Toe Walking: Cause for Concern?

In babies, Children, parenting, Uncategorized by compleoPTLeave a Comment

Kids do funny things. I love watching my son go through little phases as he grows and develops. There was the week all he wanted to do was bang on pots and pans, the phase he booty bounced every time he heard music (an all time favorite phase), and a only wanting to eat spaghetti phase.

Kids play with movement patterns as they grow, especially in the early years they learn through movement and exploration. But When does a phase become a cause for concern? In the physical therapy realm, I consider an impaired movement pattern/phase concerning if it lasts more than 2-4 weeks.

Examples include: toe walking, army crawling or bottom scooting (not transitioning to hands and knees crawling), and W sitting. Here I am going to dive into toe walking. If you have questions about your toe walker, contact us for a free screen!

What is toe walking?

Toe walking is when your child walks on the balls of their feet (their forefoot) and you don’t see the heels always touch the ground. Picture walking in high heels all the time but without actually having high heels on. Other signs of toe walking may be frequent tripping or difficulty getting shoes on. 

Why does it happen?

Toe walking can happen for a myriad of reasons and is not always connected to another diagnosis, it is often called idiopathic which means “no known cause.” The most basic explanation (and the case in idiopathic toe walking) is an imbalance in the muscles. This can come from tightness in the achilles tendon or weakness in certain muscle groups.

In toe walking, the calf, quad (thigh) and back muscles are stronger/work harder than the glutes (bottom muscles), core and dorsiflexion (muscles on your shin). We see this imbalance happen from environmental causes such as too much time in baby walkers. In one case, I had a patient who only wore her dress-up high heels, thus tightening the achilles (true story!)

Sensory Processing is another reason some children toe walk. If they are seeking sensory input, they get more concentrated input from a small area (ball of the foot) instead of dispersing the input across the whole foot.

Increased Muscle Tone in the legs can also cause toe walking, it is difficult for the child to get their leg straight or heel flat due to resistance from the muscle tone. This is often connected with a neurological diagnosis such as cerebral palsy.

Visual Processing Impairment is another common cause. The child has to go up on their toes for the world to look right to them. In this case, you will need to work with a pediatric opthamologist to assess and consider prism glasses. 

Why address it?

If this has gone on longer than a few weeks, your child most likely will not grow out of toe walking without outside intervention. Chronic toe walking can lead to knee and back pain from changes in mechanics. Unaddressed, the achilles tendon will continue to tighten requiring more intense intervention to correct, such as serial casting.

How can I work on it?

If your child walks on their toes the majority of the time and has been doing this for longer than 2-4 weeks, I would seek an intervention from a pediatric physical therapist. From a therapist, your child’s plan would be individualized based on the underlying cause of their toe walking and their specific needs.

If you notice your child starting to walk on their toes try the following during play time at home:

  1. Push/Pull/Carry Heavy Items
  2. Work on play in the squat position
  3. Yoga Poses such as Down Dog, Boat, and Shark (We love Yoga Pretzels at the clinic!)
  4. Red Light, Green Light, Yellow Light to Practice neuromotor control
  5. Find a hill and play catch with feet pointing up hill

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