the prism lenses.
Casting is another intervention used to stop toe walking. This procedure involves wearing a cast to stretch out the tendon. In most cases, the cast is applied every two weeks for a total of 6 to 8 weeks. Another treatment involves surgery. Long-leg casts are then worn for six weeks and followed by night splinting for several months.
It is important for parents to learn as much as possible about treating toe walking before selecting an appropriate intervention for their child. When making a decision about any treatment, parents should take into account the treatment’s effectiveness, safety and cost.