Toe Walking in Children: A Guide | Ivy Rehab

Toe Walking in Children

Toe walking is when a child walks on the balls of their feet instead of heel to toe. Children may begin walking on their toes when they first learn to walk, or it may start later in childhood. Before, it was thought that toe walking was a normal part of development, but more recent research suggests this is not the case. Even so, there may or may not be a medical cause for this type of walking. 

What does toe walking indicate?  

Toe walking can mean one of several things is happening. It may mean: 

  • Your child feels unstable on their flat foot
  • Your child may have too much mobility in their feet and ankles
  • Your child may have muscle weakness, low muscle tone, or low muscular endurance
  • Your child may be seeking or avoiding sensory input to their feet or body
  • It may be a symptom of a medical diagnosis such as Autism or Cerebral Palsy

When should I worry about toe walking?  

Children usually show a lot of movement when learning a new motor skill like walking. They will show a more consistent pattern, often heel-toe, after about six months of walking practice. If a child (at any age) is walking on their toes most of the time or does not or cannot put their heels to the floor without looking unbalanced, you should talk to your child’s doctor. If left untreated, it can lead to changes in the muscles, tendons, and bones as the child grows. Earlier intervention usually means less treatment is required to correct toe walking. 

Is toe walking neurological?  

Neurological disorders, like Cerebral Palsy, can cause children to walk on their toes. Neurological disorders can cause muscle tightness, increased muscle tone, spasticity, and weakness, leading to persistent toe walking. To avoid future complications like muscle contractures or bone deformities, it is essential to follow up with your child’s specialist if you often notice your child walking on their toes. However, if your child walks on their toes, it does not necessarily mean they have a neurological disorder. 

Why does my 10-year-old walk on his toes?  

Young children often start toe-walking for one or more reasons listed above. If this continues into childhood or adolescence, it is likely they can no longer get flat-footed without additional help. Irreversible changes can occur as early as five years old. If your child continues to walk on his or her toes at ten years, you should speak to your child’s doctor. 

What causes toe walking in Autism?  

Up to 20% of children with Autism walk on their toes. While we don’t know the exact reason(s) why, new research has shown that children with Autism have trouble with coordination of movements, balance, and vision leading to delayed or disordered milestones. This can lead to clumsiness, decreased activity, and falls.  

See related: W Sitting in Children: Problems & Prevention

How do you treat toe walking? 

There are several strategies to treat toe walking, depending on the signs or symptoms the individual child presents. These can include: 

Stretching: This can help maintain flexibility if a child who toe walks has not yet lost any mobility in their feet and ankles. It can help relax and lengthen muscles short-term but usually cannot help with regaining lost flexibility long-term. 

Serial Casting: Short leg walking casts may be recommended if your child has lost a lot of flexibility due to walking on their toes. This is the fastest way to allow your child to stand and walk flat-footed. Serial casting should be pain-free and is usually well-tolerated by children of all ages. It can last anywhere from 6-8 weeks, and the goal is to regain flexibility in the ankles. Physical therapists who are specially trained in serial casting will measure your child’s flexibility before casting begins and every time casts are removed. This will help them know when to stop casting and start exercises and bracing. 

Physical Therapy: Treatment sessions can include balance, strength, endurance, and walking exercises. Pediatric physical therapy for toe walking is usually performed 2-3 times per week. It can help your child get stronger, improve balance, and learn to use their new flexibility to walk heel-toe regularly. 

Braces: Most children benefit from regular use of custom braces called AFOs (Ankle Foot Orthotics). Wearing AFOs have the most effect if worn during the night and daytime. They should fit well and not be painful to allow children to tolerate wearing them. If they are painful or leave red marks on your child’s legs, reach out to your child’s orthotist. Bracing can last from 6-12 months, depending on how long they are worn during the day. 

Surgery: In a small number of cases, other treatments fail to correct toe walking. Doctors may suggest a surgical procedure that lengthens the calf muscle or Achilles tendon. Your child will spend eight weeks in casts and a wheelchair following surgery to allow the legs to heal. Braces and physical therapy are usually prescribed to help regain strength and walking ability.

How can pediatric physical therapy help 

Your child’s physical therapist will perform an evaluation looking at muscle strength, flexibility, walking pattern, and more. Depending on their findings, they will recommend one or more of the treatment options above to help your child reach their goals. Your child’s therapist will incorporate play and fun into each session to engage your child. Each physical therapy session progresses as your child gets stronger. Your therapist will also have you work on exercises at home, which help achieve your child’s goals faster.

 


Article By: Sarah Goncalves, PT, DPT, PhD(c), PCS, CI

Sarah began her physical therapy career 11 years ago. Sarah loves working with the pediatric population and believes in the importance of empowering parents with the information they need to allow their children to thrive. She currently specializes in child development, toe walking, and rehabilitation research. She currently works with pediatric therapists across the country to promote best practices and current evidence through mentorship and education.

 

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