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Toe walking

Toe walking is extremely common in children who are learning to walk, and we see many cases in our clinic.

What is toe walking?

Toe walking or walking on tip toes, is a when children walk on the balls of their feet with their heels having no contact with the ground. It’s very common in children who are learning to walk, but by the age of 2 years, most children walk with a normal heel-to-toe pattern. Usually, the condition disappears on its own, but sometimes this condition may persist into childhood.
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What causes children to walk on their toes?

Most of the time, toe walking is idiopathic. This means that the child walks on their tiptoes for no known reason. While they can usually stand and walk with their heels down if they’re asked to, their natural preference is to walk or run on their toes.

Sometimes toe walking may be caused by tight calf muscles or tight Achilles tendons. However, some medical conditions can also cause children to walk on their toes. These include:

  • Cerebral palsy
  • Muscular dystrophy
  • Spinal cord abnormalities
  • Neurological conditions

Toe walking is also linked to autism. However, it’s believed that it may be sensory-related, rather than caused by a physical condition.

Signs and symptoms of toe walking

The most obvious sign of toe walking is not having the usual heel-to-toe walking action. However, some children, particularly those aged over 5 years, may complain about problems wearing shoes, or may have difficulty participating in sports and other physical activities.

Should I be concerned if my child is walking on their toes?

Toe walking is a normal variation of walking in young children who are learning to walk. However, the condition can make a child more likely to fall, or may be linked to other underlying condition. If you notice toe walking in your child, we recommend you make an appointment for your child to be assessed.

Diagnosing toe walking

While the majority of cases of children walking on their toes is nothing to be concerned about, it’s important that the cause of toe walking be diagnosed.

At The Foot Hub, we will conduct a thorough examination which will include:

  • taking a medical history, including asking when toe walking started
  • asking about family history of toe walking
  • assessing your child’s walk and gait
  • checking for obvious abnormalities including differences between each foot and leg
  • checking the range of motion in hips and knees.

If we feel that toe walking is caused by an underlying condition, we can provide referrals to relevant specialists for further investigation.

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How do you correct toe walking?

Treatment for toe walking will depend on the age of the child and whether they are able to walk with a normal heel-to-toe action.

Non-surgical treatment is always the first step. For children between the ages of 2 and 5 who can walk flat-footed this may involve:

  • regular monitoring to see if the child eventually stops
  • walking on their toes of their own accord
  • short leg walking casts designed to progressively stretch and lengthen calf muscles and tendons
  • wearing an ankle-foot orthosis brace to help stretch and lengthen muscles and tendons
  • botox injections to temporarily relax calf muscles – this is usually reserved for those with a neurological abnormality which can cause increased muscle tone

In children over the age of 5, surgical treatment may be required. This may involve surgery to lengthen the Achilles tendons to improve range of motion and function of the ankle and foot.

Physiotherapy is also recommended after both non-surgical and surgical treatment to help the child walk on their feet more consistently.

When to see a podiatrist

While intoeing is quite normal in children under 2 years of age, we recommend making an appointment to see us for any concerns you may have about your child’s feet or gait. It’s particularly important to book in for an assessment if:

  • your child is older than 2 years and still walks on their toes
  • they previously walked normally but then began toe walking
  • toe walking makes it difficult for them to walk or run without falling or tripping
  • toe walking is occurring only on one foot
  • your child can’t stand with both heels on the ground.

We pride ourselves in providing excellent care and advice at The Foot Hub. If you’re concerned about any aspect of your child’s feet, or ability to walk and engage in physical activity make an appointment with our experienced podiatrists.

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