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.

Recommended Stretches and Activities of Toe Walking

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

Gateshead

NE8 4YL

Telephone: 0191 445 3124

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