Toe Walking in Children

Toe walking is when a child walks primarily on their toes or the balls of their feet rather than using a typical heel to toe pattern.

Toe walking is common when children are first learning to walk. However, when a child continues to walk on their toes beyond the early toddler years, it is worth taking a closer look at why it is happening.

What Is Idiopathic Toe Walking?

Idiopathic Toe Walking (ITW) describes toe walking when no underlying neurological, muscular, or orthopedic condition has been identified.

Idiopathic toe walking is generally bilateral and symmetrical, meaning the child tends to toe walk on both sides. Children with ITW typically have a normal neurological examination and may be able to walk with their heels down when asked.

Toe walking can also occur with conditions such as cerebral palsy, muscular disorders, or orthopedic limitations. For this reason, a Physical Therapist or other healthcare professional should evaluate persistent toe walking to determine whether there is an underlying cause.

When Should I Be Concerned About Toe Walking?

Many children experiment with walking on their toes as they develop their walking skills. If toe walking persists beyond approximately 2–3 years of age, or becomes frequent or consistent, an evaluation can help determine what may be contributing to the pattern.

Could Sensory Processing Play a Role?

For some children, sensory preferences may contribute to toe walking.

A child who is sensitive to certain textures may prefer to keep their heels elevated when walking barefoot on surfaces such as grass, sand, or carpet. Other children may enjoy the increased sensory input they experience through their feet when walking on their toes.

Because every child is different, sensory preferences should be considered as one possible contributor, rather than assuming that sensory processing is the cause of toe walking.

Treatment Ideas

Our goal is to assess and address the mobility, strength, balance, body awareness, and confidence needed for a more efficient heel to toe walking pattern.

Passive Range of Motion

Calf Stretch: With your child lying on their back or sitting, gently bring the foot upward toward the shin until you feel a light stretch in the calf. Hold for about 15 seconds and repeat on the other side.

Hamstring: With your child lying on their back, gently lift one leg with the knee straight until you feel a comfortable stretch behind the thigh. Hold for about 15 seconds and switch sides.

Active Range of Motion

Incline Wedge: Standing barefoot on an incline wedge allows opportunities to address active flexibility of foot, ankle and lower body.

Strength 

Toe Basketball: Have your child pick up small objects such as pompoms with their toes and drop them into a cup or basket. This helps activate the intrinsic musculature of feet.

Bean Bag Elevators: Place a soft bean bag on top of your child’s foot and have them lift their foot to move it into a container. This encourages active ankle dorsiflexion while strengthening the muscles along the anterior compartment musculature.

Scooter Board: Seated scooter board activities can encourage active use of the plantar intrinsic and anterior compartment muscles while incorporating weight bearing through the feet.

Hurdles and Cones: Stepping or jumping over hurdles or cones offer additional ways to activate trunk and leg musculature!

Balance Board: Challenge trunk and lower body strength with activities atop a balance board. 

Peanut Ball Play: Sitting on peanut ball shifting weight back and front, side to side will help activate abdominals and obliques.

Dynamic Bridges: Bridging exercises are great not only for trunk strengthening, but utilizing the dyna disc as seen above also incorporates arch activation!

Weight-Bearing Activities

Squat to Stand: Encourage barefoot standing using a variety of textures, promote squat to stand with fun activities to facilitate weight bearing. We always love dyna-disc for these activities!