Toe-walking is commonly seen in babies as they learn how to walk. They get up on their toes to explore how balance works, how their body works and how their feet work. As children get older, if toe-walking persists and when a child seems to prefer walking that way, then it is an issue that should be addressed. At that point, it’s important to start by understanding the reason a child is toe-walking so the right treatment can be developed.
Causes of Persistent Toe-Walking
Many times, there’s muscle tightness or weakness that’s affecting a child’s ability to get their foot flat on the floor. Most commonly, their calf muscles are really tight and that makes it very difficult to get their heel down on the floor. So they rise up onto their toes and choose to walk like that.
There can also be a sensory challenge. There are many senses involved with walking, particularly tactile or proprioceptive, which is the sense associated with the position and movement of the body. Some of the kiddos have aversions or adverse reactions to those perceptions. They don’t like the pressure or the touch vibrations. They want to avoid that full contact with the floor, ground or whatever surface they are on. Therefore, they rise up on their toes to try to avoid receiving all that pressure through their feet.
When Does it Become Unacceptable to Keep Toe-Walking?
Is there a timeline for a child to transition from toe-walking to normal walking? As we said, we see it in babies as they’re exploring their feet, but we never really want to see it as a persistent and consistent form of walking. It is desirable for a child to transition out of toe-walking by the time they are two years old. When we see that toe-walking is persistent and preferred, we’re going to want to maybe take a deeper dive into why the child is walking like that.
Regardless of the reasons, extended toe-walking can have impacts on a child’s development. From a physical therapy point of view, if a child has tight and weak muscles through the legs and hips and often the core as well, that’s really going to affect their ability to learn new motor skills and do other activities.
If a child consistently walks on their toes, that will start making significant changes in the bony development of the foot. That change could be permanent and impact a child’s development. Therefore, it’s important to notice toe-walking when a child is young so it can be addressed before there are changes that could last through adulthood.
Which Pediatric Diagnoses May Be Related to Toe-Walking?
Since there is a sensory challenge associated with toe-walking, this pattern may not be identified until there is a diagnosis of sensory processing disorder or autism. That may not happen until the child is two years old. That’s also about the time that a child should start walking with their feet flat on the floor. So sensory concerns may show up about the same time that a parent begins to notice that their child is still toe-walking. At that point, a physical therapist or occupational therapist can begin to provide therapy to help with sensory input or physical causes for toe-walking.
At this point, providing that sensory or proprioceptive input that the child is seeking can then decrease the amount of toe-walking over time. It could start with just five or ten seconds flat on their feet. Then ideally those small little instances add up to a full half day without toe-walking. This is so important to prevent physical changes resulting from prolonged toe-walking.
Helping Toe-Walking Children at Home with Stretches and Shoes
Is there a way parents can start working on this at home? Yes, there is. If you’re noticing that your kiddo’s up on their toes a lot and they’re having a hard time getting that foot flat, there’s lots you can do. There are many stretches that can help adjust that.
It’s also important that toe-walkers have supportive shoes—shoes that are going to encourage them to get their feet flat. That means that they can’t be easily flexed so the person can rise up on their toes. That also means avoiding shoes like Crocs and sandals that you can just bend from heel to toe. They will need a more supportive tennis shoe that’s going to help support that foot and discourage them from rising up on their toes.
Creating Varied Sensory Experiences at Home Can Help Toe-Walking
Once you find out what your child is sort of craving—maybe it’s a tactile or touch sensation—or if there’s a surface they don’t like, there is even more you can do. You can try having them walk on different surfaces. That way, they get a different sensation or pressure that they might be craving or avoiding. By providing what they seem to be seeking or avoiding, you can get the result of them beginning to press the entire foot to the floor.
Occupational therapists working tandem with physical therapists can often get the best results with a toe-walker. They can work together to satisfy the child’s sensory needs and correct the body’s structure.
When Concerned about Your Child’s Toe-Walking, Call Us
If you find that you’re concerned about your child’s walking pattern, if they seem to be up on their toes a lot and you’re not quite sure what to do from there, give us a call. We would love to meet with you and your child and determine if their toe-walking is motor-based or sensory-based or both.
We can then work out how to best address your child’s needs and give them those experiences and exposures they need to work on that walking pattern and get those feet flat. Whenever you are concerned about toe-walking that goes on too long, call us at (408) 337-2727.
About Stacey Wong
Stacey received her Doctorate of Physical Therapy from Eastern Washington University in 2017 after receiving her Bachelor’s in Applied Exercise Science from Azusa Pacific. Stacey has experience working in many settings including outpatient, early intervention, home health, and schools. She has treated children from birth through high school with various diagnoses including delayed milestones, abnormalities in mobility/walking, torticollis, and plagiocephaly, cerebral palsy, Down Syndrome, infants with a history of fetal drug exposure, and children with genetic abnormalities.
About Sam Campanelli
Sam graduated from Samuel Merritt University in 2023 with a Doctorate in Occupational Therapy, and from CSU Monterey Bay in 2011 with a Bachelor of Science in Kinesiology. Sam has experience working with the pediatric/adolescent population, working with youth as well as adults with ASD, traumatic brain injury, self-regulation deficits, adverse childhood experiences, chronic pain, organ transplant, cardiovascular disease/disorders, and orthopedic trauma.