Idiopathic Toe Walking

What is Toe Walking?

Often in the early stages of walking, children will try different foot positions for walking. Walking up on their toes may be part of this and is considered a normal part of development. By around 24 months, a child should walk with their feet flat on the ground, and by 3 years should walk with a heel-toe pattern. If walking on their toe persists beyond this, it is referred to as toe walking.

There are a number of medical reasons for toe walking. Idiopathic (or habitual) toe walking is the term used when no medical reason has been identified. Idiopathic toe walking occurs in otherwise healthy and typically developing children and is always in both feet.

Idiopathic Toe Walking

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. Toe walking is often exaggerated when they walk bare-foot or when they walk on surfaces with increased tactile sensations (e.g. carpet, cold tile, grass)

What causes it?

The exact cause is unknown. Many factors may contribute to the development of toe walking in children, including:

  • Tactile processing (an increased response to touch sensations)
  • Altered proprioceptive processing (sensing the body’s position in space)
  • Flexibility of leg and foot muscles
  • Overall body strength: weakness in the muscles of the trunk/ core
  • Family history: parents or siblings who have a history of toe walking
  • Habit: a child may just get used to toe walking, which over time may lead to tightening of the calf muscles

Treatment of Idiopathic Toe Walking

For young children with idiopathic toe walking without Achilles tendon tightness who can place their feet flat on the ground, there is often no need for active intervention and toe walking with often resolve on its own as the child continues to develop.

For preschool children with Achilles tendon tightness/ shortening advice will include:

  • Regular passive stretching of the lower limbs
  • Active stretching and strengthening exercises
  • Encouraging heels down/ feet flat activities (e.g. walking on heels, walking with feet flat)
  • Wearing supportive, well fastened footwear to help your child maintain a good foot position and improve their walking pattern

In cases where a child shows more significant tightening of the Achilles tendon and they are permanently on their toes a referral may be made to orthotics who will work alongside physiotherapists to provide one or more of the following:

  • Insoles
  • Specialist supportive footwear
  • Night Splints
  • Serial Casting

These options will be discussed further with you if deemed appropriate following assessment.

Benefits and Risks of Treatment

The above treatments can: reduce associated symptoms (tightness, pain, fatigue, clumsiness and falls), increase muscle length and improve your child’s walking pattern.

There is a risk with serial casting that your child could experience dry, itchy skin or rubbing on their skin. There are no risks or side effects to the other treatments.

Cup one hand around your child’s heel. Keeping your forearm in contact with the sole of the foot gently draw the foot towards a right angle. Use your other hand to stabilise the leg and use a gentle pressure. Hold for 15 – 30 seconds.

Take the leg to be stretched so the hips and knees are at right angles. Position one hand at the knee and the other supporting the ankle. Gently straighten the knee, keeping the thigh straight, until you feel resistance. Hold for 15- 30 seconds.

Heels down activities

  • Walk like a crab or bear with all fours on the ground
  • Try and walk like a penguin, heels down and toes up
  • Try a game of leap frog: jumping, hopping, squatting then leaping forward

General Strengthening Activities

Play activities such as swimming, bikes, balance bikes, scooters, soft play and climbing can all be beneficial in improving your child’s muscle strength, balance and coordination.

Contacting the Team

Community Paediatric Physiotherapy  

Community Business Unit

Bensham Hospital



Telephone: 0191 445 3124

How do I make a comment about my visit?

We aim to provide the best possible service and staff will be happy to answer any of the questions you may have.

If you have any suggestions or comments about your visit, please either speak to a member of staff or contact the patient advice and liaison service (PALS) on 0191 445 6129 (09.00 – 17.00, Monday to Friday).

You can also email PALS at [email protected]

Alternatively, you may wish to complain by contacting our complaints department:

Chief Executive,

Gateshead Health NHS Foundation Trust,

Trust Headquarters,

Queen Elizabeth Hospital,

Sheriff Hill,



The PALS team will listen to your concerns, suggestions or queries and is often able to help solve problems on your behalf.

Data Protection

Any personal information is kept confidential.  There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible.

In order to assist us to improve the services available, your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews and Statistics. 

Further information is available via Gateshead Health NHS Foundation Trust website (Privacy – Gateshead Health) or by contacting the Data Protection Officer by telephone on 0191 445 8418 or by email [email protected].

This leaflet can be made available in other languages and formats upon request.