Tessa Irwin, PT, DPT,
Lead Physical Therapist

What is toe walking and what are the signs? What does it look like?

Toe walking is exactly what it sounds like; walking on the toes or balls of the feet without letting the heels touch the ground.

Toe walking is typical for new walkers and should be of no concern in the first few months, or even first few years of walking. Some doctors, therapists, or medical institutions will argue that it is normal until 5-years old and there is no need for treatment unless they are still walking on their toes after that. While a lot of kiddos may "grow out" of toe walking, I like to err on the side of caution. We have treated kiddos for toe walking as early as two and a half. If there is an underlying cause or not, a Physical Therapist may be able to help prevent any tightness down the road.

How is toe walking diagnosed?

Toe walking is typically diagnosed through observation from a Physician, Physical Therapist, Occupational Therapist, or other discipline. When a Physical Therapist evaluates a patient for toe-walking, there are a few key things that we look at. The first is ankle range of motion, meaning how far the child can flex their ankle. If they have tight calf muscles (gastrocnemius and soleus), then they may not be able to stand with their feet flat even when you ask them to.

A Physical Therapist will also look at ankle strength. A child may be walking on his or her toes if they do not have the strength to lift their toes up to place their heel on the ground first. A majority of the time, toe walking is idiopathic, meaning the cause is unknown. A Physical Therapist may help to determine if there is an underlying cause that also needs to be addressed.

What can a parent(s) do?

If the child is tight, stretching will be the most important thing to work on at home. Being able to get their child to stand with feet flat is the first step. If the child is not tight and is able to stand with their feet flat, they may need exercises to help strengthen their ankles or different ways to help remind them to walk with their heels down.

 
 

Ideas for strengthening:

The two easiest ways to strengthen the anterior tibialis (or the muscle on the front of the lower leg) is heel walking and toe taps. Heel walking is the exact opposite of toe walking. Instead of keeping the heels off the ground, have the child walk with their toes off the ground and only their heels touching. Another activity is toe taps. Put on some fun music and have your child sit and tap their toes to the beat, keeping their heels in contact with the floor.

Reminders for heel toe walking:

If your child responds well to you asking them to walk with their heels down, they may do well with an auditory reminder, or something they can hear. Taping quarters to the heel of their shoe is a fun way to remind them with every step. Anytime they walk with their heels down, their shoes will click on hard surfaces. On softer surfaces, it sometimes helps to tape two quarters to the bottom of each shoe so that they click together.

Your child’s Physical Therapist will help you determine what to start with at home!

What is the outlook and treatment for toe walking?

There is a broad outlook for toe walking. Since most of the time the cause is idiopathic (meaning the cause is unknown), it can be difficult to treat. PT’s biggest concern will be maintaining adequate range of motion. When a child walks on his or her toes, they are putting their calf muscles (gastrocnemius and soleus) in a shortened position. If they are doing this 100% of the time, it may become very difficult to stand with feet flat and this can affect their gross motor skills.  If there is moderate-significant tightness, there are other options that may help position the foot and gain range of motion, such as nighttime stretching splints or casting.

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