Toe Walking – an Introduction

Toe walking is a pattern of walking where a child walks on the balls of their feet or ‘tiptoes’.
It is common when children are learning to walk and up until 2-3 years of age. It may present during the development of pre-walking skills, when the child first begins to walk, or within 6 months of starting to walk independently.

Toe walking can be due to:

  • Musculoskeletal Conditions (Muscle shortening or overuse and elongation or underuse)
  • Sensory or Developmental Condition
  • Neurological Conditions
  • A combination of the above
  • Musculoskeletal

Your child may display the following:

  • Reduced range of movement in his or her ankles
  • Tightness or pulling in the back of the leg with movement of the ankles or feet
  • Can achieve heel contact when standing however will often lean backwards
  • Have difficulty performing a squat while maintaining heel contact
  • Have difficulty walking up slopes
  • Weakness through the buttocks and core due to underuse of the muscles
  • Toe walking worsening with a growth spurt

Your child may have the following:

  • History or diagnosis of a sensory processing disorder, or conditions such as Autism Spectrum Disorder, ADHD, etc
  • Toe walking may occur in order to increase sensory input. A child toe walks to increase their vertical movement with walking to seek a greater sensory experience or to have a better understanding of where their body is in space.
  • Toe walking can also be a result of trying to minimise sensory input. It can worsen with bare feet or on alternate terrains such as sand or grass, etc
  • Increased overall muscle activity
  • Toe walking increases with excitement, stress or anxiety
  • Walking pattern can be described as ‘bouncy’
  • Range of movement is often normal however muscles are at risk of shortening over time

Your child may have the following:

  • History or diagnosis of a neurological condition such as cerebral palsy, muscular dystrophy, etc
  • Increased or decreased muscle tone, they will often toe walk to increase stability

Your Physiotherapist can:

  • Identify the underlying cause of toe walking and provide a treatment plan accordingly
  • Provide gentle manual therapy techniques to release tightness in shortened muscles
  • Education on targeted stretching exercises to loosen tight muscles, restore range of movement and normal foot and ankle posture
  • Provide a fun and creative graded exercise program to strengthen the ankle, core and buttock muscles
  • Walking/gait retraining
  • Referral to a podiatrist or orthotist for orthotics and insoles as required
  • Prevention of further progression of toe walking and muscle shortening or lengthening

How physiotherapy can help children with toe walking

Physiotherapy is a wonderful way to have your child assessed in a friendly, non-threatening environment. Using a combination of play and manual therapy, your Physiotherapist will be able to work with you and your child to treat the problem.

If your child is 2 years or older and is toe walking, we recommend that they be assessed by a physiotherapist. Early identification and treatment are needed to prevent shortening of the calf muscles and to prevent the development of persistent problems in walking and balance.

To book an appointment with one of our Physiotherapists, please call 08 6389 2947 or click here to make an appointment online.