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Toe Walking

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What is toe walking?
Causes
Is toe walking a problem?
Toe walking in adults
Treatment for toe walking
FAQs

Kids can start walking on their toes from a very young age, even just shortly after they’ve mastered confidently walking and balancing on their own. This can raise alarm bells for many parents regarding the potential reasons behind their child’s toe walking, and whether it’s normal or could be a sign of an underlying problem.

What Is Toe Walking?

Toe walking is defined as bearing weight only on their forefeet and toes for prolonged periods, without having any contact with their heels on the floor. With the majority of the body weight being taken by the forefoot with every step, it’s not thought of as the most comfortable or natural type of gait. 

Causes: Why Do Kids Walk On Their Toes?

There are several causes of toe walking, with the most common category being ‘idiopathic toe walking’, which is typically the diagnosis given when all other explanations and causes (like neurological causes) have been ruled out. In a portion of these cases, the reason why the cause is unknown is that there isn’t anything ‘medically’ wrong - an adventurous and developing child is simply exploring a new walking pattern that they may perceive as fun, and they enjoy doing it. Sometimes, this may last for a short time. Other times, it can become a long standing habit.

Other known causes of toe walking include:

• A congenitally short Achilles tendon
  
• Ankle equinus (where the ankle joint lacks flexibility and upwards movement of the toe)
  
• Neurological causes such as cerebral palsy, Charcot-Marie-Tooth and spina bifida
  
• Muscular causes such as muscular dystrophy
  
• Anatomic problems such as a leg length difference, resulting in toe walking on the shorter leg
  

Is Toe Walking A Problem?

As a regular heel-to-toe walking pattern tends to develop by the age of 22 months, if consistent toe walking is persisting beyond two years old, we’d recommend bringing your child in for an assessment. This will allow us to perform a series of tests (including evaluating your child’s gait pattern, muscle tone and strength, looking for signs of any neurological deficits and the like) in order to better understand the cause behind your child’s toe walking, and either make a treatment plan to help support them, or refer them appropriately if an undiagnosed medical condition is suspected or worth investigating further.

Toe Walking In Adults

While it’s much less common to begin toe walking in adulthood, it can occur for several reasons:

• Neurological: the development or further progression or change in neurological conditions and their symptoms can also lead to adult onset toe walking. Examples include cerebral palsy, muscle spasticity or weakness following a stroke, and peripheral neuropathy 
  
• Muscular: progression or changes to muscular conditions including muscular dystrophy, myopathies, Achilles tendon contractures and ankle equinus 
  
• Psychological: in some cases, psychological factors or behavioural patterns can contribute to toe walking in adults. These may include anxiety, sensory processing disorders, or psychogenic causes where the toe walking is not related to any physical condition but is driven by psychological factors.
  
• Idiopathic: while uncommon, some adults may begin toe walking as a result of a new habit, exercise trend, or other reason that does not have a medical explanation.
  

Treatment For Toe Walking

Here at The Feet People, we always take the time to carefully assess and diagnose toe walking, knowing that it can be linked to serious underlying medical conditions where early detection can lead to the best management outcomes. 

Every appointment begins with a comprehensive assessment, the results of which guide your management plan entirely. Your care with us may include:

• The Surestep SMO: the Surestep supramalleolar orthoses (SMO) is a revolutionary treatment for children with low muscle tone who toe walk due to sensory or stability concerns. This customised foot-ankle brace helps facilitate a regular heel-toe gait pattern by using compression and a posterior tongue extension which serves as a reminder to keep the heel down. As the brace does not block the ‘downward’ movement of the toes (plantarflexion), kids are free to continue working on their gait development and gross motor skills that require this movement, so they are not held back and restricted in any way. Surestep is a personal favourite of ours due to its effectiveness and its slimline design that children love and adapt very quickly to.
  
• Stretching and strengthening exercises: these are very specifically prescribed for each person, and often involve addressing the Achilles tendon and gastrocnemius complex, as well as the hamstrings, while working on ankle dorsiflexion (where possible).
  
• Footwear that may have a more rigid sole to best support heel-to-toe movement and keep you comfortable throughout your management. In some cases, we may recommend making custom footwear modifications so that your shoes can offer you the best support and assist your progress most effectively.
  
• Mobilisation: foot mobilisation involves the hands-on manipulation of stiff or dysfunctional joints in the foot in order to improve joint alignment, release tension and help your feet and legs function more efficiently.
  
• Referrals: if we suspect an underlying cause of your toe walking that has not been addressed or detected previously, we will refer you to the appropriate health professional for further investigation and care.
  
• In rare cases, certain conditions like the severe contracture of the Achilles tendon may require surgery to help lengthen the tendons.
  

FAQs

Can toe walking be a sign of autism?

Toe walking can sometimes be associated with autism spectrum disorders (ASD). While not all children with ASD engage in toe walking, studies have shown a higher prevalence of toe walking among children on the autism spectrum. 

Will my child outgrow toe walking on their own?

Some children may naturally outgrow toe walking without any intervention. However, if toe walking persists beyond the age of 2 years, it is recommended to have your child assessed. Early identification and intervention can help address any underlying issues and promote more typical walking patterns.

Are there any exercises or stretches that can help with toe walking?

Physical therapy exercises and stretches can be beneficial in addressing toe walking. These may focus on stretching tight calf muscles, strengthening weak muscles, and promoting proper foot and ankle alignment. These are typically prescribed on a case-by-case basis depending on the underlying cause of the toe walking.

Can toe walking affect my child's balance and coordination?

Persistent toe walking can potentially impact a child's balance and coordination. Walking on the toes alters the natural alignment of the foot and can affect stability, leading to challenges with balance. Addressing toe walking through appropriate interventions can help improve balance and coordination.

Will my child need surgery to correct toe walking?

Surgery is generally not the first-line treatment for toe walking, with most cases of toe walking can be effectively managed through non-surgical interventions like the ones we’ve mentioned above. Surgery is considered in rare cases when conservative measures have been unsuccessful, and there are specific structural abnormalities that require surgical correction. This option should only be explored after other options have failed to yield adequate results.