Toe-walking simply refers to a walking pattern in which a child walks on their tiptoes without their heels contacting the ground. Sometimes a child’s toe-walking is related to their medical diagnosis, as is often the case in cerebral palsy or muscular dystrophy. Other times, a child’s toe-walking may be more habitual or occur for an unknown reason. This is called Idiopathic Toe-Walking. Idiopathic toe-walking always occurs in both feet. Toe-walking can occur in typically developing children, however has also been found in children with speech delays, autism, low muscle tone, or general developmental delay.

When does toe-walking become a problem?

Toe-walking is a natural part of a child’s development. When children are learning to walk, they often explore with a variety of foot positions and gait patterns—this often includes toe-walking. Toe-walking may even persist up to 6 months after the start of independent ambulation.

Idiopathic Toe-walking is of concern if a child is over two year of age and continues to toe-walk frequently. Toe-walking is often more exaggerated when asked to walk barefoot. The child may even be able to walk with flat feet when asked or when wearing shoes.

Toe-walking can lead to problems such as:

• Tight Calf Muscles and Joint Contractures
• Decreased Foot and Ankle Range of Motion
• Poor Balance
• Frequent Falls
• Appearance of Clumsiness or Lack of Muscle Coordination
• Delayed Gross Motor Skills

How can physical therapy help Idiopathic Toe-Walking?

Physical therapy treatment for toe-walking often includes:

• stretching
• range of motion exercises
• strengthening
• balance training
• gait training
• parent education

Your physical therapist will also assist in developing a home exercises program to incorporate stretching into your daily routine.

Early identification of toe-walking and implementation of a stretching program can help prevent joint contractures. In more severe cases, other treatment options may include orthotics, serial casting, or orthopedic surgery to lengthen the Achilles Tendon.