Toe Walking in Children

Walking is essential for daily activities. In the normal walking pattern, the heel strikes the ground first, followed by the sole and toes. This heel-to-toe movement distributes forces and supports body weight (about 60% of the cycle).

What is toe walking?

Also known as tip-toe walking, is an atypical gait pattern seen in children. Walking on the balls of the feet without the heels touching the ground is toe walking.

Is toe walking normal in children?

It is commonly seen in early childhood. However, after the age of 2 most children outgrow toe walking and begin to walk with a normal heel-to-toe pattern.

When should one be concerned about toe walking?

Persistent toe walking beyond this age may be a sign of an underlying medical condition. It can be troublesome and is mandatory to seek out a paediatric physician to assess to see if Physical Therapy or Occupational Therapy evaluation is required.

If pain or discomfort while walking or signs of tight muscles are seen, professional help is required.

Comprehensive evaluation is required, if toe walking is accompanied by other developmental delays or unusual behaviours.

 Why do children do toe-walking?

1. Habitual Toe Walking: A habit of toe walking may develop in children with no known medical issue. This is called idiopathic toe walking.
2. Tight Muscles or Tendons: If the child has shortened or tight Achilles tendon (ankle) or calf muscles, it can lead to toe walking as to avoid discomfort when trying to walk with their heels down.
3. Spasticity and flexion of the hip and knee joints: Spasticity causesthe hips and knees to be flexed, the body weight gets shifted to the toes and forefoot leading to toe walking

4. Sensory Processing Issues: Children with sensory processing disorders may exhibit toe walking as a response to sensitivities towards certain textures or sensations on the bottom of their feet.

5. Neurological Disorders: Toe walking can be associated with neurological conditions such as cerebral palsy, or autism spectrum disorder. In these cases, toe walking may be due to muscle tone abnormalities or coordination issues.

Can toe walking cause long-term issues?

Early intervention is key to managing toe walking effectively. Addressing it on time can lead to better outcomes for the child’s long-term mobility and comfort. If unattended, in the long term, it may affect posture, gait, and balance, potentially causing foot or leg discomfort

What are the treatments available for toe walking?

1. Occupational Therapy: Occupational therapy addresses retained reflexes (eg Babinski reflex), tactile sensitivity, vestibular processing, proprioceptive seeking, and issues with balance and coordination.
2. Physical Therapy: Physical therapists provide exercises to stretch tight muscles and strengthen weak ones, that encourages proper walking patterns.
3. Bracing or Casting: In some cases, a period of casting or bracing may be recommended to help stretch the muscles and tendons in the calves and encourage a normal gait.
4. Surgery:Surgical lengthening of the Gastroc – Soleus- Achilles complex may be an option if other methods are unsuccessful. 

Exercises or Activities that can help with toe walking at home:

• Gentle stretching of Achilles tendon and calf muscles can help improve flexibility.
• Playing games that focus on stepping the heels down
• Practice walking on heels of the foot.
• Activities like standing on one foot, walking on a balance beam, or playing hopscotch can help improve overall balance, coordination, gait and reduce toe-walking.
• Practice squatting or jumping for strengthening of leg muscles.

Conclusion

Early intervention is important to prevent long-term physical issues like muscle tightness. With the right guidance and support, Occupational therapy and Physical therapy can address toe walking, especially when it’s related to sensory processing or motor coordination challenges.

In some cases, consulting a medical professional is necessary to rule out neurological or orthopaedic conditions.