Toe Walking in Children: When Should You Be Concerned?

Toe walking is exactly as it sounds, it is when a child walks on their toes instead of the normal heel-toe gait (a gait is a way a person walks). Toe walking can be normal, especially when a child is first learning to walk. Some children grow out of it once they gain more balance and stability, and get a general sense of walking. However, if toe walking persists past the age of 3, it should be addressed because it can have long-term effects on your child’s quality of life.  

Causes of Toe Walking

Toe walking can be caused by other muscular or sensory issues or comorbidities like Cerebral Palsy. Alternatively, toe walking can be idiopathic. It is considered idiopathic because the cause is unknown, meaning that other factors are excluded, and muscle tone and reflexes are all typical. In this case, the child still walks on their toes but it can be more out of habit than anything else contributing to the toe walking gait.

Toe walking has been associated with a variety of different conditions including autism spectrum disorder (ASD), developmental delays, cerebral palsy, neuromuscular disorders, and myopathic disorders.^1,2,3

Long-Term Effects of Toe Walking

Although toe walking can seem like no big deal, it can cause serious long-term effects on the body if not addressed early on. When a child walks on their toes, over time it will affect the muscular anatomy causing muscular tightness, a change in muscle fibers, and an overall contracture of the main muscles. This causes a loss in the range of motion of the ankle and foot. This again becomes more prominent in older children, becoming more difficult to treat. Posture is offset impacting hip and core strength, thus affecting other movements such as squatting or climbing stairs. There is also a loss of balance and ankle stability, making the child more prone to falls and ankle injuries. This tightness and shortening of the muscle cause pain in the foot and leg.

Physical Therapy Treatments

One of the best ways to treat toe walking is through physical therapy. In more severe cases, physical therapy will be combined with other treatment methods. The severity of the toe walking gait and the age of the child will determine the intensity of treatments. Most toe walking in younger children can be addressed with less invasive methods, which is why it is important to try and treat toe walking when your child is younger. With older children, often there is a significant amount of muscle tightness and shortening, making treatment a bit more invasive and intensive.

Toe walking treatments^1,4 include:

• Stretching of the leg muscles

• Strengthening the leg muscle

• Gait training

• Home exercise programs

• Night splinting

• Orthotics

• Casting

• Botox injections

• Surgery

Your child’s physical therapist will also recommend some home exercises and tips on what to do to help your child walk properly. This is great to improve the efficiency of treatment, especially if therapy only occurs once or twice a week.

In Ohio, a referral is required for physical therapy services. If your child is consistently walking on their toes, a great first step is to visit your child’s pediatrician in order to evaluate the cause and then receive a referral for physical therapy if necessary.

• In-Text Citations

  1. Le Cras S, Bouck J, Brausch S, and Taylor-Haas A. “Evidence-based Clinical Care Guideline for Management of Idiopathic Toe Walking,” Cincinnati Children's Hospital Medical Center. 4 (2011): 1-17. https://daniz53y71u1s.cloudfront.net/documents/idiopathic-toe-walking-pdf-new-9.pdf

  2. “Toe Walking in Children,” Dinosaur Physical Therapy, accessed 15 June 2022, https://blog.dinopt.com/toe-walking/.

  3. “Idiopathic Toe Walking,” Physiopedia, 28 April 2022, https://www.physio-pedia.com/Idiopathic_Toe_Walking.

  4. Davies, Karen, Alec Black, Michael Hunt, and Liisa Holsti. “Long-Term Gait Outcomes Following Conservative Management of Idiopathic Toe Walking.” Gait & Posture, 62 (2018): 214–19. doi:10.1016/j.gaitpost.

• All Sources

  Davies, Karen, Alec Black, Michael Hunt, and Liisa Holsti. “Long-Term Gait Outcomes Following Conservative Management of Idiopathic Toe Walking.” Gait & Posture, 62 (2018): 214–19. doi:10.1016/j.gaitpost.

  Gonçalves Coutinho de Oliveira, Vanessa, Lucas Simões Arrebola, Pedro Rizzi de Oliveira, Cristina dos Santos de Sá, and Liu Chiao Yi. “Effect of Plantar Flexor Muscle Strengthening on the Gait of Children With Idiopathic Toe Walking: A Study Protocol,” Pediatric Physical Therapy. 31, no. 4 (2019): 373–78. doi:10.1097/PEP.0000000000000650.

  “Idiopathic Toe Walking,” Physiopedia, 28 April 2022, https://www.physio-pedia.com/Idiopathic_Toe_Walking.

  Le Cras S, Bouck J, Brausch S, and Taylor-Haas A. “Evidence-based Clinical Care Guideline for Management of Idiopathic Toe Walking,” Cincinnati Children's Hospital Medical Center. 4 (2011): 1-17. https://daniz53y71u1s.cloudfront.net/documents/idiopathic-toe-walking-pdf-new-9.pdf

  Stamos, Gina Marie. “Toe Walking-What You Need to Know,” Spaulding Rehabilitation Network, 6 February 2020, https://spauldingrehab.org/about/news/toe-walking.

  “Toe Walking in Children,” Dinosaur Physical Therapy, accessed 15 June 2022, https://blog.dinopt.com/toe-walking/.