Our approach to treating toe walking includes a casting process, braces, regular exercises and follow-up.
During the serial casting phase, joints that are limited in range of motion are immobilized with a well-padded plaster and fiberglass cast. The casts are applied and removed on a weekly basis. With each series of casts, the affected joint or joints are gradually set in a more correct alignment until the desired range of motion is achieved.
The casts extend over the child’s toes to provide a stable base of support while realigning joints, allowing muscles to strengthen and teaching children to correct their center of weight for a more effective walking pattern. Our physical therapists work very closely with our orthotics team to develop the casts and the braces our patients wear. A unique aspect of our program is that physical therapists and orthotists work together with the patient and have a shared understanding of the patient’s unique needs.
We encourage children to participate in all of their typical daily activities while wearing their casts. The regular movement helps strengthens the muscles they need for correct walking alignment. We also ask that children complete at least an hour a day of standing exercises. This hour can be divided into smaller time periods. Your physical therapist will give you specific exercises.
There is no typical amount of time for the casting process because each child’s muscles change at different rates. As long as the range of motion keeps improving, we’ll continue to do weekly casts until the goal range is achieved. However, if we haven’t seen any change in a four week period, then we’ll finish casting and start the next step.
After the child has completed the casting process, they will be fitted with day braces and night braces. They’ll continue doing their standing exercises, as well as a few ankle strengthening movements. Once their new walk becomes easy for them, they’ll slowly be weaned out of the day braces. Once the child is completely comfortable with their gait and walk, they’ll need about 10-15 minutes of standing exercises each day. They will need to continue to wear their night braces until they’re done growing to avoid losing any range of motion.
After completing the program, we ask that patients come back every three months so we can monitor their progress, make sure they are not losing any range of motion and revise the exercise program as needed. Children must complete the full casting and post-casting program to keep their alignment.