Toe walking in children

Sara Kester, DPT

Toe walking in children can be very common and many parents wonder when it should be considered an issue. In this post we will address what toe walking is, it’s occurrence among various diagnosis, when it’s considered a problem, and the various treatment modalities that exist to correct the problem.

Toe Walking in Children: 

Toe- walking is when the child walks around on their tippy-toes and rarely let their heel touch the ground. There can be several reasons which cause toe-walking such as a muscle or neurological disorder, however, the most common reason is known as idiopathic toe-walking. This simply means there is no known cause to why the child is toe-walking and is habitual. Typically, these kids are able to go down onto their heels when prompted by an adult and stand flat-footed.

 When we start walking, it’s not uncommon to walk on our toes for the first couple of years. If toe-walking persists after the ages of 2-3 years old, physical therapy should begin treatment to limit future problems. Persistent idiopathic toe-walking may cause muscle weaknesses, loss of joint motion, increase clumsiness, and change the shape of bones from ankles to spine. It is best to begin physical therapy as early as possible to decrease complications and the possibility of more aggressive treatments.

Signs and Symptoms of Toe Walking: 

Physical therapists will assess for signs and symptoms of more concerning issues and determine if physical therapy is the right place or if another health care provider should rule out other possibilities. In general, more concerning toe walking is if:

·       your child has never walked on his or her toes and suddenly is walking on their toes all the time.

·       Only uses one foot to walk-on toes

·       Has a diagnosis of cerebral palsy or another nervous system, orthopedic, or muscular disorder

How to Stop Toe Walking:

 Typical physical therapy treatments for idiopathic toe-walking generally include: stretching of the calf musculature, strengthening of the hips, legs, and ankles, balance activities, and walking retraining. If the child has significant loss of foot motion night splinting, serial casting, bracing, and other more aggressive treatments may be necessary. Aggressive treatments are used when conservative treatment has failed.