Toe Walking – Is it “Normal”? - Kinetic Edge Physical Therapy
Thursday February 18, 2021
by Whitney Vander Veen, PT, DPT, ATC

Do you find yourself questioning if your child is walking normally?  Does your child take several steps at a time up on their toes or on the front part of their foot?  Telling the difference between “normal” toe stepping and more problematic, idiopathic toe walking can sometimes be difficult – but idiopathic toe walking is not a part of normal development.  Research is showing that toe walking is a visible symptom of other problems that have not become evident yet – whether from the vestibular, proprioceptive, tactile, or visual sense systems.  These sense systems are the human foundation for optimum development and movement.

Toe Stepping vs Idiopathic or Problematic Toe Walkingtoe walking

Signs when Toe Stepping may not be cause for concern:

  • Your child takes a few steps on their toes & then returns to flat foot
  • The “toe walking” is reducing in frequency
  • Your child has only been walking independently for a few weeks

Signs when Toe Walking is cause for concern:

  • The first part of the foot to come in contact with the ground is the front of the foot and your child has been walking independently for longer than six months
  • Does your child dislike their feet being touched or other touch senses?
  • Your child is clumsy, fall often, or bump into things
  • They get car sick
  • Your child loves spinning & similar activities more than other children
  • They are either experiencing, or have a history of, delayed milestones
  • Ankle flexibility is getting tighter & they have difficulty standing on flat feet even if they try
  • Your child was premature &/or low birth weight
  • Your child has difficulty with speech &/or learning

Future implications if Idiopathic Toe Walking continues without being addressed:

  • Bony Deformities: the foot is at greater risk for deformities during the first 2-4 years of walking
  • Pain in other joints and areas of the body including feet, hips, knees, and low back
  • Decreased balance strategies

What can you do if you are concerned:

  • Consult with a pediatric physical therapist, preferably one who is experienced & successful in treating Toe Walking

                 **Early intervention is key as skeletal changes are less likely to respond to intervention after 4 years of age

  • Become more knowledgeable on the topic:  Visit knowtochange.com and learn from Liesa M. Ritchie (Persaud), PT, DPT, PCS – she has 28 years of experience and is leading the way in education for non-invasive treatment strategies for Idiopathic or Problematic Toe Walking

If you have any questions or would like to talk through any concerns you have please reach out to us online or by calling 866-588-0230.

Resources

  • knowtochange.com
  • Ackman J D et al. Comparing Botulinum Toxin A with casting for treatment of Dev Med Child Neurol. 2005 Sep.
  • Dietz, FR, Albright JC & Dolan L. Medium Term Follow Up of Achilles Tendon Lengthening in the Treatment of Ankle Equines in Cerebral Palsy. The Iowa Orthopaedic Journal. 2006;26:27-32.

Schumway-Cook A, & Woollacott H. Motor Control: Theory and Practical Applications.  Baltimore, Maryland: Lippincott Williams & Wilkins; 2001:25.