• Does your child walk on their toes?

• Does your child have trouble standing in one place without taking a bunch of little steps?

There are several reasons children might walk on their toes (or balls of their feet):

1. Some toddlers walk on their toes because they like the sensation. If it is not more than 50% of the time, it should resolve within 6 months. If not, ask your pediatrician or pediatric physical therapist.

2. Some kids have sensory issues and don’t like the feeling of the ground on their feet, especially grass or sand. They may not tolerate the pressure through the bottom of their feet (proprioceptive input). A pediatric occupational therapist can help with this by “desensitizing” them.

3. Children with autism may have sensory issues or hyper-reactive calf muscles. Fast movements that occur in walking might cause muscle spasms so they walk on their toes to avoid this uncomfortable spasm.

4. They might have tight Achilles tendons or heel cords caused by other medical conditions such as cerebral palsy, muscular dystrophy, or other neurological conditions. If the toe walking persists more than six months, or is only one sided, speak to your pediatrician. Tight heel cords can develop because they walk on their toes often. A pediatric physical therapist can instruct you on appropriate stretches and activities to help resolve the tightness. Research supports walking on a treadmill at max incline for 10 minutes per day.

Often this pattern of walking becomes an “engrained motor pattern” or habit that needs to be broken. If stretching isn’t helping, they may require stretching braces for night time or Ankle Foot Orthoses (AFOs) braces for the daytime to help break the habit. Some orthopedic physicians or neurologists use a series of casts called serial casting to stretch the tight muscles and tendons. More extreme cases might require Botox injections or surgery.

What if they never outgrow it?

If left untreated, your child may develop foot deformities, muscle imbalances, and balance issues. Postural imbalances can lead to other issues such as back pain.

If you have concerns regarding your child’s toe walking, it is important to speak to your child’s pediatrician as your child may need a referral for physical therapy.

If you have additional questions regarding toe walking, please visit our website at www.collaborativecorner.org and reach out to our physical therapist susan@collaborativecorner.org free of charge.

Additional activities for children who walk non their toes can be found here.

Susan Robins, PT
Pediatric Physical Therapist
susan@collaborativecorner.org

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