Tots who trot on tip toes!

(AKA “what is toe walking?” for those who don’t speak in alliterations lol)

Toe walking is a condition where a child walks with the weight of their body primarily on the balls of the feet and the heels do not contact the ground. This is what is commonly referred to as walking on “tip toes.” Toe walking is associated with a number of different diagnoses, including cerebral palsy, spina bifida, muscular dystrophy, and autism. If this is the case for your child, talk to your health care provider about ways to address it!

Other times the cause of the toe-walking is unknown, and this is what is called idiopathic toe walking (ITW). ​Idiopathic (cause unknown) toe walking occurs in up to 24% of otherwise typically developing children. Recent research shows that about half of all children with ITW outgrow it and resume a typical, heel-toe walking pattern around the age of 5.

For those whose toe walking doesn’t resolve, there are several contributing factors that may be at play:

Musculoskeletal factors—

Many children begin toe walking out of habit or other unknown reasons at a young age, and over time the calf muscle shortens and the child begins to lose the range of motion in his or her ankles. This makes it difficult or even impossible for the ankle to stretch enough to make heel contact. When this happens, it is commonly referred to as a heel cord or Achilles contracture. This can also lead to flattened arches in the feet. Muscle weakness can also play a role in toe walking. If the muscles on the front of the ankle and foot are lacking enough strength to pull the toes upwards and allow the heel to contact the floor during walking, toe walking can result. Weakness in the core muscles (hips, low back and abdominal muscles) can lead to decreased balance overall and difficulty maintaining a typical walking pattern, also leading to toe walking.

Sensory processing factors—

Some children have either an increased or decreased response to touch and various sensations which causes them to either avoid or seek more sensory input. One way they may do this is through walking on their toes, as this can help avoid certain sensations while enhancing others.

This child may be avoiding the sensory input of the rug on the bottom of their feet, OR seeking sensory input through muscle contraction and joint compression throughout the entire foot and leg.

Proprioceptive factors—

Proprioception refers to the body’s ability to determine where it is in space. By walking on their toes, children are able to increase the amount of input provided to their legs in order to get a better feel for where their body is in space. Thus, toe walking may be compensating for decreased body/spatial awareness.

My child toe walks… now what??

Many children experiment with different ways to walk when they are first learning, with toe walking being one technique they are likely to try out, and this is normal. If they continue to toe walk into their late toddler years or spend a significant amount of time on tip toes (>50% of steps), it might be time to consider intervening. More on this next time!

TL;DR

• Toe walking can be a normal way of exploring walking for kids, especially when they are young and first learning to walk. Over half of kids who toe walk resolve by 5 years of age.

• If toe walking is also associated with known medical conditions, including cerebral palsy, spina bifida, muscular dystrophy, and autism. Talk to your provider if this is the case.

• Idiopathic Toe Walking (ITW) occurs when the cause of toe walking is unknown or unexplained.

• There are many aspects of toe walking to consider, including musculoskeletal factors, sensory factors, and proprioceptive factors.

• If toe walking persists past age 2, or your child spends >50% of steps on their toes, we want to intervene. More on this to come!