Some kids walk on their toes because of medical conditions (i.e., cerebral palsy), some kids because of neuropsychological conditions (i.e., autism), others because of unknown reasons (i.e., idiopathic toe walking or ITW). Toe walking is a complex diagnosis to treat because of the need for addressing its cause and the many contributing factors that may be present.
Research shows that parents and family members are often the first to voice concern regarding toe walking and those kiddos are often referred to interventions such as physical therapy at around 4 years of age, despite first mention of concern around age 3. 1
Walking patterns go through several stages of development in developing walkers, but toe walking (also referred to as equinus gait) is not considered a normal stage of walking development. There are many reasons why kids walk on their tippy toes but what should be known is that a new walker should have established a more mature (heel strike) walking pattern within 5-6 months of initial independent walking. This means that by an average of 18 months kiddos should be striking their heel to the ground when walking.2 By 3 years of age body systems have improved communication amongst one another to support a more consistent, or normal walking pattern. With that said, if you have concerns about your kiddo and how they are walking by age 3, be their advocate! Seek interventions to help them early on. Yes, spontaneous resolution of toe walking can occur, but it is not guaranteed and early intervention impacts prognosis and outcomes in a positive way. Talk to your pediatrician and utilize direct access to physical therapy to figure out what can be done!
Why should toe walking be addressed?
Multiple systems (skeletal, muscular, neurologic, integumentary, etc.) undergo lifelong physiological adaptations in response to loads they are placed upon them. We want these systems to be influenced in an optimal way that minimizes risk and injury and improves health and functional tolerance.
What contributes to toe walking?
What can be done to treat tippy toe walking, and how can physical therapy help?
Assessment of the previously mentioned influencing factors is crucial to designing and addressing deficits and the areas that contribute to dysfunctional movement patterns. Utilization of tools and activities that address biomechanical, strength and sensory impairments are key to improving the degree of toe walking present and create the possibility of resolution. We want to replace the toe walking pattern with a more efficient one, not just try to stop it. This involves practice!
Also, bracing, wedging, shoe orthotics and/or footwear changes are potential tools that can influence the foot position statically and dynamically to help normalize walking and improve mechanics.
Sometimes toe walking is associated with: (we could look at these as markers for early diagnosis and treatment)
- language disorders
- high prevalence for children with cognitive disorders
What matters to you should matter to your health care providers. The path of interventions for kids that toe walk is not always a straight one and utilization of shared decision making and problem solving with kids, parents/caregivers and medical providers should be utilized.
Physical therapy works to improve movement patterns by influencing external factors and building internal strength, proprioception, and patterns to support changes that improve the way we walk and navigate our everyday environments. This is all done to increase function and therefore, improve quality of life and health.
Myth Busting (misconceptions):
- A stretching program alone will solve toe walking of a 7-year-old. FALSE! (Why not? This addresses a symptom — muscle tightness — not necessarily the issue of patterning.)
- Your kiddo will grow out of their toe walking by age 7. FALSE! (Why not? Muscle memory and integration of several systems have been trained to move the way your child has moved their entire life.)
- Toe walking only influences the foot and ankle. FALSE! (What else? Mechanics from the bottom up can impact the knees and low back as well.)
- BarkocyM, Muir N, Le Cras S, et al: Parent Perspective Regarding Care Delivery for Children With Idiopathic Toe Walking to Inform an American Physical Therapy Association Clinical Practice Guideline. Pediatric Physical Therapy. 2021;33(4):260-266.
- Sutherland DH,Olshen R, Cooper L, et al: The development of mature gait. J Bone Joint Surg (Am) 62: 336, 1980.
Get Started Today
Physical therapy treatment for toe walking depends on the underlying cause of the condition. If your child’s toe walking persists beyond age 2-3, it’s important to advocate for them. PTs are experts in musculoskeletal conditions and will work with you to create a plan of care for your child to ensure they avoid pain and can participate in all the fun activities of childhood without limitation.