Toe Walking
Date issued: September 2023
Review date: September 2025
Ref: B-482/KM/Physiotherapy/Toe Walking v2
PDF: toe walking final September 2023 v2.pdf[pdf] 206KB
What is toe walking?
Toe walking is when a child stands or walks mainly on their toes.
This can be normal when a child learns to walk and they should quickly grow out of it as a toddler. A small number of children will continue to toe walk as they get older.
What problems may occur?
Children might have no symptoms other than walking on their toes.
Children may:
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Experience pain or discomfort
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Be more wobbly on their feet
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Have a tendency to walk fast or run
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Fall over more frequently
What causes it?
Habit
Children may get used to walking on their toes, creating a habit. Over time this can cause muscle tightness in their calf muscles.
Weak trunk muscles
Children may walk on their toes to improve their balance if their tummy, back and bottom muscles are weak.
Short calf muscles
Children may be unable to get their heels to the floor secondary to tightness in the calf muscles. This can sometimes follow a growth spurt but can result from habitual toe walking over longer periods of time.
Autistic spectrum disorders
Toe walking can be associated with autism. It is less likely that physiotherapy management will resolve this form of toe walking long term.
What can I do to help?
Treatment will depend on each child’s presentation. Giving children time to grow out of toe walking is usually the first option.
Prompting
As children get older, try prompting them to walk slowly and practise heel-toe walking.
Calf stretching
If your child’s calves become tight, daily calf stretching can help to ensure your child can still stand with their feet flat to the ground.
Assisted calf stretching:
Have your child lie down with their knee straight. Support the ankle and push the foot upwards. They should feel a stretch in the back of their leg.
Hold for 30 secs
Repeat 4 times each leg
Independent calf stretching:
Place one-foot forwards and one back with both feet facing forwards. Bend your front knee and keep your back knee straight. Keep your heels on the ground and push into the wall.
Hold for 30 secs
Repeat 4 times each leg
Resting Splints
These hold your child’s calf in a stretched position for a longer period of time. They may be advised to wear them at home whilst resting, watching tv and gaming.
Serial Casting
Weekly below knee casts are applied to progressively increase the length of the calf muscles. The aim is to bring the heel down to the floor and enable the child to walk flat. Children may still return to toe walking after intervention (often with future growth spurts) and need further physiotherapy intervention.