Toe Walking – What’s the Big Deal?

Toe walking is a common developmental phase in toddlers, but if it persists beyond age three, it can lead to muscle weakness, balance issues, and long-term joint problems. Early assessment and intervention are crucial.

You’ve probably heard someone in the pediatric world mention toe walking. What’s all the buzz about? What is toe walking, and who does it? Should you be concerned if you notice your child toe walking? APT’s very own Amie Caple – PT, DPT walks us through the basics.

Toe walking is when a child walks without their heels hitting the ground. It is common in toddlers just learning how to stand and walk, and it is typical for a child to experiment with toe walking for 3-6 months after they begin walking as they test out their new found independence and can even continue off and on after that in some kids. By three years old, children should have adopted a more typical pattern of walking heel to toe.

It is a concern if a child continues to walk on their toes past the age of three, if the distance between the heel and floor is extreme, or if he/she is unable to bring their heels down to the floor. Toe walking can cause trunk and leg muscle weakness, decreased flexibility in leg muscles, and decreased balance which can cause issues in keeping up with peers and successfully engaging in play activities. Over time, habitual toe walking places abnormal stress on the bones and ligaments in the feet, knees, and lower back which can deform bones and stretch ligaments, causing joint pain, impaired function, knee instability, arthritis, and increased risk of injury as one grows older.

A child may toe walk for a variety of reasons including core or ankle weakness, heel cord tightness, spasticity or neurological condition, sensory processing issues or Autism, prematurity, GI issues, vestibular issues, or visual impairments. There is also another category of toe walking called ‘idiopathic’, meaning muscular, neuromuscular, and sensory issues have been ruled out and toe walking persists due to habit. Treatment of toe walking depends on severity (time spent on toes and amount of ankle flexibility) and can include Botox injections, serial casting, bracing, physical therapy for stretching, strengthening, manual therapy and balance training, and/or surgery. If you think that your child walks on their toes a lot, have your pediatrician or friendly neighborhood pediatric physical or occupational therapist complete an exam to determine the next best step for your child.