Toe walking is something we often see children doing and something I frequently get asked about as an OT.  I went to an awesome course a few years ago presented by Rachel Ottley, OT, and Liesa Persuad, PT, about toe walking.  I wanted to share some of the main ideas I learned with you. Today, let’s explore a little more about toe walking – why kids might do it, when to be concerned and next steps to take.

What is toe walking?

Typically, when we walk, the heel strikes the ground first, follow by the ball of the foot and then the toes.  Toe walking is when a child walks by putting most of the weight on the balls of his feet, near the toes.  The child’s heels do not consistently strike the ground.

Why does a child toe walk?

There are a few reasons why a child may walk on his or her toes past the toddler stage.  First, toe walking may be due to underlying muscle weakness, neurological conditions such as cerebral palsy or balance difficulties.  I’ve also heard of toe walking running in families. Additionally, toe walking may be related to difficulties with sensory processing.  This is likely going to be a reason behind toe walking in children on the autism spectrum.

Sensory Processing and Toe Walking

For many children on the autism spectrum, the sensory system has an impact on why the child may be toe walking.   Think about the sensory components of toe walking.  A sensory seeker will get a lot of input and pressure from toe walking.  A sensory avoider will be able to avoid input through their feet by toe walking.The  proprioceptive, vestibular and tactile systems have an impact on toe walking.  If a child has difficulty knowing where his body is in space (proprioception), or his sense of balance is off (vestibular), he may be more prone to toe walking.  If a child is sensitive to tactile input, toe walking will relieve the sensation on his foot.  Additionally, there is some evidence that the visual system impacts toe walking.  The visual system is an important component to helping us navigate the environment safely.  

Is toe walking something to be concerned about?

It depends.  When young children are just learning to walk, they may walk on their toes during that time. Additionally, some older children may occasionally toe walk, especially without shoes on.   These situations are not necessarily concerning.  However,as a child grows out of the toddler stage, you should begin to notice a more typical gait pattern more consistently.  If you continue to notice a child toe walking most of the time as they grow, it may be helpful to have a conversation with your pediatrician. Long term toe walking can lead to a variety of issues, including joint pain, arthritis, and instability.

Next Steps

A great next step would be to talk to your pediatrician and ask for a referral for OT and/or PT.  It may be helpful to go to a multidisciplinary therapy center, with both OT and PT available. Because toe walking has to do with the gross motor skill of walking, you may think a referral to PT would be appropriate.  This could be true. However, if the main reason behind the toe walking is sensory as I talked about earlier, it would be more appropriate to see an OT for sensory based evaluation and treatment.  Regardless, talking to your pediatrician and getting connected with a therapist who can properly assess the underlying factors and design an appropriate treatment plan is a great place to start.

You can also try to incorporate a few activities into your daily routines to try to address toe walking.  Talk with your OT or PT, as they may have specific suggestions..  These ideas are from the book Raising a Sensory Smart Child by Lindsey Biel, which is a great resource for all things sensory:

  • Massaging feet with or without lotion.
  • Try having your child explore different materials/textures with their feet.
  • Bring awareness to body parts and verbally cue them to walk with heels down.
  • Have the child hop on a mini trampoline, cueing the child to land with heels down.
  • Try different types of shoes and socks.

Will my child grow out of it?

I sometimes hear people ask if their child will ‘grow out’ of toe walking.  This may be the case in some situations.  However, I am a big proponent of early intervention.  If you are concerned at all, seeking out guidance and possible treatment from a professional can be helpful.  When I went to this course, the presenters stated that toe walking is not necessarily a safe and efficient way to move.  Your body won’t choose it unless it meets a greater need.  This has led me to recommend, more often than not, that families pursue additional services to address toe walking as opposed to waiting it out to see if the child will grow out of it.

References and Resources:

  • Rachel Ottley, OTR/L and Liesa Persaud, PT, DPT, PCS, CKTP – Toe Walking: from the head,down & the ground, up.  Presentation, October 2012.
  • Lindsey Biel, MA, OTR/L and Nancy Peske.  Raising a Sensory Smart Child.

 

This blog is for informational purposes only.  Please contact your medical professional for specific recommendations for your child.  

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