Toe Walking… What causes it and what to do next!

​Standing and balancing on tip toes is a skill that requires strength and balance. Typically developing children should achieve this skill around 2 years old. However, consistent tip toe walking can become a problem if it is child’s primary gait pattern. If your child is walking up on their tip toes more than 60% of the time at home and has been walking for more than 3 months, it is recommended that they be evaluated by a physical therapist to determine to root of the problem and begin working towards a more typical gait pattern. 

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What are some reasons a child might toe walk?

1. 1. Sensory Based Toe Walking: Children may begin toe walking due to difficulty processing sensory input on the bottom of their feet. With sensory based toe walking, it usually presents bilaterally (meaning child is up on tip toes of both feet), it oftentimes changes depending on the surface they are walking on (i.e. carpet v. hardwood; barefoot v. shoes), and oftentimes the child may show other signs of sensory aversiveness in addition to toe walking (i.e. difficulty tolerating certain clothing, clothing tags/seems are irritating to them etc.).
2. 2. Instability Based Toe Walking: Children may walk up on their tip toes because they never developed the appropriate balance reactions and foot/ankle strength to feel stable with their feet flat on the floor. This type of presentation is typically bilateral (meaning child is up on tip toes of both feet). Typically, when the child places their feet flat on the floor, you may notice excessively flat feet and lack of medial arch development.
3. 3. Neurological Based Toe Walking: Children with neurological involvement commonly walk on tip toes due to changes in muscle tone (typically increased muscle tone). Usually this type of toe walking is asymmetrical (meaning the child only walks up on toes of one foot). 

If my child continues to toe walk, what will happen?
If toe walking is not addressed early on, it can lead to problems with muscles and gross motor development down the road. The primary problems that arise from prolonged toe walking include, shortened heel cord and significant tightness of calf muscles (primarily gastrocnemius), weak hips, ankles and feet, decreased stability and balance, and difficulty/delayed achievement of higher-level gross motor skills. 

What is the next step if my child is demonstrating this gait pattern?
Schedule and evaluation with a skilled pediatric physical therapist to begin an individualized therapy plan and home program in order to address the root of the problem and work towards a more optimal gait pattern! 

In the meantime, … Is there something to be working on at home?
It is important to be evaluated by a skilled, pediatric PT to determine the root of the problem and begin an appropriate, individualized treatment plan. However, here are 3 simple exercises which can be practiced at home that can begin to address some common deficits found in toe walkers and are helpful for strength and development in all children!

1. 1. Backwards Walking
2. 2. Single Leg Balance
3. 3. Glut Bridges 

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