Toe Walking in Children

What is toe walking and how do we correct this.

Toe Walking

Toe walking is a condition in which a child walks only on their toes without the heels contacting the ground. Often when children are learning to walk, they regularly transition between walking on their heels and toes.

Toe walking is common in young children two years and under and is generally something they grow out of by the time they are six to seven years old. If a child is continuing to toe walk after two years of age an assessment is recommended to ensure there are no underlying medical conditions. 

What causes toe walking?

Often toe walking has no identified cause. If all other medical causes of toe walking have been ruled out the term “idiopathic toe walking” is used. Other medical conditions which can cause toe walking include:

· Neurological conditions such as cerebral palsy where the calf muscles are very tight and prevent the heels from touching the ground. 
· Sensory conditions such as Autistic spectrum disorder where the child prefers the sensation of walking on their toes
· Neuromuscular conditions such a Muscular dystrophy which causes progressive weakness in muscles 
· Hip dysplasia or dislocation 

When to be concerned?

In the vast majority of cases toe walking is not a cause for concern. However, it is worth having the child assessed by a paediatric physiotherapist if they are displaying any of the following signs:

· Toe walking on one side only (this could be a sign of hip dysplasia)
· Toe walking begins after normal walking pattern has been established
· Inability to stand with the heels flat on the ground 
· Frequent tripping or falling 
· Toe walking continues after the age of seven 

Treatment options for toe walking

The treatment for toe walking generally depends on how severely the child’s ankle movement has been affected. Children who have a long history of toe walking often have very tight calf muscles and are unable to stand with their feet flat. In these cases referral to a paediatric orthopaedic surgeon is recommended with possible surgery to lengthen the Achilles tendon. 

In less severe cases physiotherapy is recommended as the first line of treatment. Physiotherapy management involves strengthening and stretching of the calf muscles, exercises to encourage walking with the heels down, and exercises to improve balance and prevent falls. 

toe walking children

Written by: Tracey Guy – Physiotherapist

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