Surgery for Toe Walking

What is Idiopathic Toe Walking?

Idiopathic toe walking is a walking pattern that involves a healthy and normally developing child persistently walking up on their tip toes for no known reason.

In some cases the habit of walking on toes causes the child’s calf muscle to become so tight that the child can no longer stand with their heels touching the ground. In this instance a surgical lengthening of the calf muscle may be indicated.

What does the surgery involve?

The surgery involves lengthening the calf at the junction of where the muscle meets the tendon.

Will my child need to stay in hospital?

Your child will usually need to stay in hospital overnight. They will be able to walk within the casts with shoes that fit over the plaster casts for safe walking (these are accessible from the hospital). Some children walk comfortably the day after surgery, while some children take a bit longer (up to a week) to get comfortable to walk within the casts.

How long will my child need to have a plaster cast?

Your child will require plaster casts for six weeks. After the first three weeks your child will return to the operating theatre for removal of the first set of casts and a cast of your child’s feet will be taken and used to make an Ankle Foot Orthotic (AFO).

Following this another set of plaster casts will put on. These casts will stay in place for a further three weeks. Your child will adapt very quickly to walking within the casts.

What are Ankle Foot Orthotics (AFO’s)?

AFO’s are made especially for your child and they are essential for breaking the toe walking habit. After a total of six weeks in plaster casts you will return to clinic to have your casts removed and AFO’s fitted. In most cases your child will need to wear the AFO’s during the day for a period of six months.

What rehabilitation is required?

Once the AFO’s are fitted your child will need to see a physiotherapist. The physiotherapist will teach your child how to stretch their calf muscles to optimise their calf length following surgery. They will also teach your child to walk with a heel toe pattern (gait re education). You will also work on regaining calf strength and joint proprioception/balance.