Toe Walking in Children

# Understanding Toe Walking: Causes, Assessment, and Solutions

## What Is Toe Walking?

Toe walking is when a child walks on the balls of their feet without letting their heels touch the ground. This behavior is quite common in toddlers who are just learning to walk. Many kids go through a short “toe-walking phase” between ages 1–3 as part of normal development.

However, persistent toe walking after age 3 can sometimes indicate underlying issues. In such cases, further assessment by a podiatrist, physiotherapist, or paediatrician may be necessary.

## Common Causes of Toe Walking

There are several potential reasons a child might toe walk:

• Idiopathic Toe Walking (most common)

This means there is no clear medical cause. Often, it runs in families. If the habit continues, muscles and tendons can tighten over time.

• Tight Calf Muscles / Short Achilles Tendon

This condition can physically make it hard for the heel to reach the ground.

• Sensory / Behavioural Factors

Some children, especially those with sensory processing differences or autism spectrum, find that toe walking gives them extra sensory input or feels more comfortable on their feet.

• Neurological or Medical Conditions (less common)

Conditions such as cerebral palsy, muscular dystrophy, or spinal abnormalities may lead to toe walking. These are usually accompanied by other signs, such as delayed milestones, stiffness, or weakness.

## Assessment of Toe Walking

A podiatric & chiropractic assessment typically includes:

• Observing the walking pattern and posture

• Measuring ankle range of motion and calf/Achilles length

• Checking reflexes, muscle tone, and coordination

• Reviewing developmental history, birth history, and family history

• Sometimes, referral for further investigations if red flags are present

  
  

## How We Fix It: Treatment Options

Treatment depends on the cause and severity of toe walking. Here are some common approaches:

1. Stretching & Exercises

• Regular calf and Achilles stretching (e.g., wall stretches, heel drops)

• Strengthening foot and leg muscles to support proper heel strike

  
  

2. Footwear & Orthotics

• Supportive shoes with a firm heel counter to discourage toe walking

• Custom orthotics or heel lifts to improve alignment and encourage heel contact

  
  

3. Cueing & Habit Retraining

• Games and reminders to “walk with heels down” (e.g., walking like a duck, stomping games, barefoot heel walking on grass)

• Consistent positive reinforcement

  
  

4. Casting or Splinting (if tightness is significant)

• Short-term serial casting or night splints can gently stretch the Achilles tendon over weeks

  
  

5. Referral for Specialist Input

• If neurological or sensory causes are suspected, referral to paediatricians, neurologists, or occupational therapists may be appropriate

  
  

## When to Seek Help

It’s important to seek help if:

• Toe walking persists past age 3

• The child walks on toes more than 50% of the time

• There are tight calves, pain, or difficulty standing flat

• There is asymmetry (one side is more affected than the other)

• There are delays in other developmental milestones

  
  

## Prognosis for Toe Walking

Many children with idiopathic toe walking improve with a combination of stretching, exercises, footwear adjustments, and habit retraining. Early intervention works best. Prolonged toe walking can lead to tight tendons and future gait issues if left untreated.

## Conclusion: Understanding and Addressing Toe Walking

In summary, toe walking is a common behavior in young children. While it often resolves on its own, persistent toe walking may require assessment and intervention. Parents should be proactive in seeking help if they notice concerning signs.

For more information on addressing toe walking, consider booking an appointment with us. Understanding the underlying causes can lead to effective treatment and a brighter future for your child.

Anthony Gum Podiatrist & Chiropractor