What is Toe Walking?

Toe walking is when a child remains on their toes when walking, instead of stepping normally through their heel, arch, ball of foot, then  toes.

Many children walk on their toes when they are first learning to walk. This may be present up until 6 months of a child walking independently. After 6 months, continued toe walking is considered a concern.

Causes of Toe Walking

Toe walking may be caused by Cerebral Palsy, congenital contracture of the Achilles tendon, or muscular disorders such as Duchenne’s Muscular Dystrophy.

Some kids walk on their toes for no reason. This is called idiopathic toe walking.

What is Idiopathic Toe Walking (ITW)?

ITW is a term used to describe when a child walks with a “tiptoe” pattern without a known cause. This is a diagnosis of exclusion, in which other physical conditions that may cause toe walking have been ruled out.

What causes ITW?

We do not yet know the exact cause of ITW. However, it can be influenced by several factors.

Some children have difficulty with vestibular and proprioceptive processing, meaning their brain is not getting accurate information about their body position and movement.

This may make them want to walk on their forefoot to increase the impact they feel from the ground with each step. Some children also “bounce” while on their toes in order to seek more vestibular input. 

Other children may be hypersensitive to touch and not like the feeling of different surfaces touching their feet, so they rise on their toes to avoid having full contact with the floor.

What we know about ITW

Often with idiopathic toe walking, children are able to stand with flat feet and even walk with a heel toe pattern when asked. But without cueing, they remain on their toes.

ITW tends to run in families1, and research shows there is a higher prevalence in males2. It has also been shown to have a positive correlation with language delays and learning disorders.

How is ITW Treated?

Parents should speak with their physician to identify the underlying cause of their child’s toe walking. Then, a referral may be made to a pediatric physical therapist who will assess the child and design a treatment program tailored to the child’s specific needs and condition.

Physical Therapy treatment may include a combination of stretching, strengthening, balance and sensory integration activities to encourage proper gait and full use of the child’s feet.

If your child is still toe walking after 6 months of walking independently, we can help. Call 425-481-1933 or visit our Intake Forms page to schedule an Initial Evaluation for physical therapy. We’d love to work with you to support your child’s development.

Article by Dr. Marci Westman, DPT

Article References: 1Le Cras S., Bouck J., Brausch S., & Taylor-Haas, A. (2011, February 15). Management of idiopathic toe walking in children and young adults ages 2 through 21 years. Retrieved from www.cincinnatichildrens.org/WorkArea/linkit.aspx?LinkIdentifier

2Fox A., Deakin, S., Pettigrew G., & Paton, R. (2006). Serial casting in the treatment of idiopathic toe walkers and review of the literature. Acta Orthopaedica Belgica, 72, 722-730.

Image credits: (top) MissLunaRose12 – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=83444254. (bottom) Bothell Pediatric & Hand Therapy, 2019.

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