How Physical Therapy Can Help with Toe Walking

By: Holly Thompson, DPT

Do you notice your child walking on their toes throughout the day? Do they prefer to be up on their toes rather than keeping their feet flat when they are standing and walking? By two years old, children typically demonstrate a heel-toe walking pattern. While toe walking may appear harmless, over time it can cause secondary complications that interfere with your child’s gross motor skills.

  • Decreased flexibility – with continued toe walking over time, the Achilles tendon (the heelcord and major tendon at the back of your ankle) can become tight, and your child may develop decreased ankle range of motion.
  • Difficulty with functional tasks – when a child has decreased ankle flexibility, it is difficult to keep their heels down for tasks including jumping, going up/down stairs, standing on one leg to put on pants, or squatting down to pick items up off the floor. This can make it challenging to participate in age-appropriate activities at school and in the community with their peers.

    • Why do some children toe walk? Every child is different and unique – the following are often contributing factors for why a child may demonstrate toe walking:

  • Sensory feedback – seeking the feedback from the ground and the bouncy feeling of being up on their toes.
  • Decreased core strength and decreased ankle stability – difficulty maintaining neutral alignment with their feet flat and seeking increased stability with their ankle extended.
  • Ankle injury – a recent injury that makes it difficult for them to walk with their feet flat and have full range of motion.

    The following are reasons you may want to seek out a Physical Therapy screening or evaluation for your child:

  • Toe walking for >50% of the time
  • Maintaining a tip-toe stance when doing standing tasks
  • Unable to mimic a heel-toe walking pattern when it is demonstrated for them
  • No initial heel contact on the ground when walking

    If your child is evaluated and qualifies for Physical Therapy, the therapist will look at what the underlying cause may be for your child’s toe walking and work with you and your child to create a custom plan of care. In Physical Therapy, we often work on the following areas:

  • Core and lower extremity strengthening
  • Range of Motion
  • Functional Mobility
  • Balance
  • Home Exercise Program
  • Orthotic and/or shoe recommendations
    If a child is demonstrating toe walking due to sensory seeking behavior, Occupational Therapy may also be helpful to address and treat sensory dysfunction.