Is Toe Walking Really Idiopathic?
Toe walking, or walking on the balls of the feet, can occur during the toddler years. Some kids will grow out of this without intervention. Toe walking alone is not necessarily a cause for concern. However, if it does not resolve, it can become a habit that, if left untreated, will cause physical changes that can be difficult to treat. And while toe walking in a 2 year old girl might seem cute, in a 10 year old boy it could lead to difficulty participating in sports, teasing, and impairments of the musculoskeletal system.
Causes of Toe Walking
- Achilles tendon (heel cord) or hip flexor tightness
- Sensory system impairments – vestibular, visual, proprioceptive, tactile
- Spasticity or increased muscle tone (seen in kids with cerebral palsy)
- Abdominal/hip/knee weakness
- Increased lumbar lordosis (increased spinal curve)
Treatment For Toe Walking
- Exercises to strengthen/educate weak or underused muscles, especially the tibialis anterior
- Stretching to lengthen muscles that have become tight, including muscles of the hip, knee, and ankle
- Core stabilization to increase strength of the abdominals, hips, and improve the position of the lumbar spine
- Gait training to work on proper heel strike
- Balance training
- Bracing
- Taping
- Sensory integration interventions to provide the stimulation that the child is lacking, seeking, or avoiding
- Visual motor exercises to help the eyes work together
- Education
- In severe cases, serial casting or surgery to increase tendon/muscle length
When to See a Physical Therapist
If you have concerns regarding your child’s toe walking, a physical therapist can screen or evaluate them and recommend an individualized plan of care based on the child’s needs. In general, if your child is a toe walker, you should immediately try to address it at home. Encourage them to walk with “heels down,” “flat feet,” “not on tiptoes,” or with a “heel-toe” pattern. Do not use a jumper and avoid using a walker or an exersaucer if your child cannot touch the floor with feet flat on the ground. The sooner you notice and address toe walking, the quicker it will resolve with or without intervention from a physical therapist.