Watching your child walk on their toes can raise lots of questions for parents.
Is it just a phase, or could something else be going on? While occasional toe walking is common in toddlers learning to walk, ongoing toe walking which persists beyond 2 years old can sometimes suggest underlying sensory, motor or neurological differences (Oetgen & Peden, 2012). Concerns about persistent toe walking are a common reason for referral to paediatric physiotherapists.
Idiopathic toe walking (ITW):
Idiopathic toe walking (ITW) describes ongoing toe walking in children when no medical, neurological, or bone-related cause can be found. ITW affects up to 5% of typically developing children, but is important to get assessed by a physiotherapist in order to manage potential fatigue, maintain calf muscle length, ankle range, or leg pain over time (Caserta et al., 2019).
Sensory causes:
Some children toe walk because of differences in how their body processes sensory information. For these children, toe walking may be a sensory-seeking need. Walking on toes increases proprioceptive(pressure) feedback from our muscles and tendons, which lets us know where our bodies are in space. This additional input can help improve body awareness for the child, if they have a harder time coordinating their own body (Williams et al., 2013).
For some children, walking on their toes can feel more comfortable if they are sensitive to touch or vibration on the soles of their feet (Williams et al., 2012). You may notice your child only toe walks on certain surfaces such as grass, cold tiles, wet floors, sand or in certain shoes.
Motor causes:
Some children toe walk because of differences in muscle strength, flexibility, or motor control. Tight calf muscles can make it difficult for toe walkers to place their heels on the ground (De Oliveira et al., 2021). In some cases, neurological or neuromuscular conditions can affect how the muscles work together, which can influence walking patterns. An early assessment from one of our experienced Paediatric Physiotherapists at Ocean Kids Health can help identify the underlying cause and provide guidance (Besios et al., 2024).
When to seek a Paediatric Physiotherapist at Ocean Kids Health:
- Persistent toe walking beyond age 2–3
- If your child cannot walk on flat feet when asked
- If the toe walking is one sided
- Increasing toe walking
- If you cannot stretch your child’s foot back to their shin past a neutral position
- If your child has pain in their legs/feet
- If your child struggles to keep up with their peers, appearing more fatigued
- If your child is frequently tripping when walking/running.
Our Paediatric Physiotherapist’s will provide:
- A thorough assessment to identify the cause of your childs toe walking
- Targeted stretching and strengthening exercises (in the form of games of course!)
- Sensory based strategies for sensory processing differences
- Assessment of foot, leg and body posture
- Referral to appropriate podiatrist or orthotist if needed
- Balance and coordination training
- Endurance and fatigue management
- Gross Motor skill development
- Postural and core strengthening
- Recommendations for supportive footwear
Our Physiotherapy Top Tips!
★ Balance Games: When balance is challenged, a child is more likely to place their heel on the ground in order to maintain their balance. Fun activities include: standing on one leg like a flamingo, balance beam obstacles and kicking cones and balls.
★ Playground Activities: Walking up ramps and hills, climbing playground equipment, squatting, jumping and bike riding are all activities which stretch the calf muscles with gravity in a fun and functional way!
★ Barefoot Play: Encourage barefoot play on different surfaces such as sand and grass to help your child feel comfortable with the sensation of different surfaces.
View out helpful parent/carer handout here.
References
Besios, P., Kyriakatis, G. M., & Besios, T. (2024). Conservative therapy and physiotherapy in children with toe walking: a systematic review. International Journal of Clinical Trials, 11(3). https://doi.org/10.18203/2349-3259.ijct20241591
Caserta, A. J., Pacey, V., Fahey, M. C., Gray, K., Engelbert, R. H., & Williams, C. M. (2019). Interventions for idiopathic toe walking. Cochrane Database of Systematic Reviews, 10. https://doi.org/10.1002/14651858.cd012363.pub2
De Oliveira, V., Arrebola, L., De Oliveira, P., & Yi, L. (2021). Investigation of Muscle Strength, Motor Coordination and Balance in Children with Idiopathic Toe Walking: A Case-control Study. Developmental Neurorehabilitation, 24(8), 1–7. https://doi.org/10.1080/17518423.2021.1899326
Oetgen, M. E., & Peden, S. (2012). Idiopathic Toe Walking. Journal of the American Academy of Orthopaedic Surgeons, 20(5), 292–300. https://doi.org/10.5435/00124635-201205000-00005
Williams, C. M., Tinley, P., Curtin, M., & Nielsen, S. (2012). Vibration Perception Thresholds in Children With Idiopathic Toe Walking Gait. Journal of Child Neurology, 27(8), 1017–1021. https://doi.org/10.1177/0883073811432748
Williams, C. M., Tinley, P., Curtin, M., Wakefield, S., & Nielsen, S. (2013). Is Idiopathic Toe Walking Really Idiopathic? The Motor Skills and Sensory Processing Abilities Associated With Idiopathic Toe Walking Gait. Journal of Child Neurology, 29(1), 71–78. https://doi.org/10.1177/0883073812470001
