Toe Walking in Children
As a new walker is taking their first steps and training their muscle spindles and refining neuromuscular control, it is typical that they may push up onto their tippy toes. This is part of the learning process. However, if your child is consistently walking up on their toes once they are walking comfortably, it may be time to consider a physical therapy evaluation.
What is toe walking?
To understand toe walking first we must discuss the gait cycle. In a typical adult gait cycle, the heel will contact the ground initially and then lower to stance through full surface of the bottom of the foot. This allows the structures of the foot to prepare for push off to propel into the next step. As a child is learning to walk, their feet are often wide apart with full foot contact on the ground. This allows them to have a large base of support. While taking a step they often shift their body weight to the side and step forward with full foot contact. As their balance, strength, and coordination improve, they progress to achieving heel strike as seen in the adult gait cycle. In a neurotypical child this happens around the age of 2.5 years. Toe walking is the absence of heel strike throughout the gait pattern.
Why does my child toe walk?
This is a great question and often the answer can be complex and most likely cannot be answered without a comprehensive evaluation. Sometimes toe walking may indicate an underlying neurologic or orthopedic diagnosis. For example, a child with a leg length discrepancy may walk up on their toes to equalize the length of their legs. This could be seen due to a structural difference in the length of the bones in the legs or a functional leg length discrepancy caused by a scoliosis. There are also multiple neurological diagnoses that can lead to toe walking. Then there are children who choose to walk up on their toes for sensory reasons. A child who has hypermobility may want to walk up on their toes because it allows their joints to be locked out in an end range position and avoid using large muscle groups such as the glutes and abs. In many cases this also allows for more joint stability. Sometimes a child may seek sensory feedback that can be achieved through toe walking and on the other hand a child may not like the way the ground feels on their heels. If there is truly no underlying cause for your child’s toe walking, it is called idiopathic toe walking.
Does it matter that my child is toe walking? What’s the big deal?
Consistently toe walking can lead to many secondary impairments. The most notable is tightness in heel cord (Achilles Tendon). It will also lead to weakness through the Anterior Tibialis (muscle on front of shin that hold foot up), glute (buttocks) muscles, and abdominal (belly) muscles. This tightness and muscle weakness can often cause pain in feet, knees, hips and even the back. Structurally, the development of the bones in the foot and ankle will be altered as well potentially leading to further pain and lifelong changes. Functionally, only being able to walk on one’s toes leads to difficulties with jumping and navigating over uneven surfaces and difficulties with balance leading to increased tripping and falling.
My Child is toe walking. What do I do?
The first step is to have a physical therapy evaluation. In preparation you can start by noting patterns of your child’s toe walking. Is it all the time / In certain footwear / environments / time of day etc.? Does your child seem to struggle to keep up with peers physically and/or fall more often than peers? The therapist will complete a comprehensive examination and begin to understand the factors that are leading to the toe walking. They will also evaluate for secondary impairments discussed above. They may refer your child to specialty provider for further medical investigation in conjunction with physical therapy.
What to expect at Kids’ Rehab Gym PT
Your child will have a one-on-one evaluation by a pediatric specialized physical therapist in our kid friendly gym space. The therapist will take measurements, analyze the way your child walks, and ask them to complete a variety of motor skills such as running and jumping. In conjunction with the parent/caregiver and the child, a plan of care will be made which may include further therapy and referral to see an orthotist for possible bracing. Physical therapy treatment will consist of stretching tight muscles, strengthening weak muscles, and attempting to re-train the gait pattern to decrease toe walking. Consistent follow through with home exercises is an important part of success in physical therapy. Despite excellent compliance with the physical therapy plan of care, some children might continue to toe walk. However, it is important to maintain the muscles length and strength for your child to have the best possible outcomes as they grow and develop.
Some Resources that we have found helpful.