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Is Toe-Walking a Reason For Concern?


It is not uncommon for toddlers to tiptoe while they explore their newfound skill of independent walking. Some children take a few months to develop appropriate balancing skills before they are able to exhibit a normal gait pattern. As long as your child is not “stuck” on the toes all of the time it is safe to watch and wait for a normal gait pattern to develop. If your toddler spends most of his time walking on his toes or can't seem to put his weight on his flat feet, or if toe-walking persists after the first 4-6 months of independent walking it is a good idea to discuss options with your doctor or physical therapist.


Causes of Toe-walking:


Toe-walking that persists after the first few months of walking is usually called “idiopathic toe walking” (meaning there is no definitive cause). These children typically stand with feet flat on the ground, but when walking or running will prefer to be up on toes. Toe-walking is often described as escalating when the child is barefoot, excited or nervous.


Possible causes of Toe-walking include:


  • Congenital Shortening of the Achilles tendon – Some children are born with shorter heel cords. This limitation in range of motion pulls them up on to their toes.

    • If the limited range of motion is not severe, physical therapy treatment including stretching, strengthening and gait training is usually sufficient in correcting the problem.  If the muscles are severely tight, orthopedic intervention such as serial casting, Botox or orthotic wear is often warranted in conjunction to physical therapy treatment.


  • Hypotonia or Muscle Weakness - Children presenting with low muscle tone or weakness in their lower extremity muscles will often demonstrate toe-walking. Rising up to tiptoes causes a strong calf contraction providing a false sense of stability. In addition this position “locks-out” a weak and unsteady ankle joint providing the child with a seemingly more stable base of support.

    •  In this case physical therapy treatment will focus on strengthening weak muscles and improving balance to prevent the need for this gait compensation.


  • Sensory Integration Disorder - There are many possible sensory causes for toe-walking that can be explored together with your therapist. For example a child with tactile defensiveness to certain textures may rise from the floor to prevent foot contact with undesirable surfaces. A child seeking deep pressure and proprioceptive input through his joints might rise to his toes to experience the deep contractions of the calf muscles.

    • When sensory causes are suspected, the physical therapist works closely with the parents and child to provide sensory input in other means to prevent the need for rising to toes. Often an occupational evaluation will be recommended as a conjunction to physical therapy treatment to fully address all sensory needs.  


  • It is important to note that there are other less common causes of toe-walking such as cerebral palsy and muscular dystrophy. Should your healthcare provider suspect these possible causes, referal will be made to a pediatric neurologist.


At PTatric Therapy we wil guide you through the appropirate treament options for your child's specific needs.

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