Occupational Therapy for Ideopathic Toe Walker

I am wondering if anyone has witnessed success/progress for kids who have undergone occupational therapy for idiopathic toe walking.  It has been recommended for my 8 year old son, but there are no studies supporting efficacy that I can find.  We have seen neurologists, orthopedic surgeons and physical therapists with mixed results. He did casting about a year ago.  I am concerned about long term damage to his bones and joints if this pattern continues.  Braces correct his gait, but he goes back up as soon as they come off. A lot of kids grow out of it, but I am not sure he will.  I am willing to pay out of pocket for services if they will help, but I do not want to buy snake oil.  All practitioners suspect sensory issues are at the root of his gait issues, still I am not sure how to help him with this, other than nag him to come down on his heels.   

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Hi there! Yes, this is a big concern, and it does seem to me that long term walking on toes will cause damage that will cause pain and disability throughout his life (I am a P.T.) I am not sure about O.T. for this, I love O.T.s, have always felt that I should have gone to O.T. school instead, and have worked in a team with O.T.s for many years, but....generally, lower limbs are not their field. Although a lot of our training overlaps, we have tried to leave the specialized upper limb mechanics to them as they have left the specialized lower limb mechanics to us P.T.s. It also seems that you have tried all of the standard treatments. Casting is so difficult, I really wish that you would have seen results from it. There is an old, old modality that in the distant past we used for people who had knee replacements who could not get their quads going again called Biofeedback. It is not a "sexy" new treatment, not a flashy thing, no company will get rich by selling the treatment or technology so it has kinda fallen by the wayside, but... it is very simple- you place a sensor on one muscle and if it contracts then a beep goes off on a small battery powered machine you carry with you. It can be used to remind a person that the wrong muscle is being used (or I think that we set it so that the beeps would happen stronger and stronger as the quad muscle was used more and more as we were trying to encourage the use of that muscle.) But you can also use it to let someone know that a muscle is being activated that you don't want them to use so that they can be aware of it and stop activating it. It might be worth a try- if he is physically able to come down from his toes but it is just a learned movement pattern that he can't stop repeating when he stops thinking about it (our muscle memory is deep- and very subconscious, so I am not surprised by this), then having an auditory reminder of what is happening physically may allow him to change this deeply ingrained muscle habit. I don't know therapists around here who do this, I am a full time Mom right now and not actively practicing P.T. but it seems that some of the older P.T.s who have been around and have lots of experience might know how to do this. It is non-invasive, non-painful, portable, and also should be fairly inexpensive, as medical stuff goes (-: Just start asking P.T.s that you have worked with about this, if they know any other P.T who has experience using biofeedback. I am thinking that the Alta Bates/Summit Outpatient P.T. clinic there on Telegraph might be a good place to ask, too. Or any of the colleges that give P.T. degrees- the Professors who teach are usually practicing P.T.s and know lots of other P.T.s who do rather specialized things. Good luck to both of you!

You might look into the HANDLE Institute program, stands for Holistic Approach to Neuro Developmental Learning Efficiency. The local practitioner is Sindy Wilkenson, in Lafayette at the Enhanced Learning and Growth Center. 925-934-3500. See if they can help. Good luck.

Hello my daughter also walked on her toes, since she was 3 until she was 15 and had Achilles Tendon Lengthening surgery or TAL surgery as it is called.  My daughter also has sensory processing issues.  We tried casting twice and a lot of physical therapy.  The surgery was the only thing that worked for her.  She had it about 18 months ago and she had 100% success so far. In retrospect I wish we did the surgery when she was younger.  She started getting severe back pains when she turned 14th from walking on her toes for all those years.   The surgery took almost all the pain away.  The surgery was outpatient.  Recovery was hard the first few months but it was really worth it.  We were hesitant to put her through major surgery but  we researched it and it has the best results of any treatment option.  She had the surgery at Kaiser Oakland.   You do have to be pushy, our regular pediatrician did not know about this surgery nor did the Physical Therapist at our local Kaiser.  You can e-mail us if you have more questions. 

Good Luck!