Serial Casting for toe walking?

[summerrluvv]

DD (3) is a toe walker. Has tight heel cords so we're going to be starting PT to stretch them for six weeks. If that doesn't work, doc. said we'll talk about serial casting. I know someone who had it done, didn't work. Has anyone had success with it OR just success with just PT? DS toe walks and PT did nothing for him, and is now 11 and still toe walks (also on the autism spectrum though).

 

[jagafen]

Is the serial casting being done so that MAFOs (molded ankle foot orthosis...it's basically a plastic splint) can be worn later? PT isn't necessarily going to make the toe walking "go away". Toe walking usually results from a neurological issue (autism, MD, CP, etc), and if the issue doesn't go away, to toe walking won't either. Serial casting can be used for long term stretch to the achilles tendon, to get the foot to the point that a brace (MAFO) can be worn, to hold the foot and ankle in position so that the child walks on their feet instead of the balls of their toes. Not knowing your daughter's general status, it's difficult to understand how progressed her tendon shortening is....

FWIW, there's also idopathic toe-walking, where there is no diagnosed neurological defect...that runs in our family. DH's oldest neice walked on her toes ALL the time. People used to talk about how she was "naturally inclined" to be a ballerina....I tried to talk to her mom about remediation, but it wasn't a big deal to her....until years later. Last summer, the poor girl (who was 12 years old) had to spend the summer with big heavy boots on her feet to stretch out her ankles....DS is an ideopathic toe walker too....we just nag the heck out of him to walk on his feet....

 

[woodkins]

DD7 was also a toe walker and at age 4 we started PT for stretching but also used AFO braces at night for prolonged stretching. They were able to help her regain her range of motion. It also took ALOT of reminding her to "walk on her whole foot" etc to get her to change her gait. Even after regaining the range of motion the toe walking was habitual. She still at times will stand at the counter on her tiptoes or pop back onto them when she is walking. We also did yoga classes for a long time as a fun way to increase her stretching time.

 

[mickeyluvr004]

My neice who is 6 also does this and the doctors are not concerned.. i feel they should be doing something but my sis in law said nope they are not doing anything right now...

 

[summerrluvv]

Thanks all...(was on vacation that's why it took so long to respond)

DD does not have any neurological issues

It's my understanding the serial casting would stretch her heel cords (and maybe something else), so that she is able to walk flat footed. Right now she can't put her foot entirely flat. When I try to flex her foot toward her..she says it hurts.

I guess we'll see what happens with the PT

 

[A&E'sMom]

PT does help a lot. My 6 yo son started PT when he was four (he'd been toe-walking since he learned to walk). He doesn't have any neurological issues either. After PT (nearly a year at only once a week), he walked well, and was inspired to keep it when he saw how much faster he could run. But, it's very important to keep up with the stretching exercises. When I drop off, he inevitably will start creeping back on his toes again, and has to be reminded to "walk on his feet", or "walk like a penguin" (what his therapist called it ). Also, he does have issues with very dry skin on his feet, and sometimes it cracks under his toes. When that happens, he also starts toe-walking again. So, we work to remember to check on his feet and keep them in good condition.

Also, we do his stretching right before bed, to cut down on soreness and cramps. But, when PT starts, expect some complaining about sore legs.

 

[holden]

DD7 is a toe walker, but mostly when she's barefoot. She ice skates, so that forces her to balance on her feet correctly. If she goes on her toes, she falls!

We took her to an ortho when she was about 4 and he said it was ideopathic (habitual). We just nag her. She does okay most of the time except when she doesn't wear shoes.

 

[TheRatPack]

My 6 year old didn't start walking till he was 2 years old, and that was only because physical therapy stepped in while he was in Foster Care. He still toe walks and is on some spectrum....we just don't know what exactly. He has a lot of issues, and has seen all sorts of specialist that say the same thing, they know something is wrong...just not sure what. He toe walks, had inserts for no arch....etc etc etc. The PT said he didn't need to be seen on a regular basis....so we haven't. He toe walks, and runs really really forward, which causes a lot of falling because he gets going too fast down a hill or something and he's leaning forward and on his toes...etc.

We try to remind him to walk on his whole foot....not sure if it'll ever work though. He has really flat wide feet too, so when he walks on his whole foot he slaps them on the floor LOL Not sure which is more damaging.

 

[Tinkh]

My niece is a horrible toe walker. Even points her toes in her sleep. She is 14 now and they have never done anything with hers. She is very athletic and does year-round softball as a pitcher. We swear her pointed toes have helped her be the amazing pitcher that she is. Runs incredibly fast, so the doctors feel any change would hinder rather than help her.

 

[Surfercisco]

I have a six year old son who started walking at 12 months and was up on his toes from the very beginning. He was an idiopathic toe walker (that is, there was no reason for this to be happening. He could walk and stand still on his feet but did this rarely in the beginning. No sensory integration disorder, autism or anything else).

We were concerned enough to take him to a pediatric ortho surgeon at 16 months of age (my husband is a doctor so we had access to these consults). He suggested that since my son was just learning how to walk that we get him physical therapy.

We did this for a couple of months- it did not help.

At 2 and 3 years of age, he was still on his toes and we did a second round of PT somewhere else. This did not help. At this point, the original ortho surgeon recommended that we serial cast with subsequent splinting.

With this information, we sought the advice of THREE other ortho surgeons who worked with my husband. They all said to leave it alone.

The last, who was the head of the pediatric department, related to us that his son toe walked, and grew out of it. He recommended we wait until the spring before Kindergarten and then to serial cast if he continued to toe walk.

We were distressed. Our son fell constantly on his face due to his foot position. He was a slow runner which bothered him. In retrospect, I think I was more focused on when he was toe walking than when he was down on his feet. I have photos of him at 2 yrs. running down on his feet. But to talk to me then, I would say this never happened because I was so distressed by it. It didn't help that his preschool teachers were diagnosing him despite my explanations that we had already consulted other professionals (didn't mention to them that my husband and I have medical and advanced degrees in psychology).

At the end, he grew out of it. We saw more and more improvement over the years. He walks normally now. The turning point was five years of age. I switched preschools and placed him in a Montessori School where he was not allowed to wear shoes in the classroom. Who knows if this had anything to do with it, but I remember at this point of his life, that we were no longer reminding him as much about his walking. He finished kindergarten and I am happy to see that the heels of his sneakers are worn down.

I don't think anything we did changed the course of his development. We worried and I understand the worry. It didn't help when people attributed serious issues with our son without having any background to do so.

Good luck with this. Be patient and really try to observe to what degree your little one is up on the toes. Seek the advice of more than one doctor/professional.

 

[canadianjovigirl]

My 15 year old was a toe walker and nobody seemed concerned about it and thought it was cute like a ballerina.......needless to say we moved and our new pediatrician was concerned and discovered she would not put her foot flat so PT was skipped and we went right to casting..........the first set was the worst as she was 2 1/2 and cried and cried to take them off as they hurt..........it did get better each cast change and after 6 months she was walking flat footed and still to this day does..........

 

[TruBlu]

DD (3) is a toe walker. Has tight heel cords so we're going to be starting PT to stretch them for six weeks. If that doesn't work, doc. said we'll talk about serial casting. I know someone who had it done, didn't work. Has anyone had success with it OR just success with just PT? DS toe walks and PT did nothing for him, and is now 11 and still toe walks (also on the autism spectrum though).

It worked perfectly for our DS! We didn't start with PT - just went right to the braces. He went thru 2 sets, then very little PT. That was 7 years ago and he's never had a problem since!

 

[TruBlu]

Forgot to ask...
Have your doctors mentioned the need for a MRI? DS had to get one before they could be sure of his diagnosis. They were concerned that he had a tethered spinal chord. After the MRI was negative, we went right to the braces. It was really hard at first because he had to wear them to pre-school, but the kids didn't even notice. His teachers were amazed because he even figured out a way to jump with them on! I'm really glad we got it fixed right away. I guess I just notice it more because of him having gone thru it, but I notice adults who toe walk. I'm sure it's much easier to correct with young children.

Good luck with everything!

 

[Magic Mom]

DS was a toe walker until about 11, then it sort of turned into a bounce. But he is 19 now and it's 99% gone. I can notice a very slight bounce, but no one else can. His Dr. tested for neurological issues, but that was ruled out. He didn't have any type of PT for it.