Toe Walking Treatment (Equinus)

Causes, Symptoms, and Treatments of Equinus

Equinus, commonly referred to as toe walking, is a gait pattern where an individual walks on their toes or the balls of their feet without their heels touching the ground. While this can be a normal phase in toddlers learning to walk, persistent toe walking beyond the age of three may indicate an underlying condition that requires intervention. Whether the cause is idiopathic, neurological, or related to a physical condition, understanding the appropriate treatment for toe walking is crucial for ensuring proper foot development and preventing long-term complications.

For those who continue walking on tiptoes as they grow, early diagnosis and therapy for toe walking can help correct the issue and promote a healthy, natural gait.

Feet with a equinus toe walking condition

Symptoms, Causes, and Treatment of Equinus (Toe Walking)

Is Toe Walking a Concern?
Toe walking is a common concern for both parents and adults, especially when it persists beyond the toddler years. In children older than three and in adults, walking on tiptoes may not be typical and could signal an underlying neurological, developmental, or physical condition. While many cases can be managed with conservative treatments, it’s essential to identify the cause and address it appropriately.

Over 90% of toe walking cases can be effectively treated without the need for surgery, making early intervention key to a successful outcome.

Common Causes of Toe Walking

→ Idiopathic Toe Walking (ITW)

Idiopathic Toe Walking (ITW) refers to a condition where an individual continues to walk on their toes without any identifiable neurological, orthopedic, or mental illness. This condition affects 7-24% of children but can persist into adulthood. If not addressed, ITW can lead to muscle tightness, improper bone growth, and joint discomfort, requiring targeted therapy for toe walking.

→ Neurological Disorders

Neurological conditions such as cerebral palsy or muscular dystrophy can cause toe walking due to muscle spasticity or weakness. For instance, cerebral palsy often increases muscle tone, shortening the Achilles tendon and leading to toe walking. Muscular dystrophy, a group of genetic diseases that progressively weakens muscles, also contributes to gait abnormalities like toe walking.

→ Developmental Disorders

Toe walking is sometimes associated with developmental disorders, such as autism spectrum disorders (ASD). Individuals with ASD might exhibit this gait pattern due to sensory processing issues or motor development delays. However, it’s crucial not to overlook potential physical abnormalities that may require specific toe walking treatment.

Physical Conditions
Several physical conditions can lead to toe walking, including:

→ Shortened Achilles Tendon

A congenitally short Achilles tendon prevents the heel from touching the ground, necessitating surgical intervention in severe cases.

→ Heel Pain

Conditions like Sever’s disease, which causes heel pain, may lead individuals to walk on their toes to avoid discomfort.

→ Musculoskeletal Issues

Structural abnormalities such as flat feet or tight calf muscles can contribute to a toe-walking gait, requiring targeted therapy.

Symptoms and Diagnosis of Equinus

Symptoms
Equinus typically displays the following symptoms:

→ Walking on Toes or Balls of Feet

The most obvious sign is walking on tiptoes without the heels making contact with the ground.

→ Unnatural Gait and Posture

The gait may appear unsteady or awkward, with noticeable posture issues.

→ Lack of Heel Contact

The individual may consistently avoid placing their heels on the ground while walking or standing.

→ Tightness in Calf Muscles

Persistent toe walking can cause tightness in the calf muscles, further exacerbating the condition.

→ Discomfort or Pain

Over time, toe walking can lead to discomfort or pain in the knees, hips, or lower back due to the unnatural gait.

Diagnosis
Diagnosing toe walking involves a comprehensive approach, beginning with a physical examination to assess muscle and joint function. Gait analysis is crucial to observe walking patterns and determine the severity of the condition. In some cases, Dr. Chandan Narang may also offer a virtual consultation to pre-diagnose toe walking, providing convenience and ensuring timely intervention.

Toe Walking Treatment Options

Conservative Treatments

Physical Therapy
Physical therapy is a cornerstone of toe walking treatment, focusing on exercises that stretch and strengthen the Achilles tendon and calf muscles. This approach helps improve flexibility and promotes a normal gait pattern. Techniques may include manual stretching, functional exercises, and gait training to address muscle imbalances and enhance motor skills.
Bracing and Orthotics
Bracing and orthotic devices, such as the Toe Walking Brace, support proper foot alignment and encourage heel-to-toe walking. Custom-fitted for comfort and effectiveness, these devices gently correct the foot’s position, reduce muscle strain, and promote a natural walking pattern.
Casting
Serial casting is another effective treatment for toe walking. This method involves applying a series of casts to the lower leg and foot, gradually stretching the Achilles tendon and calf muscles over time. Each cast is typically worn for a few weeks before being replaced with a new one that further improves alignment.
Achilles Tendon Lengthening (ATL) Surgery
Achilles Tendon Lengthening is a surgical procedure recommended when conservative treatments for toe walking fail to produce results. Dr. Narang, who specializes in Achilles tendinitis treatment, routinely performs this surgery to lengthen the Achilles tendon, allowing for normal foot positioning and gait.

Dr. Narang’s Toe Walking Surgery Process:

Pre-Surgery Consultation: The process begins with a telehealth appointment to discuss the condition and determine eligibility for surgery. An in-person office visit the day before surgery confirms candidacy.
Day of Surgery: On the day of surgery, the individual arrives an hour before the procedure. Post-surgery, a cast is applied, and they typically leave an hour after the surgery. A follow-up at two weeks involves removing the initial cast and applying a new one.
Post-Surgery Care: At week four, the patient transitions to a walking boot for two weeks. Around week seven, they move to regular shoes. Physical therapy begins six weeks post- surgery, with a final follow-up six months later.

Types of Toe Walking & Terminology

Terminology
Toe walking, also known as Equinus, refers to a walking pattern where the individual walks on the balls of their feet without their heels touching the ground. The condition can be classified based on its cause or persistence.

Types of Toe Walking:

Idiopathic Toe Walking (ITW): Persistent toe walking without an identifiable medical cause, affecting 7-24% of individuals. It is common in children over three years old and often requires targeted therapy for toe walking.
Neurological Toe Walking: Caused by conditions like cerebral palsy, which result in increased muscle tone and spasticity, leading to toe walking.
Developmental Toe Walking: Associated with developmental disorders such as autism spectrum disorders, where sensory processing issues or motor delays contribute to the gait pattern.
Physical Toe Walking: Resulting from physical conditions like a shortened Achilles tendon, heel pain, or other musculoskeletal abnormalities that prevent normal heel-to-toe walking.

Toe Walking FAQs

At what age is toe walking a concern?

Toe walking is common in toddlers under two years old but typically resolves by age three to four. Persistent toe walking beyond four to five years old often requires medical evaluation.

Is toe walking always a cause for concern?

Not necessarily. While toe walking can be a normal part of early walking development, it should be assessed if it persists to rule out underlying conditions.

How is toe walking diagnosed?

Diagnosis involves a thorough medical history, physical examination, gait analysis, and possibly neurological and orthopedic evaluations. Dr. Narang can often diagnose toe walking through a virtual consultation.

What is Idiopathic Toe Walking (ITW)?

ITW is toe walking without an identifiable cause, affecting 7-24% of children and some adults. It is diagnosed when no neurological, orthopedic, or mental illness is present.

What are the conservative treatments for toe walking?

Conservative treatments include physical therapy, bracing and orthotics, and casting to gradually correct foot positioning and promote a natural gait.

What does Achilles Tendon Lengthening (ATL) involve?

ATL is a surgical procedure to lengthen the Achilles tendon, allowing the foot to achieve a normal position and gait.

How long is the recovery from Achilles Tendon Lengthening?

Recovery involves an initial cast for two weeks, transitioning to a walking boot for two weeks, with physical therapy beginning six weeks post-surgery.

What is the success rate of treating toe walking?

Toe walking is 100% treatable, with many individuals responding well to conservative treatments or surgery if necessary.

Conclusion

Toe walking, or Equinus, is a common condition that can affect individuals beyond the toddler years. While it may be a normal part of early development, persistent toe walking requires careful evaluation and treatment. Whether the cause is idiopathic, neurological, or physical, addressing the condition early can prevent long-term complications and promote a healthy, natural gait.

Dr. Chandan Narang is a leading specialist in foot conditions, including toe walking treatment and Achilles tendinitis care. With extensive experience in diagnosing and treating Equinus, Dr. Narang provides comprehensive care tailored to each individual’s unique needs. Schedule an appointment with Dr. Chandan Narang today to explore the most effective treatment options for toe walking and ensure proper foot health for both children and adults.