Does Your Child Walk on Their Toes? What This Means

What is toe walking?
Most children begin walking at 12 to 15 months of age. Often, in the early stages of walking, children try different foot positions for walking. Walking up on their toes may be part of this. By around 24 months, they should walk with their feet flat on the ground. By 3 years of age, children should walk with a heel-toe pattern. If walking up on their toes persists, this is called toe walking. Toe walking refers to a walking pattern in which a child walks on the balls of their feet and there is no contact between the heels and the ground.

There are many medical reasons for this type of walking pattern, which is called idiopathic toe walking. Idiopathic toe walking, sometimes referred to as habitual or behavioral, occurs when a child walks on the balls of their feet for an unknown reason. This term applies to toe walking in a child who has been evaluated by their doctor and no medical reason has been identified.

Idiopathic toe walking occurs in otherwise healthy and typically developing children. It always occurs in both feet. Some children with idiopathic toe walking are able to walk with their feet flat when asked to do so. When these children wear shoes, they might not walk on their toes. Their toe walking is often exaggerated when they walk bare-footed from one room to another or when they walk on surfaces that have increased tactile sensations (carpet, cold tile, grass). These children typically do not have tightness in their Achilles’ tendons (heel cords) early on.

Can idiopathic toe walking lead to foot or leg problems?
Some children with idiopathic toe walking develop tight Achilles’ tendons, as they get older. This is called a contracture. When this happens they can no longer drop their heels to the ground. This tightness can lead to problems with how their feet and legs line up and can contribute to the development of flat arches and/or outward rotated legs when the child tries to maintain heel contact with the ground.

What causes idiopathic toe walking?
The cause of idiopathic toe walking is unknown. Many factors may contribute to the development of toe walking in children, these include:

  • An increased response to touch sensations
  • Altered sensing of the body’s position in space
  • Difficulty processing balance
  • Visual processing
  • Flexibility of leg and foot muscles
  • Overall body strength
  • Environment, such as hard floors or surfaces that may cause overstimulation
  • Family history: parents or siblings who have a history of toe walking

Can idiopathic toe walking be treated?
For young children with idiopathic toe walking without Achilles’ tendon contractures, watching and waiting is an option. Younger children can benefit from physical therapy for stretching, strengthening, gait training and home exercise. Night-time bracing with plastic orthotics may be helpful. In some cases, idiopathic toe walking may resolve on its own.
If you have concerns about your child’s walking pattern, physical abilities, please contact our pediatric therapy specialists to schedule a free screening.

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