Is Toe-Walking an Early Sign of a Health Condition?

By Brian Rog with Contributions by: Annie Kender, PT, DPT, C/NDT of the ATI Grand Blanc, Mich., Clinic

Is Toe-Walking an Early Sign of a Health Condition?

When a child learns to walk, instinctively, he or she will begin walking with their feet flat on the ground. But because this is a skill that takes much practice, it’s not uncommon for them to transition on and off their tip toes as their walking abilities develop.

Some children begin walking on their toes for stability, others walk on their toes for sensory reasons – these children sometimes have difficulty tolerating pressure through their heels or they prefer the sensations (or proprioceptive input) they received from their joints locking out. Children may also walk on their toes due to range of motion restrictions in their calf muscles (gastrocs).

As your child’s coordination and muscles develop, they will begin walking with a heel-toe pattern; on average around 18 months of age. However, should those heels remain ascended beyond age 2-3 as your child’s only means of getting around, this may be an early sign of a neurological condition (Cerebral Palsy, Spina Bifida, Tethered cord, etc.). Conversely research reports 7-24 percent of children who walk on their tip-toes are idiopathic toe walkers, meaning they do not have a correlated disgnosis such as Cerebral Palsy.

When to see a specialist

Research supports the idea that heel strike in children begins around 22 weeks following initial onset of walking independently. For the majority of children, this occurs around 18 months of age. Toe walking is not considered a normal part of this early independent gait. As we mentioned, if by age 2, your child hasn’t outgrown toe walking, this may be an indication of neurological immaturity or muscle weakness.

To that, ATI Physical Therapy experts suggest consulting with your pediatrician, because if left untreated, toe-walking can put your child at further risk for contractures, foot deformities and balance deficits. And in severe cases, your child may require surgical interventions if deformities or contractures are advanced. Fortunately, physical therapy interventions are an effective way to help your child overcome this.

Long-term effects of toe walking, if left untreated

As you can imagine, toe-walking places a great load on the muscles and tendons. Many children who consistently walk on their tip-toes since establishing independent ambulation, may develop foot deformities as early as the age of four. These children may demonstrate ankle range of motion restrictions, impaired balance and poor postural alignment.

Physical therapy for toe walking

Therapeutic treatment such as physical therapy can assist your child in achieving a heel-toe gait pattern as well as correcting any range of motion restrictions, muscle imbalances and postural deformities.  After identifying the child’s origin for toe-walking, a plan of care is established to address the child’s deficits. Treatment methods typically include stretching, strengthening of lower extremities and core, balance retraining, sensory integration techniques, serial casting, orthotic training and a home exercise program.

After completing physical therapy, what’s next?

Once your child has successfully completed their PT treatment, you will receive a home exercise program to further continue their treatment plan at home.

For children with an established heel-to-toe pattern, who no longer demonstrate weakness or range of motion restrictions, their home program is minimal. For children with neurological conditions as an underlying source of their toe-walking, they may require intermittent services over their lifetime to maintain gains, usually around growth spurts.

Is your child toe-walking? ATI may be able to help

If you are concerned about your child’s toe-walking tendencies, we first suggest connecting with your pediatrician to determine the next course of action. Should physical therapy be required, please don’t hesitate to contact your your nearest ATI physical therapy clinic to see what pediatric therapy options are available for your child.

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Study: A Daily Baby Aspirin Has No Benefit For Healthy Older People

Daily low-dose aspirin can be of help to older people with an elevated risk for a heart attack. But for healthy older people, the risk outweighs the benefit.

Many healthy Americans take a baby aspirin every day to reduce their risk of having a heart attack, getting cancer and even possibly dementia. But is itreally a good idea?

Results released Sunday from a major study of low-dose aspirin contain a disappointing answer for older, otherwise healthy people.

“We found there was no discernible benefit of aspirin on prolonging independent, healthy life for the elderly,” says Anne Murray, a geriatrician and epidemiologist at Hennepin Healthcare in Minneapolis, who helped lead the study.

The study involved more than 19,000 people ages 65 and older in the United States and Australia. The results were published in three papers in the New England Journal of Medicine.

There is still strong evidence that a daily baby aspirin can reduce the risk that many people who have already suffered a heart attack or stroke will suffer another attack.

And there is some evidence that daily low-dose aspirin may help people younger than 70 who have at least a 10 percent risk of having a heart attack avoid a heart attack or stroke, according to the latest recommendations from the U.S. Preventive Services Task Force.

But for older, healthy people, “the risks outweigh the benefits for taking low-dose aspirin,” Murray says.

The primary risk is bleeding. The study confirmed that a daily baby aspirin increases the risk for serious, potentially life-threatening bleeding.

Surprisingly, those who took daily aspirin also appeared to be more likely to die overall, apparently from an increased risk of succumbing to cancer. That was especially unexpected given previous evidence that aspirin might reduce the risk for colorectal cancer.


Related: Panel Says Aspirin Lowers Heart Attack Risk For Some


The researchers stressed, however, that the cancer finding might have been a fluke. There’s also a possibility that any colorectal cancer benefit wasn’t seen because the subjects had only been followed for about five years.

Regardless, the findings raise serious questions as to whether otherwise healthy older people should routinely take low-dose aspirin.

“A lot of people read, ‘Well, aspirin is good for people who have heart problems. Maybe I should take it, even if they haven’t really had a heart attack,’ ” Murray says. But “for a long time there’s been a need to establish appropriate criteria for when healthy people — elderly people — need aspirin.”

That’s why the researchers launched their study, called ASPREE, in 2010. It involved 19,114 older people, with 16,703 in Australia and 2,411 in the United States. The U.S. portion included white volunteers ages 70 and older, and African-Americans and Hispanics subjects ages 65 and older.

Participants took either 100 milligrams of aspirin every day or a placebo. People in the study were followed for an average of 4.7 years.

“We were hoping that an inexpensive, very accessible medication might be something that we could recommend to elderly to maintain their independence but also decrease their risk of cardiovascular disease,” Murray says.

But based on the findings, Dr. Evan Hadley of the National Institute on Aging, which helped fund the study, says any elderly people taking aspirin or thinking about it should think twice.

“This gives pause and a reason for older people and their physician to think carefully about the decision whether to take low-dose aspirin regularly or not,” Hadley says. “And in many cases the right answer may be: Not.”

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Cubs’ Yu Darvish Suffers Season-Ending Setback

Brian Cole MD of Midwest Orthopaedics at Rush & Steve Kashul discuss Chicago Cubs’ Yu Darvish’s season ending injuries due to stress reaction in elbow.

Click here to have your question addressed live by Dr. Brian Cole on an upcoming show.

Sports Medicine Weekly on 670 The Score

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Fall Sports and the Risk of ACL Injuries

Anne Bierman of Athletico is a Board Certified Specialist in Sports Physical Therapy and Staff Physical Therapist in Naperville, IL

Brian Cole MD of Midwest Orthopaedics at Rush, Steve Kashul and Anne Bierman discuss upcoming fall sports season and ACL related injuries. Anne also explains Athletico’s ACL 3P program and how it can identify risk factors for ACL injuries.

Sports Medicine Weekly on 670 The Score

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