Toe Walking

By Cara Yochai PT, DPT

“This little piggy went to market. This little piggy went home…”

Many children walk on their toes for a variety of reasons. Pediatricians may recommend a wait and see approach as toe walking is often considered typical when first learning the nuances of walking.  If your child is consistently walking on toes over the age of two years, it is recommended to return to your pediatrician and seek physical therapy services for your child.

Why is my child toe walking?

• Children may walk on their toes due to a sensory need (Refer to our posts on Sensory Processing: The Tactile System and The Proprioceptive System for more information)

  • Hyposensitive to tactile input:

    • Your child may have difficulty sensing the input from the ground.  By walking on toes, your child is altering the walking pattern to increase the intensity of the input to the ball of the foot.  

  • Hypersensitive to tactile input:

    • Your child may feel the ground too much.  Lifting the heel off the ground may help to decrease some of the tactile input.

  • Difficulties with proprioception: the knowledge of where your body is in space

    • Your child may have a hard time knowing where their body is in space, frequently called “poor body awareness.”

    • Sometimes, walking on toes helps your child to compensate for difficulties with proprioception by increasing the input they feel when they take a step.

• Other reasons your child may walk on toes:

  • Decreased range of motion in the ankle

  • Decreased flexibility of ankle and lower leg muscles

  • Decreased muscle strength

  • Visual perceptual problems which may need to be ruled out

Is it harmful for my child to toe walk?

• Toe walking alters the typical walking pattern:

  • The center of mass is shifted upwards and forwards, causing your child to utilize different balance reactions while walking

• Certain muscles are overused:

  • The muscles at the back of the legs, such as gastrocnemius and soleus, are constantly overworking.

• Certain muscles are underused:

  • The muscles at the front of the legs, such as quadriceps muscles at the knees and tibialis anterior muscles at the ankles are constantly underworking, and may have decreased strength

  • Abdominal and gluteus muscle weakness can also contribute to toe walking

• Certain muscles can become tight:

  • The muscles at the back of the legs, such as gastrocnemius and hamstring muscles, may become tight from frequently being in a shortened position.

Activities that help to decrease toe walking:

• Penguin walking (refer to our post on animal walking)

• Sit with feet on a support surface

  • If your child has to point their toes to reach the floor, help them by placing something underneath their feet.  This gives your child a chance to experience the sensation of their entire flat foot touching the surface.

  • Use a box or a wedge if you need more height underneath your child’s heels.

• Calf stretching and ankle pumps:

  • Sit with back against the wall and move toes up and down to promote moving through an increased range of motion at the ankle and increasing flexibility of the calf muscles.

If you are concerned about your child toe walking, please refer to a pediatrician. Some children are recommended for braces to improve the position of the ankle.  However, this does not always address the cause of toe walking for all children and physical therapy may be able to help!