Toe Walker – First Follow-up

It has been three weeks since I wrote the article “Toe Walking – Not Just For Ballerinas Anymore” pertaining to toe walking in toddlers. Two office visits and more than 10 hours of exercises later, I thought I’d update you all to our progress, and perhaps get a little more conversation going around this surprisingly common subject.

First, let me say that I really like the doctors we are seeing at Children’s Memorial Hospital. They are knowledgeable, patient, and willing to crawl around on the floor walking like a bear or crab, and rolling large padded columns up and down inclines. They are also expensive, like much of our healthcare in America. Billing at slightly higher than $400 for 30 minutes of thoughtful and targeted exercise is very excessive in my opinion, but I will leave it at that for the healthcare topic. The point is that those weekly visits will not be weekly, but rather bi-weekly or even monthly depending on our feelings about Xavier’s progress. After all, the 30 minute sessions in the office aren’t going to correct the issue, our 30 minutes a day at home will, so other than to officially monitor progress or offer tips and additional exercise ideas, we will save ourselves and the (ahem) insurance company the cost of weekly $400 visits.

Xavier is progressing decently, though slow progress is to be expected. He is physically able to walk with a healthy heel-strike-first gait, a big advantage. His range of motion is normal, so whenever we remind him to “walk on flat feet” he immediately begins walking correctly…for a little while anyway. This is actually one of the more important things we have been advised to do is to constantly observe his walk, and remind him to get off his toes. It is both amusing and annoying to listen to us walk down the street having a normal conversation interrupted every couple of minutes or so with a “FLAT FEET” or “HEELS DOWN” reminder tossed the way of my little man. To his credit, he never complains, and drops his heels down every time, no questions asked.

The other important element of the treatment is the exercise routine. About 30 minutes of each day (not all at one time) we do fun little exercises to strengthen Xavier’s core muscles designed to make it easier and more natural for him to steer his balance back to his heels from his toes. Some of these exercises include:

• Duck Walking – Stand with feet close together and bending at the knees, put hands just below each knee. Take small steps across the room or around the playground, quacking like a duck while walking. This is both the toughest exercise, but also might be the most effective according to the therapists. Done correctly, it is very difficult to do this without the body weight being centered over the heels.
• Air Kick-Ball – Lay on back and try to grab a ball held above your chest with both feet, or instead of grabbing, just kicking is OK. Try this once yourself and it will be obvious that this is designed to strengthen the abdominal muscles making it easier to keep body weight balanced over the heels. Xavier actually thinks this one is really fun and will interrupt a regular game of kick-ball to do this exercise.
• Squat Toy Pick-up – Stand with feet about shoulder-width apart. Keeping heels planted on the floor, squat at the knees and with both hands pick up a toy or small object placed between feet and slightly behind heels. Note that I personally have never been able to squat down with my feet flat on the floor, but can only do so on my toes with heels elevated.
• Bear Walk – With feet as flat as possible and bending mostly at the waist (as opposed to the knees) place hands on the floor and walk across the room or around playground.
• Crab Walk – Same concept as the Bear Walk, but with stomach and chest facing the sky as opposed to facing the floor.
• Push Something Heavy – Push a short and reasonably heavy object along the floor keeping feet as flat as possible, or even better…
• Pull Something Heavy – Same as above but pull while walking backward. This almost forces the heels to the floor first.
• Superman (or woman) – Have child lay on stomach across your lap with most of upper body hanging over the side of your lap unsupported. Have the child reach for a ball or other object with both hands. The object should be held high and far enough away so that a good stretch up and out is needed to grab the object. This is designed to strengthen the lower back muscles and complements the abdominal core exercise above. The nice thing with this exercise is that you can easily touch the child’s lower back and feel it working.

There are a handful of others we have been given, but these are in the standard rotation. Xavier is showing progress, and will sometimes stand or walk on flat feet without prompting, but still has a long way to go. It is interesting to me how many people either have a child or know a child who has been through this and has had both success and a definite lack of success in correcting it, even with serial bracing. I am very hopeful our little dancer will be fine, but not without significant effort. I wish nothing but the best to anyone else who is working on the same thing, and would love to hear about your experiences as well.

Be Well!

Toe Walking – Not Just For Ballerinas Anymore

I know nothing about dancing. I’ve never been fond of dancing myself. Aside from some occasional thrashing about in nightclubs back in my early twenties, I am generally standing on the sidelines, or more likely, near the food/bar. From what I understand however, dancers, particular those in the ballet, work long and hard to build the strength and flexibility in their calves to allow for dancing on their toes. Apparently this makes movements more graceful and beautiful.

In children, toe walking takes on a completely different meaning. Many children walk on their tip-toes as they learn to walk, and will generally abandon that for a more typical heel-first walking style early on. Sometimes, children do not shake the habit, however, and despite its cuteness, can be pretty damaging both physically and emotionally. We have just begun officially dealing with this in our own little toe-walking son.

A neighbor of ours brought it to our attention over a year ago now. She told us about her own son’s toe-walking, and his need for a serial brace work for portions of every day in order to stretch out the tendons in the Achilles area to allow for a heel-first strike. Xavier advanced through most of his physical milestones early than average, and began walking just as he turned 10 months. Very shortly thereafter, he began running and kicking (I proudly share that he already has “mad” soccer skills). I must admit, it was tough to hear that my budding athlete might have an issue with his legs, but our neighbor’s warning was accurate, and after Xavier failed to shake the habit after more than a year and a half of walking, we decided to have a consultation with a physical therapist at Children’s Memorial Hospital.

The session was held in a typical doctor’s office, but the staff was a bit different. Instead of stethoscopes and tongue depressors, they came equipped with what appeared to be some sort of protractor, some toy cars, and a basketball. As far as Xavier was concerned, there couldn’t be a more entertaining doctor’s office to visit! They asked Xavier to do a series of things like squat down, lay on his stomach (so they could measure the angles his stretched tendons would allow), and walk like a duck. He behaved wonderfully, following every request and suggestion perfectly. Eventually, we made our way to a more gym-like room where other exercises followed.

The result is that while bracing is not necessary right now, we do have some exercises to perform daily with Xavier at home, and will be heading to therapy weekly for the next 4-6 weeks. The exercises are fairly entertaining, so Xavier doesn’t put up a fuss (for now), but it does take even more discipline and diligence in all of us to make sure we are doing them regularly and correctly. I have a high degree of confidence that we are taking care of this early enough that we will be able to correct his walking through exercise alone, but time will tell. Either way, it takes nothing away from his abilities or coordination (remember…MAD SKILLS), so I am not worried.

A word of warning, however, for other parents out there. We were told that though this could just be something natural that he was predisposed to do, some things can exacerbate the problem. Among those things are the family of “exer-saucers” and “walking aids” that seem pretty ubiquitous in children’s playtime rota. Before Xavier was walking, we would frequently let him play in his Rainforest Jumperoo by Fisher-Price. It seemed like an excellent toy to us – he loved it, it appeared to strengthen his legs, and it kept him occupied without crawling all over the condo like some drunken marine doing basic training drills. Come to find out that these toys encourage the child to brace their weight on their toes early on until they graduate to walking. Then, in an evil follow-up, the “walking toys” that seem to help the child walk actually force the child out of control, and that is exactly their problem. When used, the child is encouraged to walk with their weight forward on their toes in order to keep up with the rolling toy. Again, Xavier LOVED his “walker”, though due to frequent collisions with objects both inanimate (the wall or a pile of toys) and animate (my foot or the cat), we were less in love with this one, and will happily forgo its use with Hayden.

Xavier in his Rainforest Jumperoo, a.k.a. Tendon Compactor

In place of these toys, the therapists suggest loads of “tummy time”. If you are a parent, you know what “tummy time” is, and if your not a parent…well, you can guess. Another problem that comes with toe-walking (or is it a cause – I can’t remember) is weak abdominal muscles. Strong abdominal muscles are developed during tummy time, and in turn encourage the weight to fall back on the heels when walking, standing, etc. You can actually see it on Xavier when he tries to perform a sit-up of sorts. A ridge running vertically down the middle of the stomach pushes up as he tenses his abdominals. This ridge, along with a noticeable flaring of the ribcage is the result of the two sides not yet “coming together” (again, I don’t know the scientific terminology). This too should be corrected with these exercises we are performing.

So, if you child, or soon to be child displays the toe-walking and abdominal ridge after 18 months of age, I suggest a visit to a good physical therapist to catch the problem before it becomes an impairment that needs correcting during school years. Kids can be cruel. We’ve all been there – probably on both sides of the teasing battlefield – and whether the child is forced to wear orthopedic shoes, or walk like a ballerina, chances are some taunts will be uttered in their direction.

If you have a very young child who hasn’t yet gotten into a Jumperoo-type or walking-assistance product, heed my advice, and stick with “tummy time”. Not only is it better for your child, but it will save you a few bucks as well.

Be well!