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. 
 Written By: Clarissa Aguirre

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