A key stage in a child’s development is learning to walk. However, all children develop at different rates and with different patterns of moving. A common walking pattern in children seen by physiotherapists is toe walking and there are many reasons why this may occur. This walking pattern can cause concern with parents when their child doesn’t grow out of this habit. Therefore, in this post we’re going to look at children that walk up on their toes, exploring possible reasons why they are doing this and what can be done about it.

What is Toe Walking?
A child’s walking pattern (gait) is described as toe walking when their heel doesn’t touch the ground while they’re walking. This can either occur spontaneously, referred to as ‘idiopathic’ toe walking, or can be a result of certain medical conditions such as Cerebral Palsy.

In children with medical conditions, they often walk on their toes out of necessity due to physical changes in their body. However, in this post we are looking specifically at children who experience spontaneous toe walking – with the children choosing to walk on their toes over walking heel-first regardless of physical ability.

Why does Toe Walking occur and should I be concerned?
Spontaneous toe walking can occur for many reasons, many of which parents may never know as their child grows out of the habit soon after learning to walk. However, if toe walking persists past the age of 22 months, it is worth looking into further, particularly if this is the only pattern your child shows [1]. Spontaneous toe walking that persists into childhood is commonly associated with neurodevelopmental disorders such as autism, ADHD or cognitive disorders [2].

Toe walking raises concern when it occurs only on one side of the body or when this is a child’s only form of walking. If it occurs with only one leg, please contact a health professional as it may be a sign of deeper cause.

However, if your child only walks on their toes, the persistent position of the legs can affect the muscles and joints involved with walking.

This most commonly leads to shortening of the calf and hip muscles, leading to the leg being naturally held in the tip-toe position. This can also lead to weakening of the muscles opposite the calf and the core muscles.[1] We can see a functional change in the child’s ability to balance or coordination difficulties.

These physical changes can impact a child’s ability to play with their friends or participate in school activities and therefore it is important to put appropriate steps in place to prevent these changes from occurring.

What can we do to reduce toe walking?
The various activities a physiotherapist can do with your child are based around encouraging a heel-strike gait, stretching the tightening muscles, strengthening any secondary weakness and facilitating learning of functional components such as balance or coordination.

These activities include taping squeakers to the heel of their shoe to give auditory feedback when the heel hits the ground or recreating different walking patterns such as “crab walks” or “penguin walks” which emphasise heel strike. Exercises include calf and hip stretches, core strengthening and leg strengthening.

Assistance in learning functional activities can include challenging your child’s balance through games or practicing movements such as sit-to-stands while keeping heels on the ground.

If the toe walking persists with physiotherapy input, a further referral for podiatry may be needed. Podiatrists can provide heel wedges in their shoes to encourage weight bearing through the heels, night splints to passively stretch the calf muscles or serial casting to hold the ankle in a stretch for a prolonged period.

Remember, children all develop differently and in their own time. Toe walking can occur for a variety of reasons and often resolves itself. If you notice anything odd such as it only occurring on one side of the body or it persisting beyond 22 months of age, do not hesitate to reach out to a health professional for a second opinion.

What to do now?

If you notice that your child is walking on their toes, don’t hesitate to give us a call at Generation Physio, we have a friendly team of professionals that are dedicated to changing the lives of our clients. All of our clinicians are mobile and come to your own home to conduct an examination. Give us a call on 1300 122 884 to book a consultation today.


Article Written By Emma Stewart

Physiotherapist – Moreton Bay

Emma graduated from the University of Otago in New Zealand with a Bachelor of Physiotherapy. She has gained clinical experience across musculoskeletal, neurorehabilitation, cardiorespiratory and paediatric physiotherapy.

Emma enjoys working with clients of a variety of ages, conditions and backgrounds. She has a specific interest in neurorehabilitation and paediatric physiotherapy as she loves the opportunity to empower clients to be able to do the activities that they love and reach their full potential.

Learn more about Emma here.


References

  1. DANN K. Idiopathic Toe Walking. Podiatry Now [Internet]. 2017 Apr [cited 2020 Mar 4];20(4):28–30. Available from: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=129035141&site=ehost-live
  2. Soto Insuga V, Moreno Vinués B, Losada Del Pozo R, Rodrigo Moreno M, Martínez González M, Cutillas Ruiz R, et al. [Do children with attention deficit and hyperactivity disorder (ADHD) have a diferent gait pattern? Relationship between idiopathic toe-walking and ADHD]. Anales De Pediatria (Barcelona, Spain: 2003) [Internet]. 2018 Apr [cited 2020 Mar 4];88(4):191–5. Available from: https://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=28705637&site=ehost-live

 

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