Toe walking is a pattern of walking wherein a child walks on the balls of their feet, with no contact between their heels and the ground. As our Fort Myers physical therapy team can explain, it’s common among children who are learning to walk, but most kids outgrow it after age 2, when they assume the typical heel-to-toe gait.

However, when toe walking persists beyond that, it could be a sign of an underlying medical condition, such as cerebral palsy, muscular dystrophy or a spinal cord abnormality. (Children with autism spectrum disorder and related conditions often toe walk more frequently, but there isn’t any direct link between the two conditions. There is some speculation that it’s related to sensory issues.) Sometimes, the causes are idiopathic, meaning we don’t know why it happens.

In any case, regardless of the cause, toe walking can result in complications. Children who spend a lot of time on their toes can develop stiffness, tightening and pain in their Achilles tendon and calf. In turn, this can lead to poor range of motion in the ankle, which is going to have a snowball effect. This can be treated by our Fort Myers physical therapy and occupational therapy teams.

We’ll develop various stretching techniques and exercise and practices. In some rare cases (usually if it persists beyond the age of 6) surgery might be required. However, non-surgical treatment is always preferred if possible.

• Some of these may include:
• Casting.
• Bracing.
• Botox injections.
• Pediatric physical therapy that includes stretching, strengthening, motor planning & coordination and gait training.
• Some combination of these.

All of our therapies are play-based, which is how we’ve found kids learn best.

When to Seek an Evaluation From Our Fort Myers Physical Therapy Team

We’d note that parents may have cause to be especially concerned if your child is toe-walking most of the time or if it is ALSO accompanied by:

• Premature birth;
• Lack of development of other motor skills;
• General lack of coordination;
• Other medical problems;
• Complains frequently of pain at the feet, ankles, knees and hips;
• Muscle stiffness, especially in the calf or ankle movements that are getting tight;
• Family history of muscular dystrophy or autism;
• Stumbling/awkward walking all the time;
• A seeming inability to bear weight on a flat foot.

Keeping in mind that toe-walking can be a typical part of child development, if your child is past the age of 2 or 3 and is still toe-walking, our Fort Myers physical therapy team can conduct an evaluation to determine whether therapy or some other intervention is needed. Persistent toe walking can set a child up for aches and pains into adulthood, so it is important to seek a professional opinion if you’re concerned.

Strategies to Prevent or Reduce Toe-Walking

If your child is still very young and you are not overly-concerned there may be something else going on, some exercises that can help prevent or reduce toe-walking include:

• Stretch their feet. This is good to do just in the first few weeks after your bring your baby home – especially if they are a preemie or had low birth weight.
• Help your baby stay flat-footed when bearing weight on their legs. If your baby is standing on your lap or pulls up to stand while they’re holding your hands, frequently check their feet. If they aren’t full in contact with the surface, adjust them. Also, try to avoid holding your baby up with your hands. Your support should be primarily for balance and safety, while your baby is the one bearing the weight of his/her body on their feet.
• Avoid suspension devices. This one is tough because babies love ’em. Plus, devices like jumperoos and walkers allow you to have some time hands-free. The problem is that these devices create some confusion in the neurological system because they are artificially providing support to other parts of the body. It sort of “tricks” the brain into thinking the trunk or butt can support the child’s whole body weight, and it can have an adverse impact on motor development. Plus, if a child is partly supported with only his or her toes and the balls of their feet touching the floor, it can set off the reflex to bound on your toes, which can make the child more apt to develop a toe-walking pattern once they start walking.
• Don’t try to hurry development. Absent a physical or neurological difference, children will learn to walk correctly in their own time. One thing you can prioritize is tummy time. Also, focus more on crawling before walking. These can help reduce the tendency to toe-walk.
• Desensitize your child’s feet. Sometimes toe-walking is related to sensory processing issues. If a child is overly-sensitive to certain textures, sounds or environments may start to toe-walk as a means of tactile defensiveness. Expose your child’s feet to a lot of different textures, pressures and sensations. Start putting shoes on them early on so they’re used to wearing them. Alternate that sensation with playing barefoot in the grass and sand, rubbing lotion or washing them with a warm washcloth.

If you have concerns about your child’s toe-walking, our Fort Myers physical therapy team is available to answer your questions, conduct evaluations and offer treatment. If your child has a medical diagnosis associated with their toe-walking, it is important to discuss any at-home practice/stretching with your child’s pediatrician, PT and OT.

FOCUS offers pediatric physical therapy in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.

Additional Resources:

Toe walking in children, Mayo Clinic

More Blog Entries:

Physical Therapy Targets Gross Motor Delays That Spur Other Problems, April 6, 2018, Fort Myers Pediatric Physical Therapy Blog