Kids typically begin walking around 1 year of age. At that time, they typically walk with their feet flat placed in a wide position to help them keep their balance. Over time, a child may begin walking on their tiptoes. When a child walks on their tiptoes, they primarily use their calf muscle. This causes them to not use other muscles in their leg properly while walking.

Why do children toe walk?

There are several reasons that children may toe walk. Sometimes, kids find that walking on their toes is a more stable position. Other times, children may not like the feeling of the floor on their feet, so they walk on their toes to have as little touching the floor as possible. Another reason kids may walk on their toes is that they go through a growth spurt and their calf muscle does not get longer as the child gets taller. This causes the child to have a difficult time placing their entire heel on the ground. Finally, a child may walk on their toes because performing this activity occasionally can increase the strength of their calf muscle, which is developmentally appropriate. Sometimes there may be a family history of toe walking, increasing the likelihood of children walking on their toes.

How long should I wait to be concerned about my child?

It is important to take note of how often your child is toe walking. If it is more than 25% of the time, it may be time to be a little concerned. It is abnormal for a child to walk on their toes this frequently. If your child is on their toes frequently, it is time to take action. Letting your child continue to toe walk can cause detrimental effects. If a child is always on their toes, they are not able to develop the necessary strength in all parts of their leg needed for functional activities. In addition, it can impact their core strength and how they find balance. Furthermore, allowing a child to toe walk can lead to shortening, not only of the muscles in their calf, but also ligaments around their ankle joint. When this happens, it can take a long time to regain the motion and develop the strength to walk normally.

Who can help?

Physical therapists often assist children who toe walk. A PT can provide stretching exercises, perform techniques to stretch the ankle ligaments, and assist a child with strengthening, not only their leg and ankle, but also their entire body. Physical therapists may also use shoe orthotics to decrease a child’s ability to push onto their toes, thus the child will walk with a more normal pattern. In severe cases, serial casting may be needed. Serial casting involves casting a child’s leg to provide a prolonged stretch to the calf muscle and ankle ligaments. Each week, or so, the cast will be removed and a new one will be applied, pushing the ankle into greater range of motion. A PT may also use kinesiology tape to help the calf muscle relax or other muscles to activate. If you are concerned about your child’s toe walking, see a physician and ask for a referral to physical therapy. You can also call a PT clinic in your area for an appointment.

What can I do to help my child?

There are several simple solutions to try:

• Remind your child to walk with “flat feet” if you notice them walking on their toes.

• Stretch your child’s ankles. Make sure your child’s foot is facing straight ahead and their knee is straight (see picture on right). A parent could also have a child lay on their back with their leg straight. The parent would then push the child’s foot up to make their toes point towards the ceiling.

• Wear sturdy tennis shoes or boots as these make it more difficult to toe walk.

• See a physical therapist for specific suggestions on how to help your child.

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