Toe walking in children – is it a cause for concern?

Parents might have seen this happening: their child walks on the toes or balls of their feet, with no contact of the heel with the ground. This is known as toe walking – but is it something mums and dads should be worried about?

Toe walking usually happens as your child begins to learn how to walk independently. It’s thought to be pathological at age two to three, prior to which it is considered to be part of a normal walking learning curve.

For those aged three and older, however, walking on one’s tip-toes may not be normal and could be associated with neurological immaturity or medical conditions.

These include cerebral palsy; congenital contracture of the achilles tendon, wherein muscle, tendons, ligaments or skin become tight, preventing normal movement; or a paralytic disorder such as Duchenne Muscular Dystrophy.

When an older child continues to walk on his or her toes without showing signs of neurological, orthopaedic or mental illness, this is known as idiopathic toe walking (ITW). The following are characteristic of ITW – the child:

• walks on tip-toes on both feet;
• constantly tries to balance on his or her toes;
• is nevertheless able to keep up with other children of the same age;
• can walk with straight knees;
• is often able to stand with both feet flat on the ground; and/or
• has a family history of toe walking.

ITW is usually a voluntary action with these possible factors – the child:

• wishes to increase how he or she responds to touch (tactile processing);
• tries to sense their body’s position in space;
• attempts to maintain balance;
• thinks about what they see (visual processing);
• tests the flexibility of their leg and foot muscles; and/or
• tests their overall body strength.

Consequences

When a child walks on his or her toes for an extended period, the bones and ligaments in the knees, hips and lower back are placed under unnatural tension. ITW can lead to improper bone growth and/or ligament overstretching, putting youngsters at risk of injury and joint discomfort as they age.

Left untreated, it could lead to fixed contracture of the achilles tendon or the deformity of the hindfoot.

If your child is a toe walker, he or she might first need to be assessed. Talk to your healthcare provider to learn more about best treatment options, which may include physical therapy, occupational therapy, orthosis, serial casting (where casts are applied to keep the calf muscles in a fixed position), or orthopaedic surgery.