What is Toe Walking?
Toe walking is a gait or walking pattern. Toe walking looks exactly like it sounds. Children step from the ball of one foot to the ball of the other without their entire foot coming into contact with the ground.
Every single person on the planet has a different walking or gait pattern specific to them. Most people use the same basic walking pattern which is a heel-toe gait pattern. This pattern simply means that every time we take a step, we contact the floor with our heel first, slowly load all of our weight onto our foot, and then move our weight forward onto our toes. We repeat this cycle over and over again between our right and left foot.
When children first learn to walk, they do not immediately begin with a heel-toe gait pattern. Instead, they place their entire foot on the ground all at once with each step. Over time and with lots of practice and learning, children eventually get to the mature heel toe pattern.
As children practice walking, they may spend some time walking on their tip toes. Standing and walking on our toes is a skill we use everyday. I am vertically challenged so I spend a lot of time on my toes trying to reach things in my kitchen cabinets. Even though I use a toe walking pattern at times to perform a specific task, it is not my day to day pattern.
Why do children toe walk?
Spending some time standing and walking on our toes is a very normal and important part of development. It helps strengthen muscles, improves our balance, and is a part of many gross motor skills like jumping. However, walking on our toes requires a lot more work and effort than a heel-toe pattern. Knowing that our bodies will always opt for the most energy efficient pattern when it has the option, why would we choose the more difficult pattern?
- Medical condition: When a child is evaluated by their physician for toe walking they are going to consider if a medical condition is the root cause of this walking pattern. Condition such as cerebral palsy, muscular dystrophy, tethered spinal cord, and many others cause changes in the neurological and musculoskeletal systems that lead to a pattern of toe walking.
- Sensory Processing Difficulties: Children that have aversions to specific types of sensory input may choose to walk on their toes as a way of avoiding input on the soles of their feet. Conversely, children that are seeking out sensory input may choose to walk on their toes as a way on increasing the input they receive with each step.
- Vision Deficits and Balance Deficits may also lead to this type of walking pattern.
- When no other medical reason for toe walking can be established a child is usually diagnosed as an idiopathic toe walker, which simply means there is not identifiable cause for toe walking. This diagnosis is considered an exclusionary diagnosis, meaning all other options have been excluded.
Why is toe walking concerning?
There 3 important reasons to me as a PT for why toe walking is a concern are:
- When a child uses the toe walking pattern the muscles in their calf especially stay in a shortened position for a long period of time. And muscles and joint structures in our body that stay in one position for a long period of time, tend to remain in that shortened position. I liken this to the changes that happen to individuals with desk jobs that spend a large part of their day in the sitting position. Over time the muscles in the back of their legs known as the hamstrings and the muscles in their low back can get very tight from staying in that one position for a long time. The same thing can happen in children who toe walk. The muscles in their lower leg stay in a shortened position for a long period of time. Over time these structures will get stuck in this position and may require surgery to be corrected.
- When a child uses a toe walking pattern, the bottom of their foot is not coming into contact with the ground. As children learn to stand and walk, the sensory receptors and pathways in their foot receive lots of sensory information from the ground. This information is being sent to the brain to create pathways and learning about balance and coordination. For example, when a baby is just learning to walk they shift their weight over their right and left foot as they take each step. Sometimes, they shift their weight too far in one direction and they fall down. After repeating this pattern of weight shifting and falling over and over again eventually they start to make the needed connections to remain balance. They learn that when I feel a lot of sensory input on the outside of my foot that means I am probably going to lose my balance and fall down. So the brain then understands that when it feels that type of sensory input it needs to make a correction to bring the body back to the middle. When a child toe walks they miss out on all of this very important sensory input and motor learning that impacts their balance and coordination.
- And finally toe walking can impact gross motor development. Learning to walk, run, jump, and kick a ball on flat feet is very challenging for young children. But imagine how much more difficult learning all of these new skills will be when you’re standing on the balls of your feet. When I explain this to parents I often tell them to imagine what it would be like to go to PE in elementary school in a pair of stiletto heels. Now I can barely walk in stiletto heels. I can’t imagine how hard it would be to try to kick a ball, jump, stand on one foot or even hop in that position. So we find that children who are walking on their toes have delays and their gross motor skills because it’s so much more difficult to learn to do these tasks in the toe walking position.
Activities for Toe walkers
Now that we understand the toe walking basics, let’s explore some different activities and exercises for toe walkers.
1.Gentle Range of Motion/Stretching: Research suggests that short intensive bouts of stretching is not effective in and of itself to improve mobility at the ankle. Full task based activities are best (Article listed below). However, gentle range of motion/stretching does have important benefits like improving mobility for upcoming activities, joint lubrication, and parent/child connection.
- Have your child lay comfortably on a bed or sofa. Preferably after a bath or shower. The heat from the shower helps to relax the muscles.
- Place one hand on the underside of your child’s calf (A) and grasp the bottom of your child’s foot over the arch with your other hand (B).
- Gently apply pressure with hand B moving your child’s foot up toward their knee.
2. Uneven and Inclined Surfaces: Standing on uneven surfaces like a sofa cushion, bosu ball, or dyna disc encourage full foot contact and work on ankle strength at the same time. Standing on an inclined surface such as a wedge with their heel at the low end of the wedge also encourages full foot contact. If you don’t have a wedge, you can use a book.
3. Squatting: The squatting position encourages the full foot to be in contact with the floor. Play a game to pick items up from the floor, play fine motor games like puzzles, sorting, or stringing beads in the squat position.
4. Animal Walks: These simple animal walks really help your child to get foot contact with the ground and strengthen the ankle. Plus, they are super fun!
5. Scooter Board: Sitting on a scooter board and walking forward encourages a child to use their heels instead of their toes to help them move.
6. Half Kneeling: The position of tall kneel is a great way to achieve full foot contact. Using this position you can play board games at surface, play catch, or roll a ball back and forth.
7. Provide a sensory experience. If your child is willing to try to new textures on the bottoms of their feet, it can encourage them to place their feet on the ground. Be sure to never force a child to explore textures that make them feel uncomfortable. But, if they are willing to explore then here are some great ways to do that: walking in the grass, walking in the sand, or walking in bins of materials like rice and beans.
Be sure to hop over to my freebies page to grab a free printable with all of these exercises and activities listed. You can find it here. What other games, exercises or activities do you use to help kids with toe walking? List your ideas in the comment section.
If you enjoyed this blog post, you might also enjoy: How to Get Kids and Teens to Exercise
Thanks so much for stopping by. Have a wonderful day!
-Heather
Article Links:
- Acute passive stretching has no effect on gastrocnemius medialis stiffness in children with unilateral cerebral palsy.
- Stretching and Progressive Resistance Exercise in Children With Cerebral Palsy: A Randomized Controlled Trial.
- Interventions for idiopathic toe walking.
- Children with idiopathic toe walking display differences in lower limb joint ranges and strength compared to peers: a case control study.
- Current concepts in muscle stretching for exercise and rehabilitation.