How to stop my child from walking on his toes

Toe Walking - What Every Parent Should Know

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Causes, Symptoms, and Treatment for Toe Walking (Pediatric Equinus)

Does your child walk on their tiptoes?

Toe walking is a walking pattern in which the child walks on their toes or the balls of their feet and there’s no contact of the heel to the ground.

Toe walking is very common in young children who are 3 years old and younger, however, in children 3 years and older walking on tiptoes may not be normal and could be associated with a neurological immaturity or medical condition. Fortunately, over 90% of these cases can be treated with conservative treatment options and surgery is not required. In the following video, Dr. Mikkel Jarman discusses toe walking and some conservative treatment options and when or if surgery may be necessary.

Cameron and Sawyer Share Their Experience with Toe Walking

Sawyer began walking on her toes at a young age and never outgrew it. Children would comment on it and it was affecting her dancing which she loved to do. Her and her mom found Pediatric Foot & Ankle researching online and scheduled an appointment with Dr. Mikkel Jarman.

Learn more about Sawyer’s toe walking story in the video above.

Cameron began toe walking at around the age of two. After following the foot physical therapies and exercises recommended by their pediatrician with little to no improvement, she decided something needed to be done.

Watch the rest of Cameron’s story and their experience with Dr. Jarman with Pediatric Foot & Ankle.

Most Children Outgrow Toe Walking

Toe Walking is fairly common in children just learning to walk but is something most children outgrow. Children who continue to walk on their tiptoes or ball of their feet past their toddler years frequently do it simply out of habit. This by itself usually isn’t anything you need to be concerned about as long as your child is developing and growing normally, but toe walking after the age of 3, referred to as Idiopathic Toe Walking, may not be normal and should be looked into.

What is Idiopathic Toe Walking?

Idiopathic Toe Walking (ITW) is when a child, three and older, continues to walk on their toes without showing any signs of a neurological, orthopaedic, or mental illness. The NIH’s National Library of Medicine says ITW effects between 7 and 24 percent of children.

When a child walks on their toes for an extended period of time, the bones and ligaments in the knees, hips, and lower back are placed under unnatural tension. ITW can lead to improper bone growth and/or ligament overstretching, placing youngsters at risk for injury and joint discomfort as they age.

Cerebral palsy, congenital Achilles tendon contracture, and paralytic muscle illnesses like Duchenne Muscular Dystrophy may all induce toe-walking. Toe-walking has been linked to developmental abnormalities including autism and other myopathic or neuropathic conditions.

Physical therapy to stretch the Achilles tendon and calf muscles, splints or leg braces to promote a normal gait, or a series of casts to progressively relocate the toes toward the shin may all be effective treatments if it’s discovered that a physical condition is the cause of the patient’s ITW.

If left alone, the majority of kids will stop toe walking on their own. ITW can be treated with physical therapy, custom orthotics, bracing, and casts, with surgical options available if these treatments fail.

Why Do Children Walk on Their Toes?

When children first learn to walk, it’s very common for them to walk on their toes. Sometimes, though, toe walking indicates one of the following conditions:

• An Achilles tendon that’s too short
• Autism spectrum disorders
• Cerebral palsy
• Heel pain, particularly from Sever’s disease
• Muscular dystrophy, although this diagnosis typically occurs before the child reaches walking age

Toe Walking Diagnosis

When you take your child to the pediatric podiatrist, the doctor will take your child’s medical history and perform an examination. Be prepared to answer the following questions:

• How long has your child been walking?
• When did your child begin toe walking?
• Is the toe walking a new development?
• Can your child walk on his or her heels?
• Is there a family history of toe walking?
• Does your child have any medical issues?
• Was your child born prematurely?

In addition to asking these questions, the podiatrist watches your child walk. He or she then performs a physical exam to determine range of motion and gauge muscle tone. They may also conduct an electromyography (EMG) test to measure responses in the affected muscle. Finally, if conditions like autism or cerebral palsy are suspected, your doctor may order neurological testing.

Treating Toe Walking

Children who simply toe walk out of habit do not require treatment. They usually outgrow the habit eventually. However, if your pediatric podiatrist determines a physical issue is causing the toe walking, treatment may include:

• Physical therapy exercises to strengthen and stretch muscles in the legs and feet
• Leg braces or a splint to correct gait
• Custom orthotics
• Serial below-the-knee casting to properly align the toes to the shin

If conservative treatment fails, your podiatrist may recommend surgery, but only as a last resort. Typically, this only occurs if there is an issue with the Achilles tendon or calf muscles.

In this short video snippet, Dr. Jim Sears discusses toe walking with Sarah, a concerned mother of a 3-year old daughter, who had called into the show because her daughter is walking on her toes. Dr. Sears briefly goes over some stretches, but makes the primary point that it is always a good idea to contact a pediatric podiatrist. A pediatric foot and ankle specialist can run additional tests, and if deemed necessary, prescribe a custom orthotic.

(Full video can be found here: https://www.thedoctorstv.com/videos/toe-walking)

Your child’s feet are designed for life

Make an appointment today if your child has Pediatric Toe Walking.

Call Dr. Jarman at 480 534-7220

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The content on this website if for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Website last updated: January 13, 2023

Heel First! Strategies to Prevent and Reduce Toe Walking

Does your child walk on the toes or balls of the feet? Toe walking can lead to falling, and may be symptomatic of vestibular issues and developmental delays. Try our movement activities to help prevent and reduce toe walking. Remember to encourage kids to walk on their heels, and improve balance and coordination. Vestibular stimulation, like swinging on a skateboard swing, can also help reduce or eliminate toe walking.  

Causes and Consequences of Toe Walking

If your child is still toe-walking after age 2, there may be an underlying condition such as a short Achilles tendon that prevents the heel from touching the ground; a movement or muscular disorder such as cerebral palsy and muscular dystrophy; autism spectrum disorder, idiopathic toe walking or simply habit. For some toe-walkers, the vestibular system may not be giving the brain accurate information on body position and movement. Or, sensory processing disorder can make a child oversensitive to touch. These kids rise up on their toes to avoid uncomfortable surfaces or discomfort from the sensation of weight against their heels. They may also avoid socks, shoes and even bare feet. Consequently, toe walking can lead to pain in ankles, knees or hips; difficulty with squatting or climbing stairs; and decreased hip or core strength due to postural alignment issues.  

Activities to Reduce Toe Walking

First, speak with your doctor to identify the underlying causes. Then follow up with a physical or occupational therapist to develop appropriate games and exercises, which may include the following.  

• With the child sitting or lying back, grab one foot in your hand (knee straight) and stretch the Achilles heel cord. Hold for 1 minute.
• Grab a wedge and have the child stand or walk up the wedge/incline

Lean-N-Learn Wedge Cushion 10"x10"

Lean-N-Learn Wedge Cushion 13"x13"

• Walk like a crab or bear with all fours on the ground.
• Try and walk like a penguin, heels down and toes up.
• Try a game of leapfrog, jumping, hopping, squatting and then leaping forward.

• • Pick up a washcloth or marbles with your toes.
  • Balance a sock or beanbag on the foot.
  • Sit on a scooterboard and move the scooter across the floor using bare feet.
  • Walk up a slide.
  • Hold a chair pose against the wall.
  • Run up a hill, stretching the tendon and muscle by keeping the toes pointed up.

Monster Bean Bag

Soft Saddle Scooter-Small

• Balance on a wobble board.
• Walk across a balance beam, balance stones or floor spots.
• Stand on a round air cushion and balance.

Stomp, Rock and Walk Board

Sit-A-Round Cushion

• Wear high top shoes/rain boots/roller-skates and heavier shoes for better foot position.
• Place a wedge under the heel to encourage heel contact.
• Use inserts in shoes to promote good foot position

• Tape squeakers on the bottom of the child's feet to encourage auditory feedback.
• If noise doesn't help, try wheeled shoes. Kids have to pick their toes up to roll.
• Encourage barefoot walking in the grass and sand. Indoors, try setting up an obstacle course with blankets of different textures.
• Make art using the feet with paint and paper.
• Use joint compression to wake up the ankles. Vibration may work as well.
• Wear scuba flippers to walk heel to toe
• March and stomp to make the entire foot have contact with the ground

The idea behind these movement strategies is to develop the whole foot, intrinsic foot muscles and lengthen the heel cord. Be creative and playful too -- like the parent who taught her child "to drive" by positioning the heel on the pretend-gas pump!

This post was originally posted on 06/12/2018 by Ilana Danneman, PT. It was updated for accuracy and comprehensiveness on 04/27/2022.

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What to do if the child walks on his toes?

You asked about it

Children's neurologist of OKDC Nadezhda Leonidovna Kim answers your questions

Is it normal or abnormal if a child walks on toes?

I am often visited by parents whose children walk on tiptoes. This is not always a pathology. Quite often, a child, especially if he is just learning to walk on his own, can stand on tiptoe, in this case, relying on the entire foot does not pose any difficulty for him and walking on toes appears occasionally, more often when accelerating a step, when trying to examine any object lying higher when walking on uneven ground. And it is quite another matter when such a motor pattern exists almost constantly, there is a deformity of the feet, an asymmetrical gait, difficulty climbing or descending stairs. nine0003

What is the cause of abnormal raising on toes?

There are a lot of them. One of the most common causes of this condition is a local increase in muscle tone, and various hereditary neuromuscular diseases, congenital deformities of the feet, Achilles tendon, ankle joint pathology, etc. can also be the cause of this.

Why is there an increase in muscle tone?

Local spasticity may be the result of damage to the central motor neuron of the pyramidal tract due to certain negative effects on the structures of the fetal brain during pregnancy and childbirth. Depending on the degree of negative impact on the structures of the brain, various forms of cerebral palsy can form. By itself, an increase in tone in a particular muscle group causes various motor disorders, including gait disturbance. nine0003

What should I do if my child walks on his toes?

Of course, see a doctor. This may be, for example, a neurologist or an orthopedist.

What investigations are performed in the OKDC to make the correct diagnosis?

The scope of research is determined after examining the child, it can be an MRI of the brain or spinal cord and electroneuromyography, and various blood tests, such as CPK. All these studies can be performed under the conditions of OKDC. nine0003

What and how should this condition be treated?

If the reason for walking on toes is a neuromuscular disease, then this is supportive metabolic therapy, in case of detection of primary orthopedic pathology, then correction using insoles, various physiotherapy, sometimes surgical treatment. If the cause of lifting on toes in a child is local spasticity, then, of course, the gold standard for its correction is botulinum toxin therapy. nine0003

What is the essence of this therapy?

This is a procedure when botulinum toxin type A is injected into spastic muscles to relax them, improve walking, including support on the whole foot.

Are there any contraindications for this procedure?

There are very few of them, this is a history of hypersensitivity to any component of the drug, an inflammatory process at the site of the proposed injection, the acute phase of infectious diseases, pregnancy and some others. nine0003

How is the procedure performed?

It consists of multiple injections into the muscles of interest, if necessary with ultrasound guidance.

At what age is it possible to use botulinum toxin?

In pediatric practice, use from 2 years is allowed. In general, the earlier treatment is started, the better the long-term prognosis, for example, the less likely the development of persistent foot deformities.

Yes, of course. First, you need to consult a pediatric neurologist to determine the indications for therapy, the volume of the administered drug, and then sign up for the procedure itself. After performing injections of the drug for 20-30 minutes, it will be necessary to stay in the center to assess the child's condition after the procedure.

You can sign up for a consultation with a pediatric neurologist by calling the reception at 8(863) 227-00-00. nine0008