Toe Walking in Childhood: Potential Causes and Treatments

May 19, 2023

What causes toe walking? Potential causes of toe walking include the following:

  • SENSORY – Some children dislike the feeling of pressure along their entire foot, especially if the floor is a cold tile or textured carpet. To avoid feeling these surfaces, they walk on just their toes. Or, they simply like the feeling of their ankle joints being locked out. 
  • PREMATURE BIRTH – When babies spend time in the NICU, nurses have to perform “heel sticks” routinely. This makes the heels hypersensitive. When these babies begin walking, they avoid pressure on their heels by walking on their toes. 
  • BALANCE – Some children may feel more steady and stable when walking on their toes versus flat feet.
  • IDIOPATHIC – In other words, spontaneous toe walking with an unknown cause. 
  • NEUROLOGICAL CONDITION – Though not as common, it is possible that toe walking is a sign of an underlying condition, such as cerebral palsy or muscular dystrophy.

When should my child see a specialist?  It is more natural for a baby to start walking with their feet flat, but they often like to experiment by switching between walking on the toes and the heels. It is normal for them to experiment with being on their toes. However, if toe walking persists past 2-3 years of age, then speak with your child’s pediatrician.

How does toe walking gait impact my child later in life? If gone untreated, toe walking can cause foot deformities, joint contractures (shortening of the muscles and tendons), limitations in ankle mobility, and balance impairments. In severe cases, surgical intervention may be required to fix their deformities. 

How can physical therapy help? Physical therapists help determine the cause of toe walking, perform stretches and strengthening exercises, work on gait training with a normal heel-toe progression, and develop a home exercise program with the family. Physical therapists help determine correct footwear and if potential bracing is necessary. In cases where surgery is required, physical therapists work alongside physicians to ensure optimal post surgical outcomes.