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Toe Walking

28 June, 2024
Toe walking is when a child is unable to make heel contact during the walking cycle, and stays on their toes. This blog walks you through the conditions associated with toe walking, when you should get your child assessed and what treatment involves.
Close-up of a baby's chubby feet taking steps on a wooden surface.

Hi everyone. It’s been such a long time between blogs. It was much easier during the pandemic to find the time to write. However, watch this space as I’m determined to write more regularly.

One of our frequent referrals at Therapies For Kids is for toe walking. Children who toe walk may see therapists across all disciplines depending on the cause of their toe walking. So, this is a great topic for a transdisciplinary practice.

What is toe walking?

As the name suggests, toe walking is when a child is unable to make heel contact during the walking cycle, and stays on their toes. This is quite commonly seen in children under 2 years of age and the majority of cases are idiopathic (unknown causes).

If it is present after 2 years of age, it is considered to be persistent and there may be concerns about neurodevelopmental delays or a neuropsychiatric diagnosis.

What conditions can be associated with toe walking?

  • Cerebral Palsy (Physical Disability): This is a condition caused by injury to or abnormal development parts of the brain that control movement and muscle function.
  • Muscular Dystrophy (neuropathies and myopathies): A group of genetic diseases that cause progressive weakness and loss of muscle strength. Toe walking in children with musclar dystrophy usually presents later than 2 years of age.
  • Charcot Marie-Tooth Disease: These are a group of inherited disorders that cause nerve damage. Symptoms usually begin in feet and legs in childhood or adolescence.
  • Autism Spectrum Disorder (ASD) and Developmental Delays: This is a neurodevelopmental disorder involving persistent challenges with social communication, restricted interests and repetitive behaviours. Toe walking is more common in children with ASD and other developmental/neuropsychiatric conditions than in the general population.
A toddler's bare feet walking on tiptoe across a polished wooden floor.

What do we assess?

In any child that attends TFK, we will assess their?

  • Motor function
  • Their muscle tone and range of movement
  • Postural stability and balance (static and dynamic)
  • Sensory and vestibular systems
  • Strength
  • Frequent falls
  • Social stigma
  • Communication and developmental milestones

How do we treat toe walking?

Treatment will depend on what the therapist finds on examination and the age of the child being assessed. For a child under 2 with no other cause for concern, treatment will be conservative. Such as:

  • Stretches
  • Shoe wear
  • Advice on sitting and standing (some toe walkers are 'W' sitters)

Persistent toe walking in children over 2 can cause tight muscles of the lower leg and calf in addition to frequent falls, due to poor balance and weak or overactive muscles (hypotonia and hypertonia).

 

 

When to start therapy?

Early interventions are key to addressing the habit of toe walking in young children. We would suggest an assessment by 18 months to 2 years.

At TFK, we would start with an assessment by a Physiotherapist and if there are concerns in other areas of development, your child may be referred to an Occupational Therapist and/or a Speech Language Pathologist.

 

Some early intervention strategies?

  • Manual stretch by therapist
  • Wall stretch
  • Towel stretch
  • Heel drop stretch
  • Downward dog
  • Squat to play
  • Sitting on a ball/stool with heel flat on the ground
  • Bear walking
  • Penguin walk (on heels)
  • Shoe wear
  • High rise boots
If your child’s range is very poor in their calf muscles, the therapist may suggest serial casting then different shoes. In addition to the shows, they may also suggest a wedge/orthotics.
  • Walking on different surfaces
  • Brushing to desensitise the child’s foot
  • Standing on unstable, wobbly surfaces
  • Boards/duradisc
  • Strength training of weak muscles
  • Core strengthening



When should you worry about toe walking?

  • If your child is 2 years old and still toe walking
  • If you have concerns about their general development
  • If they are falling frequently/ or find it difficult to stand still

What are the long term effects of toe walking?

Walking on toes can lead to:

  • Tight muscles
  • Poor balance
  • Frequent falls
  • Muscle imbalance causing hip and core strength
  • Poor posture

Early detection and appropriate interventions such as physiotherapy and occupational therapy can be very helpful in addressing toe walking and associated issues. 

Funding

If your child has other conditions causing their toe walking they may be referred for NDIS funding or medicare funding.

 

 

Who to see?

If you are concerned about your child’s toe walking. Schedule a visit with your doctor/ paediatrician or physiotherapist. 

Stay safe, happy, and well,

Deb

Smiling woman with light brown hair and a black top, in front of a colorful rainbow-striped background.
By Debbie Evans

Executive Director

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