In typical gait (walking), the heel of the foot is what makes contact with the ground first when taking a step. Toe walking refers to when the ball of the foot makes contact with the floor first, not the heel.
Toe walking can look different for each child; some may walk as high as they can on their tippy toes, while some may walk with their heel hovering just a few centimetres off the ground.
In the very early stages of first learning to walk, a typically-developing young toddler may walk intermittently on their toes. However, toe walking beyond this age is not considered typical development and deserves to be explored further.
What causes toe walking?
Why a child may walk on their toes can be complicated and multi-faceted.
Neurological conditions that cause changes in muscle tone, such as Cerebral Palsy, often result in a child walking more on their toes. These children receive intervention specific to their neurological condition.
Persistent toe walking is common in the autistic/neurodivergent population who process sensory input differently to those who are neurotypical. Why these children use this toe walking movement pattern is specific to the individual and their sensory needs. For example, some children may not tolerate firm pressure on their heels, so they prefer to rise up onto their toes. Some children may only toe walk when they are barefoot on certain surfaces, but not so much when wearing shoes. Some children may enjoy the ‘bouncy’ feeling on walking on their tip toes. Support for children who may be toe walking due to sensory needs requires an individualistic approach.
However, many toe walkers do not fit into these categories and appear to not have an overly apparent underlying cause. This is often referred to as ‘Idiopathic Toe Walking’ (ITW).
My child toe walks – when should I be concerned?
Toe walking becomes a concern when it impacts a child’s everyday function and participation in activities.
Persistent toe walking can cause the achilles tendons and calf muscles to become shortened and tight (referred to as a ‘contracture’). This can limit how the child can move their ankles, walk, squat and walk up and down stairs.
Children who toe walk may also experience leg aches and pain, fatigue with walking, balance difficulties, psychosocial issues (eg. criticism from others), and challenges keeping up with their peers.
Signs such as asymmetry (eg. only toe walking on one side), sudden onset of pain or persistent pain, excessive stiffness in the legs, significant weakness (eg. trouble getting off the floor), and delayed development should be assessed further by a health professional.
It is important to consider all aspects of your child’s development and how toe walking fits into the picture. If you’re unsure whether your child requires intervention for toe walking, a consultation with a paediatric physiotherapist can help with this decision process.
How can physiotherapy help with toe walking?
A paediatric physiotherapist will first conduct a thorough assessment of your child which includes:
- collecting their developmental history
- measuring their joint range and muscle length
- analysing their gait (walking) pattern
- screening for neurological signs and red flags, and
- assessing their muscle strength, balance, and general gross motor skills.
Referral to a specialist (eg. neurologist, orthopaedic doctor) may be required if there are abnormal findings. Non-surgical treatment should always be the first choice of intervention.
Depending on the child’s presentation, symptoms, preferences, concerns, and goals, intervention may look like:
- education and advice
- stretching programmes
- strength and balance exercises
- the prescription of orthotics to optimise positioning and stability
- night splints for prolonged stretching
- serial casting for more severe ankle contractures
- referral to other allied health or medical professionals where appropriate
Physiotherapists are trained to analyse movement patterns and design effective interventions to address them. Therefore, paediatric physiotherapists play a key role in supporting children who are toe walkers.
If you would like to find out more information about how our Paediatric Physiotherapists can support your child, and/or you’d like to book an appointment, please call The Physio Clinic on 8342 1233.
Written by Maddie Dal Corobbo (Paediatrics Team)
References:
Australian Physiotherapy Association 2026, ‘Choose physio for Idiopathic Toe Walking’, https://choose.physio/your-lifestage/infants-and-children/idiopathic-toe-walking
Gelfer, Y., McNee, A. E., Harris, J. D., Mavrotas, J., Deriu, L., Cashman, J., Wright, J., & Kothari, A. (2024). The management of idiopathic toe walking. The Bone & Joint Journal, 106-B(10), 1190-1196. https://doi.org/10.1302/0301-620X.106B10.BJJ-2024-0466.R1
