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While we still have a ways to go before the ‘end’ of our story, we’re trying to share with you all along the way. We were clueless before this began (and do still have many questions, I’m sure), so I want to help other parents that may have a child who also walks on their toes. Today we’re onto Our Toe Walking Journey Part 3: Casting & Braces – the part that we’re in at the moment, and will be for several months to come!
In case you missed it, we shared the first steps of our journey (meeting doctors, discussing options) HERE, and then discussed the next step (MRI under anesthesia) HERE so be sure you go check those out. After the MRI came back clear, we were good to move forward with the original plan – casting and braces for his legs to both train his legs to be able to bend how they should, but also train him to walk ‘flat foot’ (that’s what we call it, easier for him to understand).
First step: Casting for Toe Walking
The reason we had to do casts on his legs were that he’d been walking on his toes so long, he’d actually allowed his muscles and tendons to grow/adjust to that angle. He wasn’t ABLE to make an ‘L’ (90 Degree Angle) with his leg and foot, even if he tried to force it or we tried to stretch it. Because of this, it was necessary to stretch out the muscles and ligaments so they would allow him the ability to walk how he should.
The solution was casting – we would take him in to physical therapy every week for several weeks to change his casts, each time stretching the angle of his leg/ankle/foot a bit further. Then the casts would hold that stretch constantly, 24 hours a day for the following week, making his legs adjust to that stretch. At the end of the week, we’d unwrap the crast (it was a wrap kind, not a cut off kind, since it was to be changed weekly) – wash his legs and feet really well, because boy those stunk! – then take him back in for new casts.
It was neat to see how much closer to a 90 degree angle he could get each week, showing that the casts were doing their job. Since the casts weren’t for an injury, he was still allowed to walk on them normally (as normally as a stiff ankle would allow, at least) with little booties to protect the bottoms of the casts. We still had to avoid getting the casts wet or allowing too much physical force (like jumping or kicking), of course, but ultimately they didn’t hinder his play too much. At night, he also had a knee brace (just one, and we’d rotate legs each night, taking turns) to hold his leg straight while he sleeps. This allowed for a little extra ‘stretch’ in the muscles while he was asleep.
We did casts about 5 weeks until one of his legs could go just a tiny bit past 90 degrees, and the other a little further than that. We’d reached out goal – YAY! Now we were ready for the braces. During the casting weeks, we went in (after taking one set of casts off but before our appointment to put new ones on) to orthopedics to have him sized for his braces. They put a cushion around his feet, ankle and legs where the braces would fit, then wrapped a layer of the casting material around for a good fit. The doctor made marks where any indents/bumps and such were, so it would be perfectly fitted and comfortable – even marking the arch of his foot perfectly. They put a tube thing in between the padding and hard material so when they cut it off, there was no possibility of cutting him – not even close.
They cut the castings off his legs, then sent those off to have his braces made. They had a whole book of designs he was allowed to choose from – and he was excited to pick Batman, with green straps, for his!
Shortly before we were done with the casts, we went in to ortho again to make sure the braces fit perfectly – and fixing any parts that may rub him the wrong way, to avoid sores and discomfort. We then had the braces ready for when the last casts came off, and he began wearing them immediately. We had to get TALL socks to wear under them – you don’t want the braces against his skin, since they are a hard plastic – then shoes a size-ish too big so they’d fit over the braces. His braces do have hingest at the back ankle, to allow a little movement, but they do restrict him to walking how he should – no more toe walking!
He has to wear the braces for 23 hours a day, every single day. Yes, that means he sleeps with them on (but not the shoes, obviously) and he does still rotate with the knee brace at night to help that extra stretching. He’ll meet with the doctor and his physical therapist again next month, so they can double check his progress and make sure he hasn’t lost any of the new flexibility the casting gave him and double check they’re still fitting him comfortably (because we all know how fast kids’ feet can grow!). He’s not restricted in what he can do (just whatever he’s comfortable with), though he is slower. He even lasted just great during our Walt Disney World trip, though we did need to get a Disability Access Service for him.
The overall plan is to wear the braces for 4 months for 23 hours each day, then we’ll very gradually taper off an hour a day for awhile. The goal we all set (doctors, physical therapist and us) was a total of 8 months in braces. It all depends on how his legs do, if he does well at walking ‘flat foot’ and not toe walking after he doesn’t have braces, and factors like that. But we’re optimistic and already love how much better he can walk!
What’s your experience with a child toe walking?
Check out the first part of our toe walking journey…
… or the second part of our toe walking journey…