More on Toe Walking

Idiopathic toe walking is medically described as the condition when a child over 2-years-old walks on their toes more than 25% of the time for no known developmental reason.

What are the potential reasons?

While there is no exact way to determine exactly why your child prefers toe walking, there are a variety of reasons that can be ruled in and out based on observation and examination such as the following:

• Premature birth, including low birth weight or admission to neonatal intensive care unit (NICU) that results in heel pricks for blood draws and subsequent sensory aversion.
• Sensory processing disorders
• Hypermobility or hypotonia (low muscle tone), resulting in more stability standing on tiptoes.
• Gastrointestinal impairments, such as reflux, which can make an extended position on tiptoes more comfortable.
• Genetic predisposition (17-61% of cases have a family history of toe walking) 

When may toe walking need further consultation?

• Only one-sided toe walking may indicate a neurological condition.
• New onset toe walking after walking normally for months or years may indicate a spinal cord injury or neuromuscular condition.
• Leg length discrepancy or abnormal ankle/foot range of motion may indicate an orthopedic condition.
• Rigid, stereotyped behaviors, limited eye contact, delayed language, or limited social skills may indicate underlying Autism Spectrum Diagnosis, which is commonly correlated to toe walking.

How can Physical Therapy (PT) help?

• A PT can offer sensory-based interventions, reduce Achilles/calf tightness and postural deviations that are present concurrently with toe walking, along with improving leg flexibility, strength, balance and coordination.
• Shoe Modifications to promote the heel touching the floor.
• Orthotic Interventions such as custom-made inserts can help prevent toe walking.
• Night Splinting and Serial Casting may be recommended when a child has significantly decreased ankle range of motion.