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Toe Walking – When should I get help?

Parents can’t wait for the moment their child starts walking on their own.  It is a sign of achievement and is usually met with great excitement. Sometimes, however, that excitement turns to worry when a child does not walk as the parents expect. One common walking problem is toe-walking or walking on the balls of the feet. Toe walking could be relatively benign (termed “idiopathic toe walking”) or it could be a sign of something more serious.

There are a number of reasons why a child might toe walk. Some of the reasons for toe walking include musculoskeletal or neurological conditions. If your child is walking on his toes and does not have any specific condition that would cause the toe-walking then he has what is known as idiopathic toe walking.  Fortunately, most cases of toe-walking are idiopathic in nature and might not need any specialized treatment.

Idiopathic toe walking is the most common diagnosis for toe walking. It is defined as a gait pattern with no contact between the heels and floor after the age of three. Studies have shown that the majority of idiopathic toe walkers will begin to walk normally between 5 and 6 years of age without the need for treatment.  There are a number of theories given for idiopathic toe walking although none are proven. We do know it is more common among children with neurodevelopmental disorders (such as autism, sensory processing disorder, and ADHD).

If your child is unable to walk with a heel-to-toe pattern when prompted before three years old or is toe walking after three years old you should seek medical attention. If toe-walking is from a musculoskeletal or a neurological condition it is better to start treatment as soon as possible. Treatment might consist of physical therapy, bracing, surgery or a combination of each. If the toe walking is idiopathic the treatment can be as simple as observation.

If physical therapy is recommended, treatment might consist of stretching the tight Achilles tendon, strengthening of the muscles in front of the ankle, “core” strengthening, proprioceptive, and balance exercises.  Other strategies used might include taping and footwear assessment and recommendations.

Dr. Jay Semel PT, DPT is a pediatric physical therapist, who along with Dr. Joshua Mazalian, run LA Orthopedic and Pediatric Physical Therapy in Encino. You can reach them at or check out

The Best Way To Warm up: Targeted Muscular Warm ups

Conventional wisdom says stretch. More recent research says dynamic warm ups are the way to go. What is the right answer? Well, as always, it depends. Dynamic warm ups are great to get the muscles warmed up and joints lubricated in a way that is supposed to be functional towards the sport or activity you are about to participate in. Stretching before actvity can be good if they are not held for a prolonged amount of time. One ingredient that is missing is Targeted Muscular Warmups (TMW). I first saw this on the Lakers sideline when Judy Seto (Lakers Physical Therapist) was doing a targeted shoulder resisted external rotation for Dwight Howard’s shoulder. By asking this specific shoulder stabilizer to turn on, you can guarantee that specific muscle will be more active during the activity, which in Dwight’s case guaranteed more shoulder stability during the game. Let’s give an example of targeted muscle warm ups:

Take a jogger. To jog at a slow or medium pace, you rely on hip stabilizers to accept the shock absorption with each step. This is in contrast to running where you rely more on hip flexors and hamstrings for propulsion. To target hip stabilizers to make sure they are warmed up, you might want to target the gluteus medius and minimus versus doing a warm up that targets the hamstrings and hip flexors. Starting to get the jist?

When applying targeted muscular warmup to your pre-workout/game routine, make sure you keep in mind 3 things:

1) Do not work the muscle to fatigue. Even doing one set of light-to-medium repetitions of an exercise is enough of a neuro-muscular wake up call for that muscle to get it revved up.

2) This is not a substitute for a total dynamic warm up and light stretching and should be performed first before any other part of your previous routine.

3) Know where the muscle is that you want to wake up. Performing an exercise that is “supposed to” activate that muscle, does not guarantee it will.

Dr. Joshua Mazalian DPT, OCS, CSCS is an orthopedic physical therapist with a sub-specialty in sports rehabilitation, who along with Dr. Jay Semel, run LA Orthopedic and Pediatric Physical Therapy in Encino. You can reach them at or check out