|By Lindsey Biel, OTR/L
While relatively common in toddlers, if your child is still walking on his tiptoes or the balls of his feet after age three—or starts doing so as he gets older—this may be a neurological soft sign you should investigate with your pediatrician and physical therapist.
A child with sensory issues may walk on tiptoes to avoid intolerable tactile input on the supersensitive soles of her feet. She may walk on the smallest surface area of her foot possible to avoid the feeling of a shoe or sock, or if barefoot, the sensation of the floor, carpet, sand, or grass. A child with impaired body awareness due to proprioceptive and visual-spatial difficulties may have an altered sense of his body’s center of mass and so may shift his body weight forward as he moves so that walking is more like controlled falling.
Speak with your occupational or physical therapist about whether you need to consult a developmental pediatrician or neurologist about this. Meanwhile:
- Teach your child names of body parts including parts of the foot, and prompt him to walk with his heels down.
- Desensitize feet by massaging them with or without lotion, engaging in deep pressure “brushing,” scrubbing feet with gentle soap and a washcloth in the tub, using vibrating toys on the feet, and playing with bare feet in the sandbox or a homemade sensory bin.
- Have your child jump on a mini-trampoline, holding your hands or a safety bar. Make sure she lands with her heels down.
- Ask your OT or PT to show you how to stretch your child’s heel cord since calf muscles tighten up from toe walking.
- Investigate whether wearing seamless socks (www.softclothing.net or www.smartknitkids.com) or inside-out socks make a difference.
- Reconsider footwear. Is there a difference between walking barefoot and in a shoe? Do shoes fit properly and provide good foot support?
- Ask your OT or PT about wearing a weighted belt (www.miraclebelt.com) or ankle weights to increase proprioceptive feedback from joints, muscles, and connective tissue.
- For new walkers, try Pipsqueaker sneakers (www.pipsqueakers.com) that squeak when the heel strikes down. Place your order by phone to request they move the squeaker back to the heel before shipping to you.
- Discuss with your PT or OT whether your child should have high top sneakers or an orthotic shoe insert that will help support proper alignment and hold the heel down. If your child does need an orthosis such as an AFO, try the seamless AFO socks from www.smartknitkids.com.
For more sensory smart ideas, please read Raising a Sensory Smart Child, and visit www.sensorysmarts.com
Lindsey Biel is a pediatric occupational therapist based in Manhattan, where she evaluates and treats children, adolescents, and young adults with sensory processing issues, developmental delays, autism, and other developmental challenges. Lindsey is coauthor of Raising a Sensory Smart Child, with a foreword by Temple Grandin, and co-creator of the Sensory Processing Master Class DVD program. Her new book, Sensory Processing Challenges: Effective Clinical Work with Kids & Teens, will be published by W.W. Norton & Company in February 2014. Lindsey is a popular speaker, teaching workshops to parents, therapists, doctors, and others on practical solutions for developmental challenges and sensory strategies at home, school, and in the community.