Reasons why your child may walk on their toes:
Most cases of toe walking are idiopathic, meaning there is no known cause. In rare cases, toe walking may be a sign of an underlying condition, such as:
- Cerebral palsy
- Muscular dystrophy
- Autism spectrum disorder
- Spinal cord abnormality
While most cases are idiopathic, there are some factors that can contribute to toe walking.
- Sensory factors. Some children process sensory information differently, making it difficult to coordinate body movements.
- Hypersensitivity, meaning increased sensitivity. Some children may not like the sensation of the floor touching their feet and toe walking minimizes this contact.
- Hyposensitivity, meaning decreased sensitivity. Some children have decreased ability to register sensory information. They may also be sensory seeking. Toe walking prolongs stimulation of joint receptors and causes muscles to tighten. This provides a calming input sensation for the child.
- Musculoskeletal factors
- Tight calf or hip muscles
- Shortened achilles tendon
- Weakness in core, hips, and/or ankles
- Congenital bone deformity
Toe walking can be normal when children are first learning to walk. By the age of 2, children should have a mature gait pattern with heel contact on each step. If your child is toe walking over 50% of the time and is over the age of 2, it may be time to get a physical therapy and/or occupational therapy evaluation.
Persistent toe walking can lead to:
- Tight calf muscles and achilles tendons, thus making it more difficult to walk with flat feet
- Decreased range of motion throughout the leg
- Pain and other musculoskeletal problems due to faulty body mechanics
- Poor balance skills and frequent falling
- Muscle imbalances due to faulty body mechanics
- Difficulty wearing shoes or other footwear
- Delayed motor skills
What can you do at home?
- Break the habit. Children often fall into the habit of walking on their toes. The more they walk on their toes, the tighter their muscles will become, which will make it even more difficulty to break the habit.
- Give your child reminders to walk with their heels down whenever you see them on their toes (i.e. “heels down,” “flat feet,” etc.)
- Bring their attention to their toe walking (i.e. “Are your heels down?”). If they become more aware of the habit, they will more easily be able to break it.
- Stretching the calf muscles everyday (see pictures)
- Activities to help strengthen and stretch the muscles, such as:
- Animal walks: bear walks, crab walks
- Walking on their heels
- Walking in flippers
- Picking up cotton balls or marbles with their toes to put in a container
- Balancing a small toy or bean bag on the tops of their food
- Jumping
- Squatting with heels down
- Balance activities:
- Balancing on one foot
- Balancing while standing with feet together, with eyes open or eyes closed
- Standing with one foot directly in front of the other (heel to toe stance)
- Tightrope walking
What can physical therapy and/or occupational therapy do?
A full evaluation and treatment plan will be tailored specifically to your child’s needs. Our goal is always to start with a conservative approach to physical therapy treatment, consisting of stretching programs, strengthening activities, and identification of possibly sensory needs/strategies.
If the conservative approach is not effective enough for your child, a therapist can help order orthotics, braces, or splints. Therapists can also provide information and resources on casting and botox injections. In more extreme cases when children do not respond to conservative treatment, surgery may be an option.
Please reach out to your pediatrician if you have any concerns. Pediatric Therapies Hawaii offers full physical therapy and occupational therapy evaluations if you have any concerns about your child’s physical development.
References:
https://my.clevelandclinic.org/health/diseases/21017-toe-walking
