Learning to walk is a fun and exciting time for new parents and young children. Children typically begin to walk independently around 12 months of age and require a lot of practice, trial and error, falling and getting back up. Kids do not have a normal, adult-like walking pattern until closer to the age of seven. Therefore, those who are just learning to walk or have been walking for a very short period of time will have a wider base of support with their legs further apart, absent heel strike, and absent arm-swing. It isn’t until 18-24 months of age when little ones consistently begin to land on their heels and swing their arms reciprocally.  Due to this lack of heel strike, it may appear that your child is walking on their toes.  Toe walking can be considered a normal variant of early walking. However, it becomes more of a concern if and when they consistently walk up on the tips of their toes.

Why is my child walking on the tips of their toes?

Many kids toe-walk and the reason is often unknown and can be considered idiopathic. Idiopathic toe-walking means there is no known reason; the child does not have any other medical diagnosis that would cause the child to walk this way. Sometimes, toe-walking can become purely habitual.

A few potential factors that may contribute to the toe-walking include: difficulty with processing sensory information through their feet and/or legs, muscular tightness and/or weakness, poor bony alignment, or nervous system involvement. Toe walking can also be associated with several diagnoses, including cerebral palsy, muscular dystrophies, autism spectrum disorder, and global developmental delay. However, this is only an association and does not mean the child has one of these conditions nor does it mean that they will necessarily toe-walk if they are diagnosed with one of these conditions.

When does toe-walking become a concern?

Toe-walking puts abnormal stresses on the body that can lead other problems. It causes extreme tightness of the calf muscles, limiting the motion of the ankle. With prolonged toe-walking, the calf muscles become tight and can limit the range of motion at the ankle. This loss of motion will not only affect the way they walk, it will make riding a bike, walking up/down stairs, and playing more difficulty. Finally, toe-walking causes more stress at the knees, hips, and back putting the child at risk for pain and/or injury in the near future.

What can be done if the child does not outgrow the toe-walking?

It is possible that the child will “outgrow” this, with the emergence of a normal heel-to-toe pattern around the age of 18-24 months. But what do you do if they don’t? Physical therapy is a great first choice of treatment to help your child beat the habit of toe walking in a conservative manner. In other words, using treatments such as stretching, strengthening, orthotics or shoe inserts, and play under the supervision of a physical therapist can help reverse the effects that toe-walking has on the body, and get your little one walking with an age-appropriate pattern. If these forms of treatments are not working as planned or the child’s toe-walking has led to severe loss of motion within their feet and ankles, another option a physical therapist can provide is called serial casting. Serial casting is considered a conservative intervention.  A series of casts are used (similar to a cast you may have after breaking a bone), which is typically on for one week, and then replaced weekly for a set period of time. With each cast, the child’s foot is brought forward towards their body (dorsiflexion) in order to stretch the calf and restore motion. At the end of the casting, the goal is for the full range of motion to be restored in order to allow for a proper heel-to-toe walking pattern and eliminate the habitual toe-walking.  If left unaddressed, toe walking can lead to contractures (shortening of a muscle leading to decreased movement) and the inability to stand with feet flat on the ground.  As the child grows, surgery may be recommended when left unaddressed or if the severity of the toe walking is such that conservative measures are unsuccessful.

 

Toe-walking can be decreased and a typical walking pattern can be established.  If you notice that your child consistently walks on their toes, consider making an appointment with a physical therapist in order to prevent future pain and injury, and help set up your child for future success. If you have any questions, contact ABC Pediatric Therapy, specifically a physical therapist, for more information, and visit our website at www.abcpediatrictherapy.com to find the location nearest you.