Does Your Child Toe Walk?

Posted by

Alicia Amsberry, PT, DPT

Time to read

2 minutes

What is toe walking? 

Toe walking refers to a walking pattern in which a child walks on the balls of their feet, with no contact between the heels and the ground. By 3 years of age, children should walk with a heel-toe pattern.  There are many medical causes or reasons for toe walking. Today we are going to discuss a specific type of toe walking, called idiopathic toe walking.

Idiopathic toe walking occurs when a child walks on the balls of their feet for an unknown reason. This diagnosis is only used after a child has been evaluated and other medical causes have been ruled out. Typically toe walking is exaggerated when bare-foot or when walking on surfaces that have increased tactile sensations (carpet, cold tile, grass). 


What causes idiopathic toe walking?

Contributing factors that may cause the development of toe walking in children include:

  • Flexibility of leg and foot muscles
  • Altered proprioceptive processing (sensing the body’s position in space)
  • Overall body strength
  • Visual processing
  • Tactile processing (increased response to touch sensation)
  • Vestibular processing (maintaining balance)


What are long-term affects of idiopathic toe walking?

One of the main concerns of idiopathic toe walking is the possibility of the child to develop tight Achilles’ tendons, also known as contractures. When a child develops a contracture of the Achilles’ tendon they no longer have the ability to drop their heel to the ground.  These Achilles’ tendon contractures can lead to other problems including poor alignment of the feet and legs, flat arches, increase the force of impact during ambulation, discomfort, and pain. 


Can idiopathic toe walking be treated? 

Options for treatment depend on the underlying cause of the idiopathic toe walking and whether the child has contractures of the Achilles’ tendons. In order to determine an appropriate treatment protocol, a comprehensive history and evaluation should be completed. 

Below is a list of different treatment options available for children who display idiopathic toe walking. 

  • Occupational Therapy: sensory integration strategies
  • Physical Therapy: stretching, strengthening, and gait training
  • Orthotics: plastic splints to be worn on ankles/feet to maintain stretch/flexibility of the Achilles’ tendons
  • Serial Casting: series of casts to stretch the Achilles’ tendons
  • Orthopedic Surgery: surgical procedure to lengthen the Achilles’ tendon (heel cord)


If you have questions or concerns about your child’s gait pattern or gross motor abilities, please contact our clinic to schedule an appointment. 


Source: Seattle Children’s Hospital, Research and Foundation Patient and family Education Flyer

Photos: Pixabay