Treatment of Idiopathic Toe Walking in Children

Physical Therapy
Written By Vicky Moroz

Idiopathic Toe Walking (ITW) is when a child has a consistent toe-walking gait. It is considered idiopathic because the cause is unknown, meaning that other factors are excluded such as comorbidities, and their muscle tone and reflexes are typical.

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

Toe walking can be normal up to the age of 3, after that it is considered abnormal and should be treated otherwise it can have serious effects on the body. Toe walking can cause pain in the foot and leg which increases as a child ages. The muscles tighten, especially the gastrocnemius, soleus, and Achilles tendon, causing a loss in the range of motion. 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.

Common Treatments

The severity of the toe walking gait will determine the intensity of treatments. Most toe walking in younger children can be addressed with less invasive methods. The most common treatments1,4 listed across the literature include:

• Stretching of the ankle plantar flexors

• Strengthening the anterior tibialis

• Gait training

• Home exercise programs

• Night splinting

• Orthotics

• Casting

• Botox injections

• Surgery

Children with ITW have similar characteristics to that of children with CP, particularly affected muscle tone, strength, and tendon reflexes, particularly in the plantar flexor muscles which contract over time.5 An effective intervention is to include plantar flexor muscle strengthening on top of stretching it, as well as the typical interventions of strengthening the triceps surae (TS) and anterior tibial (AT) muscles, gait training, and motor control training.6

Stretch and Exercise Idea

A great resource for stretches and exercises that target toe walking is included here.

This resource includes stretches and exercises that target:

·      Passive range of motion

·      Active range of motion

·      Strength

·      Weight-bearing exercises

·      Sensory integration strategies

  • 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.

    5. 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. doi:10.1097/PEP.0000000000000650.

    6. Gonçalves Coutinho de Oliveira et al, “Effect of Plantar Flexor Muscle,” 374.

  • 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/.

Vicky Moroz

Vicky works closely with a group of EJ’s therapists to curate helpful content geared towards parent education and research-based writing.

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