Is Toe Walking Normal?

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child on tiptoe.It is not uncommon for toddlers to walk on their toes or on the balls of their feet. This practice is often referred to as toe walking, a hereditary condition that may be seen when a child is learning how to walk. It is considered appropriate until the age of two, but if your child continues to toe walk beyond this point, it is important to have him/her evaluated by a physical or occupational therapist.

Toe walking is a common sensory-seeking behavior – children receive intense proprioceptive input to the calf muscle in their legs when they do it. This intensified input helps them to better prepare their bodies for play and learning. However, toe walking may be a sign of other sensory integrative difficulties and should be evaluated by an occupational therapist if accompanied by other symptoms (e.g. decreased eye contact, decreased coordination, or difficulty with gross or fine motor activities).

If your child toe walks occasionally, it may be a sign of a sensory issue. However, a child who consistently toe walks may eventually develop shortened Achilles Tendons (also known as tight heel cords) and should be evaluated by a physical therapist.

Toe walking may be considered appropriate if:

• Your child is just learning to walk

• Your child is under the age of two years old

• Your child can walk with normal gait when you ask them to

Seek professional help for Toe Walking when:

• Your child toe walks past the age of two years old

• Your child toe walks the majority of the time

• Your child demonstrates decreased eye contact, decreased coordination, or difficulty with gross or fine motor activities

Dana Pais

Dana Nadel, OTD, OTR/L is an occupational therapist who obtained her Masters of Occupational Therapy (MS) and Doctorate of Occupational Therapy (OTD) at the University of Illinois at Chicago. During her doctoral studies, she spent time working in Lima, Peru at the Centro Ann Sullivan del Peru (CASP), a center for families and their children with cognitive and physical disabilities, where she provided intervention for many children and their families in the areas of low vision accessibility, independent living, school inclusion and supportive employment. Her interests include sensory processing and its impact on daily life and managing visual deficits. She is passionate about helping children reach their full potential in every aspect of their lives.

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20 replies
  1. Judy Orbach
    Judy Orbach says:

    Excessive toe walking may also be indicative of a spinal abnormality, such as a tethered cord. It is important to seek out a neurologist’s/neurosurgeon’s input, which may perhaps include ordering an MRI to view the spine in detail.

    Thank you for your article.

    Reply
    • Dana
      Dana says:

      Hi Judy, Thanks for your comments on the blog! I agree that it is important to make sure you have all of your bases covered when determining cause and intervention.

      Reply
    • Dana
      Dana says:

      Hi Judy, Thanks for your comments on the blog! I agree that it is important to make sure you have all of your bases covered when determining cause and intervention.

      Reply
    • Kim
      Kim says:

      Hi Judy, My 13yr year old son still toe walks, we have been through many serial casting and much more therapy to try to help it, but nothing is working, he is getting a Bilateral Strayer procedure done soon, He also has a Chiari I Malformation, Even though the MRI didnt show a tethered cord, the neurosurgeon said he still could have one thats not showing and this is most likely the cause of his toe walking. For almost 10 years i’ve searched for an answer, many doctors have told me, he will grow out of it, its just a phase and finally we may have an answer! It is best to have it looked at by a neurosurgeon that knows his stuff, the first neurologist we saw, said there was absolutely no link and didnt even mention anything about a tethered cord!

      Reply
  2. Rebecca
    Rebecca says:

    Great article. As a Pediatric Physical Therapist, I have been seeing a lot of referrals for idiopathic toe walking with my new clients. I have had great success utilizing a combination of passive range of motion, active range of motion, strengthening activities for intrinsic plantar muscles, anterior compartment musculature of lower extremity, abdominal musculature with the addition of sensory integration techniques. We are able to address both the chicken and the egg in this scenario(underlying sensory concerns which lead to musculoskeletal concerns).

    Reply
    • Dana
      Dana says:

      Hi Rebecca, Thanks for your comments on the blog! We have also used those intervention technqiues in our treatment and have seen great success.

      Reply
    • Dana
      Dana says:

      Hi Rebecca, Thanks for your comments on the blog! We have also used those intervention technqiues in our treatment and have seen great success.

      Reply
  3. Regina Alberti
    Regina Alberti says:

    Hello,
    I am very curious if you have an opinion regarding the use of infant walkers? Do you have any data in regards to how many “toe walkers” were allowed to use these devices. Have you ever asked the question to parents/caregivers …how long, if any, or how many hours a day children were using walkers.
    Thank you,
    Gina

    Reply
    • Dana
      Dana says:

      Hi Regina,
      Thank you for your question. My physical therapist colleagues and I have collaborated to answer your question: There are different reasons why a child walks on his toes, and depending on the cause of the toe-walking, different treatment methods can be employed – each with their own success rate. Typically a treatment is successful depending on the age of the child, the severity of any muscle tightness created secondary to toe-walking, and the underlying cause of toe-walking. For example, a child walking on his toes can represent a sensory issue, in this case casting will not be incredibly effective in treating the primary problem, just the secondary muscular and range of motion issues. We recommend talking to an occupational therapist regarding sensory issues leading to toe-walking if you have further questions.

      Dana Pais, OTD, OTR/L
      Bridget Hobbs, PT, DPT
      Adele Nathan, SPT

      Reply
    • Dana
      Dana says:

      Hi Regina,
      Thank you for your question. My physical therapist colleagues and I have collaborated to answer your question: There are different reasons why a child walks on his toes, and depending on the cause of the toe-walking, different treatment methods can be employed – each with their own success rate. Typically a treatment is successful depending on the age of the child, the severity of any muscle tightness created secondary to toe-walking, and the underlying cause of toe-walking. For example, a child walking on his toes can represent a sensory issue, in this case casting will not be incredibly effective in treating the primary problem, just the secondary muscular and range of motion issues. We recommend talking to an occupational therapist regarding sensory issues leading to toe-walking if you have further questions.

      Dana Pais, OTD, OTR/L
      Bridget Hobbs, PT, DPT
      Adele Nathan, SPT

      Reply
    • Dana
      Dana says:

      Hi Regina,
      Thank you for asking your question. I initially posted my response to the wrong comment! My physical therapist colleagues and I have collaborated to answer your question about infant walkers: it is something we find ourselves answering a lot! We can not provide any data or numbers regarding the risks of becoming a toe walker secondary to time spent in an infant walker. We would like to share with you our opinion that infant walkers can hinder a child’s ability to walk independently. If a child is supported by an infant walker, he or she will become used to that external support, which can in turn discourage that child from walking independently at an appropriate age. We would also like to highlight that there is a high fall risk with infant walkers. A child too young to walk is usually too young to have proper safety awareness and can find themselves in dangerous situations.

      Dana Pais, OTD, OTR/L
      Bridget Hobbs, PT, DPT
      Adele Nathan, SPT

      Reply
  4. Kerry N
    Kerry N says:

    Hello,
    My son is 20months and continually walks on his toes, we took him to see a physio and they have told me that he will have to have half leg cast put on every week for 6 weeks. Can you tell me the succes rate of doing this

    Reply
    • Dana
      Dana says:

      Hi Kerry,
      Thank you for your question. My physical therapist colleagues and I have collaborated to answer your question: There are different reasons why a child walks on his toes, and depending on the cause of the toe-walking, different treatment methods can be employed – each with their own success rate. Typically a treatment is successful depending on the age of the child, the severity of any muscle tightness created secondary to toe-walking, and the underlying cause of toe-walking. For example, a child walking on his toes can represent a sensory issue, in this case casting will not be incredibly effective in treating the primary problem, just the secondary muscular and range of motion issues. We recommend talking to an occupational therapist regarding sensory issues leading to toe-walking if you have further questions.

      Dana Pais, OTD, OTR/L
      Bridget Hobbs, PT, DPT
      Adele Nathan, SPT

      Reply
  5. SFinn4
    SFinn4 says:

    Hi, my Daughter is 16months old and is constantly walking on her Tiptoes, she only puts her foot flat when she is steadying herself and when i try to put it town and tell her to stay flat she just gives out (very stubborn):D, she is extremely steady on her feet which is amazing cause she is nearly on her toes,(I myself walking on my toes till i was 17months) i am very worried about this in case it is something allot more serious. She is extremely intelligent and has perfect coordination perfect eye contact, and knows exactly what your asking of her so im just wondering have you heard of this sort of thing before

    Reply
    • Dana
      Dana says:

      Thanks for reading this blog! Yes, we have seen many children who present similar to your daughter. It is considered normal for a child to walk on their toes occasionally during the first year of walking. However, if your daughter is walking on her toes constantly, we recommend discussing it with your pediatrician and being evaluated by an occupational therapist or physical therapist to identify if therapy is warranted.

      Dana Pais OTD, OTR/L
      Bridget Hobbs PT, DPT

      Reply
  6. Happy_turtles
    Happy_turtles says:

    Hi. my 2.5 year old has always walked on his toes. It was suggested at his 18 month checkup that he has sensory issues. I have taken him to our GP to discuss behavioral issues and his toe walking, and she has said that if he is still toe walking at 3 then she would refer him to a Orthopedic surgeon. Would you agree this time is appropriate to wait? I have a 9 yr old step daughter who toe walks still and it has been suggested that she may suffer from Aspergers. Of course I leap to the worst conclusion :P My son CAN walk flat if he wants to but he doesnt/wont if that makes sense.

    Thanks, Bec :P

    Reply
    • Dana
      Dana says:

      Generally, it is considered normal for a child to walk on their toes occasionally during the first year of walking. However, if a child is still on their toes for walking at 2 years old, physical therapy is recommended. Even if a child is walking on his toes because of sensory issues, his heel cords can still tighten, causing decreased flexibility in the ankle joint. I recommend following up with your child’s pediatrician to request a prescription for physical therapy to address toe walking and prevent tightness down the road.

      Dana Pais OTD, OTR/L
      Bridget Hobbs PT, DPT

      Reply
  7. Grandma
    Grandma says:

    Hi, my grandson is 2 and 1/2. He is an extremely sensitive child. He instinctively knows when someone in his family is sick or upset about something and will comfort the family member. He gets very upset if his sister, who is 4, hollers at him or get angry with him. He walks on his toes every now and again. He can even run on his toes. He does walk regularly most of the time. When he’s upset he’ll run over to a chair or to the sofa and sit there and rock back and forth until he calms down. He does the rocking thing when he gets sleepy too. He’s healthy and is able to communicate well. But sometimes his speech is difficult to understand. Any suggestion or comment?
    Thanks

    Reply

Trackbacks & Pingbacks

  1. [...] In today’s Webisode, a pediatric physical therapist discusses the intervention needed for a toe walking child.  For more on Toe walking, read this blog. [...]

  2. [...] Learn more from this blog called “Is Toe Walking Normal?” [...]

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