Written by Stephen M. Edelson, Ph.D.
Center for the Study of Autism, Salem, Oregon
Toe walking is quite common in young children,
age three and younger; but toe walking, especially in children five
years and older, is often associated with neurological immaturity.
Many parents and professionals are not aware of the various interventions
used to treat toe walking. The following interventions are listed
from least to most invasive.
1) Physical exercises are sometimes used to stretch
out the tendon in order to reduce toe walking, but this treatment
has had minimal success.
2) A dysfunctional vestibular system, a common
problem in autism, may be responsible for toe walking. The vestibular
system provides the brain with feedback regarding body motion and
position. It may be possible to reduce or eliminate toe walking
by providing the person with therapeutic vestibular stimulation
(e.g., being swung on a glider swing).
3) Toe walking may be directly or indirectly related
to a visual-vestibular problem. I have conducted several research
studies with Melvin Kaplan, O.D. at the Center for Visual Management
in Tarrytown, New York. While conducting these studies, I observed
four individuals who were toe walkers. In each case, their toe walking
was eliminated within seconds after the child began wearing prism
Prism lenses displace the person’s field of vision
up, down, left or right. Dr. Kaplan and other developmental optometrists
have developed nonverbal assessment procedures to determine the
correct direction and degree of displacement for the prism lenses.
Unlike other interventions for autism, changes in attention and
behavior are observable immediately after the person begins to wear
the lenses. The use of prism lenses is part of a ‘vision training’
program. The program typically lasts for one year and involves wearing
prism lenses and performing daily visual-motor exercises. After
the program is completed, the person no longer needs to wear the
(4 & 5) Casting is another intervention used
to stop toe walking. This procedure involves wearing a cast to stretch
out the tendon. In most cases, the cast is applied every two weeks
for a total of 6 to 8 weeks. Another treatment involves surgery.
Long-leg casts are then worn for six weeks and followed by night
splinting for several months.
It is important for parents to learn as much as
possible about treating toe walking before selecting an appropriate
intervention for their child. When making a decision about any treatment,
parents should take into account the treatment’s effectiveness,
safety and cost.
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