Children typically experiment with walking on their tip toes between one and two years of age – after they first begin walking. Every couple of steps may be on their toes or they may walk on their toes for several days, but children should outgrow this quickly.
By three years of age, children should begin walking with a more mature walking pattern. This includes placing the heel of the foot first and pushing off their toes. If your child is walking on their tip toes for long periods of time, you should ask your health care provider for a more detailed physical exam.
While there can be many reasons for idiopathic toe walking (ITW), one cause can be abnormal bone growth. Another can be weakness in your child’s tummy and/or leg muscles. Walking on the toes allows the child to lock the ankles, knees and hips in a straight position and reduces the work that the muscles do. Toe walking can also be one of the first signs of a sensory integration disorder, which can be evaluated by a pediatric occupational therapist.
Toe walking can cause problems and pain for children, by putting abnormal stress on the bones and ligaments in the knees, hips and lower back. Over time, bones can grow incorrectly and/or ligaments can be overstretched. Toe walking can cause excessive tightening of some muscles and weakening of others. Children then are at risk for injuries and joint pain as they grow older, and often will struggle with walking long distances or participating in physical activities for longer periods of time.
Treatment for toe walking includes evaluation of the movement in your child’s foot and ankle and observation of how your child walks without shoes or socks. A physical therapist that specializes in ITW may use stretching and strengthening exercises along with gait activities to promote a typical walking pattern. Serial casting is a process involving repeated cast applications that may be utilized when other therapy activities are not successful in decreasing toe walking. Supportive orthotics may be recommended to help maintain improved gait in conjunction with idiopathic toe walking treatment.
If you have questions or concerns about your child’s feet or walking pattern, do not hesitate to call your health care provider or the Children’s Care Rehabilitation Center in Sioux Falls at (605) 444-9700, or Children’s Care in Rapid City at (605) 791-7400.
- Megan Johnke, OTD, OTR/L, Outpatient & Outreach Therapy Supervisor, Children’s Care Hospital & School, Sioux Falls