HealthInfo West Coast-Te Tai Poutini
Toe walking
Toe walking is where a child’s heel makes little or no contact with the floor when they are standing or walking.
Toe walking can be constant or come and go. It is relatively common when first learning to walk. But most tamariki (children) quickly grow out of it.
If toe walking continues after the age of 2, it might be because of a medical condition. You should ask your general practice team to check it.
Symptoms of toe walking
Occasionally, the tamaiti (child) may also:
- have pain or discomfort
- be wobblier on their feet or fall frequently
- be unable to stand still easily.
Causes of toe walking
We do not know the exact cause of toe walking. But the following can cause toe walking in some tamariki.
- Habit – A tamaiti may get used to toe walking. Over time, this can increase their muscle tightness or shortness. This can make it harder for them to walk flat footed.
- Weak tummy, back and bottom muscles.
- Short or tight calf muscles.
- Sensory difference – They like the sensation of being on their toes or dislike the sensation of their flat feet touching the floor.
In rare cases, toe walking can be due to underlying causes. These include congenital tightness of muscle. Also, neurological or development issues and autistic spectrum disorders. Your general practice team will tell you if they suspect other causes.
Diagnosing toe walking
If your child’s toe walking continues after they turn 2, you should take them to see your general practice team. You should also see your general practice team if you have any other concerns about their walking.
Your general practice team will discuss your child’s walking, their general development and their family history. They will also examine your tamaiti and watch them walking.
Treating toe walking
If there are no serious underlying problems, there are several treatments options:
Supportive footwear
Supportive, well fastened footwear can help your tamaiti maintain a good foot position. It can also help them improve their walking pattern. Boots that come up over the ankle are often good. For example, Converse or lace-up boots.
Try to prevent them walking long distances in unsupportive shoes such as jandals or sliders.
Going for long walks in stiff boots such as walking boots or gumboots can be helpful. These types of footwear make it very difficult to walk on your toes.
Physiotherapy
There are specific exercises and activities to help break the habit of toe walking. They aim to improve strength and balance and help teach your tamaiti how to walk properly. See Exercises for toe walking for details.
Other options
If supportive footwear and physiotherapy do not solve the problem, there are other options for more serious cases:
- Orthotics – These may be special insoles with carbon fibre inserts. The orthotics prevent the toes from bending, making it hard to toe walk. Some tamariki may need ankle foot orthoses (AFOs). These prevent the toes from pointing.
- Serial casting – This is where your child’s feet are put into walking plaster casts. The casts are changed every week. They slowly stretch out the muscles and increase the movement at the joints.
- Orthopaedic Surgery – In some cases, the muscles become too short to stretch with casting. If this happens to your tamaiti, they may be referred to an orthopaedic surgeon. The surgeon may consider surgery to lengthen the calf muscles.
If your tamaiti has casting or surgery, they also usually need physiotherapy. This is to help them to learn to walk heel first.
Helping your child with toe walking
There are some simple fun activities and games you can do with your tamaiti to help them walk in a more usual way.
Fun activities
- Walking on the beach or uneven surfaces, following cracks in the pavement or walking on curbs or swing bridges. These help them develop balance and body awareness.
- Stomping, jumping, hopping and using play equipment such as mini stilts or space hoppers. These are good activities to encourage them to walk with their heels down.
- Activities like climbing, hill walking and kids yoga. These encourage your tamaiti to strengthen and stretch their legs.
- 30 minutes of daily walking practice. Encourage your tamaiti to walk slowly and with long strides. Use verbal prompting such as “heels down” or “flat feet”.
Games
- squatting games
- marching like a soldier
- tightrope walking (following a line on the floor)
- moon walking
- bear crawling (hands and feet on the floor crawling)
- jumping (crouch down low, jump up and land on your heels)
- giant stomping steps
- backwards walking (touch your toes and heels)
- stomping
- walking with a beanbag on your head
- an obstacle course using the above ideas!
On the next page: Exercises for toe walking
Written by Paediatric Outpatients Musculoskeletal Physiotherapists, Te Whatu Ora Waitaha. Adapted by HealthInfo clinical advisers. Page created December 2023.
SourcesReview key: HICLF-132158
