Toe walking is a common gait impairment seen as early as when a baby first starts walking.
Toe walking describes a pattern of gait in which children walk on the balls of their feet rather than initiating contact with their heels to the floor. Toe walking may be normal in children younger than age 2, by age 3 children should have developed a heel-to-toe walking pattern. Around the age of 5, children no longer consciously think about walking. Walking has become a movement plan that is stored in their brains. Once this motor plan has become stored in the subconscious, it is extremely difficult to change. For this reason, early intervention in toe walking is key.
Causes and Effects
Toe walking on its own is not usually a cause for concern and may be treated early with physical therapy to help avoid tight calf and ankle muscles and allow normal development of running and playing. Usually, toe walking is idiopathic, or for no known cause. Other times there is an underlying condition such as autism, ADHD, cerebral palsy, or muscular dystrophy.
Idiopathic toe walking means the cause is unknown. Some potential contributors that may be treated specifically with physical therapy are; shortening or chronic tightness of the Achilles tendon, sensory integration disorders, and difficulties with balance or coordination.
If your child walks on their toes, our pediatric physical therapists at Back in Motion, will thoroughly evaluate them. We will ask questions about in-utero growth, developmental milestones, medical history, and what goals you and your child have for therapy. We then thoroughly assess your child’s muscle strength, joint movements, gait, balance, coordination, reflexes, and muscle tone. If we suspect an underlying condition, we will refer you to your pediatrician for diagnosis even as we begin to treat the toe walking. We will individualize treatment based on what your child needs. Treatment may include:
- Stretching and range of motion exercises
- Gait training using a variety of age-appropriate games and activities
- Balance training using engaging activities and performed on a variety of surfaces (stable, wobbly)
- Sensory integration exercises
- Parent training on how to best help your child walk in a heel-to-toe pattern
- Assistance with orthotics, if necessary