Walking To School . . . 

Typical Development of Gait:

Walking is a skill that begins around 12 months of age. The way you walk, or your “gait pattern”, continues to become more refined and adult-like until age 7. One year olds walk with a wide base of support (legs are further apart than the shoulders). Their legs are usually turned outward as they take a step forward. The foot hits the ground with a flat-footed strike, rather than touching first with the heel. One year olds also have a short step length. Their arms are often held tightly flexed and are positioned up by the head. As the child practices taking steps, the walking pattern will become smoother and more coordinated. Children around the age of 18-20 months learn how to walk on tiptoe and are often seen walking on their toes throughout the day as they learn this new skill. Toe-walking should then decrease, once the skill has been mastered.

By the age of 3, a child’s walking pattern is similar to that of an adult. The base of support has narrowed so that the feet are aligned under the body, and only a few inches apart. The foot points in a forward direction as the leg swings through. An arch is usually seen in the middle of the foot, so that when the foot contacts the ground there is a clear heel to toe progression. The arms swing forward and back alternately with each step, and the arms are relaxed by the sides of the body. From age 3-7 a child’s gait becomes more efficient in terms of extending the length of each step, and refining the speed of their gait.

Children with motor delays may not have a smooth coordinated walking pattern by the age of 3. One of the most common problems seen at this age is toe-walking. We also see students that have a loud “foot slapping” sound when they walk. Some students also scuff their heels on the floor as they try to step forward.

Why is it important to try to correct an immature walking pattern? Our bones, tendons, muscles, and ligaments are all designed to bear weight in a certain alignment. Gait deviations can cause the bones to grow incorrectly, the muscles and ligaments to overstretch, and can cause painful joints. Walking with an immature gait pattern is also less energy efficient, and can cause children to fatigue more readily than their peers. Finding shoes that feel comfortable can also be a problem for children who walk with gait deviations.

What causes toe walking? Several factors can cause a child to toe walk. Sometimes there is stiffness, or increased tone, in the calf muscle that can pull the foot into a toe-walking position. Sometimes there is muscle weakness, and low muscle tone, that causes the child to lock the joints in a stiff position to reduce the amount of work the muscles need to do. Sometimes the child’s sensory system is not providing adequate feedback about body position and movement.

What can help correct an immature gait pattern? Many techniques can be used to diminish toe-walking, once the underlying problems have been sorted out. It is usually not helpful to verbally prompt the child to stop walking on their toes. When we are walking, we are thinking about where we are going, or what we are going to do when we get there. We do not think about what our feet are doing. Children with immature gait patterns may benefit from a combination of stretching and strengthening activities, often done in a play format. Sensory activities such as walking on different textures and surfaces may help. Using weights on the feet, weighted belts, or ankle weights may help to give more feedback regarding the lower body’s position and movement. Improving balance through the use of tilt boards and foam stepping stones may also be indicated. For a significant gait problem, children may need to be fitted with orthotics, which are molded plastic inserts for the shoes.