Why Does My Child Walk On His/Her Toes?

Treatment:

1. In patients with mild tightness of the calf muscles, a home exercise program in patients with mild tightness that encourages proper calves (gastroc stretching) may be all that is necessary to achieve loosening of the calf muscles so that the motion goes back to the ankle instead of the foot.

2. NIGHT SPLINTS are often utilized to keep the foot at a 90-degree angle while the patient is sleeping. It may be utilized in mild cases of gastric solely (calf muscle) tightness.

3. PHYSICAL THERAPY may provide some limited benefits in patients with mild cases of muscle tightness. If there is a significant amount of tightness to the calf muscle, physical therapy will be of very limited benefit.

4. SERIAL CASTING is a procedure performed to loosen the tight calf muscles. The procedure is usually performed one leg at a time so that the patient can walk as much as possible while in the cast. The procedure is usually performed by placing a hard fiberglass cast that is not removable. It is applied from an area just below the knee to the base of the toes. While putting the cast on the foot is manipulated into its neutral position to avoid a collapsing arch. All the stress goes to the ankle and calf muscle during walking and the muscle undergoes a stretching process. The more the patient walks, the more the muscle stretches. This takes place because during gait the knee expands and the muscle stretches because the calf muscle attaches above and behind the knee. Casts are usually changed every two weeks until good mobility is present in the ankle and the calf muscle is no longer tight. In mild cases this may take 2 weeks and in more advanced cases it may take 4-8 weeks. Once one extremity is finished in the casting process a custom molded orthotic is made for the foot. The other leg is then casted in similar fashion. Casting both legs at the same time does not allow the patient to walk with knee extension; therefore, IT DOES NOT WORK. 

THE KEY WITH SERIAL CASTING IS TO HAVE THE PATIENT WALK AS MUCH AS POSSIBLE AND RESUME ALMOST ALL ACTIVITIES EXCEPT RUNNING AND JUMPING. When the casting is complete, night splints are used for a period of time to maintain the correction.

5. ACHILLES TENDON LENGTHENING SURGERY may be necessary in cases in which the calf muscle is exceptionally tight and the arch is completely collapsed. One of the most important procedures that we perform in our practice is to lengthen the calf muscle or Achilles tendon when serial casting or other measures have failed. The Achilles tendon lengthening procedure is done on an outpatient basis under a twilight or general anesthetic. Three small incisions in the back of the Achilles tendon are made, all 1/8” in length. The incisions are separated by 2.5 to 3 cm. One stitch is placed in each one of the incisions. A cast is applied postoperatively and the patient is non weightbearing for 6-8 weeks. Night splints are often utilized once the cast is removed and the patient begins physical therapy. This procedure is usually done with other procedures at the same time such as an “arthroeresis” or implant placed in the side of the foot to correct a flat foot. Full recovery can take three or more months. 

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