My 10 year old son has always walked on tiptoes, feet hurt. what could be wrong?

Question

He has been to a neurologist. They mention he may need walking casts, braces to extend the muscles, or surgery. What kind of surgery might that be? Is there a name for this? They checked his creatin kinase and that is fine. His feet are flat and he walks tiptoe because it hurts him and also other parts hurt like his hips, knees, sometimes back and etc from this stress. It hurts to extend his achilles tendon and the dr's said it should go up more than 10 degrees. My son is type 1 diabetic but all claim this is not related. I just wanted to add that this is both feet. Thank You for you time.

Answer 1

What Your Doctor May Recommend
If your child has a physical problem such as a short Achilles tendon, treatment would probably begin with a program of stretching and an ankle-foot orthosis, which is a lightweight plastic brace that goes up the back of the leg and maintains the foot at a 90-degree angle. Your child wears the brace day and night until the problem is resolved. Of course, you can take it off for baths or to practice muscle activity to strengthen the tendons. A process called serial casting (which involves using a series of casts to stretch and lengthen the tendon and increase the range of ankle movement) is sometimes used, but, says physical therapist Gay Girolami: "It's passive, and when you practice activities in an active rather than passive way, you see more progress." Also, casts can't be removed on the fly like the braces mentioned above. In select cases, surgery may be recommended.

OR

Toe Walking

What Is Toe Walking?
It is common for children to walk up on their toes while taking their first steps between the ages of 10 to 18 months. Sometimes children will toe walk up to the age of 2 or 3 years. However, if toe walking continues past these ages, the child should be evaluated by a physician.

What Causes Toe Walking?
There are many reasons for children to walk on their toes. Some of the most common are:


Tight heel cords can cause decreased range of motion of the ankle, causing the child to be more comfortable on his or her toes.
Increased tone (spasticity) can lead to tight muscles over time and cause children to walk on toes. Tone may be increased due to a neuromuscular disorder or other medical conditions, such as cerebral palsy.
A dysfunctional vestibular system may cause children to walk on their toes. This is a common problem in autism and with some balance disorders. The vestibular system gives the brain feedback about the body — it’s motion and it’s position in space. A visual-vestibular problem can also cause toe walking. Some children with poor integration of sensory input from their vision or vestibular systems feel more “secure” when they are up on toes.
When the child does not display any of the above muscular, neuromuscular or sensory reasons for walking on toes, it is said to be idiopathic in nature.
Why Is My Child Being Referred For Physical Therapy?
At Kenny Kids Rehabilitation Program, a pediatric physical therapist will evaluate your child according to the physician’s orders. The evaluation will consist of range of motion measurements, strength testing and gross motor assessments. The evaluation may consist of a screening for sensory integration dysfunction.

Your child’s physical therapist may recommend direct physical therapy services. The physical therapist can help by stretching if your child has tight muscles or help strengthen weak muscles. The therapist can also teach you gentle stretching exercises and strengthening activities for you to do at home.

What Can I Do At Home?
It is important for you and your child to follow through with your home program activities. Consistency with stretching is important for making gains in range of motion.

Trying to get your child not to walk on their toes will require some encouragement from you and others involved with your child. Be kind when encouraging by offering gentle reminders for walking heel-toe.

What Are Some Other Interventions Available?
If your child has not responded to stretching and strengthening exercises, your physician may recommend one or more of the following:


Serial casting — This procedure involves wearing a cast on involved leg(s) to help stretch out tight muscles. Serial casts are usually left on for one to two weeks. When the cast comes off, the child’s ankle motion is measured and then the physical therapist determines if the child needs more casting. The casts are usually applied for two to eight weeks.
Splinting — A splint is applied to the child’s leg, usually during sleeping hours, to help stretch the muscles of the leg. A brace, or AFO (Ankle-Foot-Orthosis), may also be recommended. This brace is worn during the day to help discourage your child from walking on toes and may also be worn as a night splint to help with stretching.
Botox injections — Botox is a strain of the botulinum toxin that is injected into tight muscles to cause temporary weakness. This weakness usually lasts about three months. During this time, your child may receive intense physical therapy to stretch the tight muscles and strengthen the weak muscles.
Surgery to lengthen their calf muscles may be necessary if your child has not responded to other forms of treatment or interventions.

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Doctor's Reply:
Thank you for your question. Toe walking in children is not uncommon. As physicians we are taught that if a problem occurs at the time of birth, if there is a lack of oxygen to the new borne then it can cause a mild form of Cerebral Palsy and this can cause toe walking. Please do not be alarmed by this because if this is the problem it is not progressive and often times is never recognized. In all cases of toe walking we place the child in an orthotic(shoe insert) and a high topped shoe. If this does not work then perhaps a surgical procedure may be necessary to lengthen the achilles tendon. Make an appointment to see a podiatrist in your area and see what they have to say. You can find a podiatrist in your area by visiting our web site www.PodiatryNetwork.com


Ok one thing I want to say is that diabetics have probelms with poor circulation, hence they have to watch what shoes and socks they wear. You need to find out FOR SURE if this is unrealted to the diabetes. I'm concerned that there is a link...

Best of Luck!

Answer 2

Wow Dufus, did you copy & paste that?? J/K.
I went to school with a girl that had the same problem, she always walked on her tiptoes. It took a while before I asked her why. I didn't want to seem nosey! She told me that the tendons & ligaments around her ankle & heel were not able to stretch enough for her to walk flat footed. She also told me that there was a surgery that would correct the problem however being that she was 17 years old, she would have to learn to walk all over again. I can't remember the name of the condition or the name of the surgery. This was 21 years ago. Perhaps the surgery is the same as your son's doctor mentioned. Which would require the cutting of the tendons & ligaments in order for them to stretch so your son can walk flat footed. I imagine the surgery has been improved compared to 21 years ago. If the doctor/surgeon recommends it then I would probally go ahead because the longer you wait the harder it will be on your son. Good Luck to you & your son.

Answer 3

My 14 year old son has no arches/flat feet. He walked with a big turn-out on both feet...the pediatrician ordered orthotics for him, he wears rigid arch supports now and they make a huge difference. His legs, knees and hips all feel much better now...he can run and enjoy outdoor activities where before he couldn't.

A physical therapist also gave him exercises to strengthen the lesser used muscle groups that had caused him to have weak ankles.

Maybe this is your son's problem? Have they checked with a physical therapist or orthopedist?

Answer 4

My sister is autistic and she's walked on her tippy toes all her life. The two are apparently related. But if this stems from more of a physical problem, follow the doctor's advice and treatment. I'm sure, by 10, you'd know if he had a mental disability.

Answer 5

My younger brother always walked on his tiptoes and he is also flat feet. They put his feet in walking casts to help straighten them which worked a little bit. My mom also had to do foot exercises with his feet by bending his foot and if they didn't want to straighten out or it hurt him she would put baby lotion on his feet and that seemed to help. He was diagnosed with cerebral palsy in his feet and just found out that he has it in his hands as well.
you could consider getting him checked out maybe he has cerebral palsy and the specialist can inform you on how to do the exercises.

Answer 6

My feet are also flat and causes aching hips,knees,back. podiatrist saw me and had me have inserts made for my shoes that creates an arch. with all things lined up now I no longer have body aches. hope it helps....I think you need to take your son to a FOOT DOCTOR : podiatrist and then work your way up..really wonder why a neurologist first?????

Answer 7

For the best answer see an optometrist who is certified COVD( www.covd.org) My daughter did the same thing, the problem is usually in his vision and not his legs or feet. I bet he leans forward when he runs and arches his back too. this has to do with balance and vision with the brain. there is another site called NORA and these eye Doctors have special training for thing like this. Check it out for sure, it has made a huge difference for my daughter

Answer 8

walking on your tip toes is a sign of some sort of brain damage that can occur when children are small, mabey he hit his head or got to hot when he was little, i know this because i have done alot of research on this subject, my 8 year old little girl has the same problem

Answer 9

has he been born disabled? i'm sorry. maybe he needs to do a certain surgery...