The majority of children begin walking at around 12 to 14 months with their feet flat on the ground. However, some children may start walking on the tips of their toes or the balls of their feet instead. This is often referred to as toe walking. One of the common questions parents want to know is how to correct toe walking in children.
This phenomenon is thought to be perfectly normal and part of the process of learning how to stride on one’s own; and it generally goes away three to six months after children have learned how to walk, normally disappearing entirely by age three.
Beyond the age of three, this occurrence is termed idiopathic (meaning without a known cause), where children will usually stand with their feet securely on the floor, but will revert back to their toes when walking or running.
Why do Kids Toe Walk?
There is no definitive research or medical explanation for why children walk on their toes. However, there are a myriad of plausible reasons that kids may cultivate a toe walking habit:
- Are they expressing tactile hypersensitivity in their feet?
- Could their sense of coordination and dexterity be compromised?
- Do they have a short Achilles tendon? This tendon connects the calf muscle to the back of the heel bone; and when shortened, it will impede the heel from contacting the ground.
- The child’s calf muscle may simply be so tense that he’s unable to set his heel down. The lower leg muscles of children who toe walk, have a tendency to tighten up, thus decreasing the mobility of their ankles, and weakening the muscles on the front of their legs as well.
In a few cases, toe walking may stem from an underlying condition, such as:
- Cerebral palsy: a developmental brain disorder that affects muscle control, movement, strength and posture.
- Muscular dystrophy: a genetic illness where the muscles become weak and easily damaged over time. It’s more common in children who began walking normally, before starting to walk on their toes.
- Autism: Toe walking when accompanied by speech difficulties and social delays, may be connected to this complex array of disorders that impact a child’s communication and interpersonal skills.
Certainly not all children who toe walk are destined for a serious neurological diagnosis. Usually, a child will leave the habit behind at some point, if he/she doesn’t display any other evidence of developmental impairment, other than walking on the toes.
A greater concern for parents is when toe walking occurs with other developmental challenges or problems in processing sensory input. If you are concerned or if your child hasn’t outgrown toe walking by the age of three, you may want to consult with your healthcare professional.
How Can Toe Walking be Corrected?
Effective therapy for toe walking will depend on a number of factors. These can be used when determining how to correct toe walking in children:
- What’s the cause?
- Do your child’s heels ever make contact with the ground? Or are they always on their tippy toes?
- How cramped have your child’s calf muscles become? And have the foot and ankle muscles been affected in consequence?
Exercise at Home
Doing exercises at home can be very beneficial for your toe-walking child. They’ll allow the calf muscles to stretch out and consequently strengthen the front of the legs. They’ll also provide additional range of motion and stability to the ankles, enabling your child to walk better from heel to toe and stand firmly on their feet.
Stretching is the first step. Afterward, it’s crucial for you and your child to engage in activities and exercises that concentrate on using the muscles that have been stretched. It’s important to engage in exercises that are fun and that are suitable for your child’s age. You may want to consult a physical therapist, to learn about enjoyable and innovative exercises you can do at home with your child or at a facility like the indoor playground found at Kids at Play.
Serial Casting or Bracing
Your physician may recommend the use of a series of casts, of various sizes and positions, applied over time, that gradually stretch out the heel tendon, and restore mobility to the ankle. Like a regular cast, they are unable to come off for bathing or for any other activity.
Bracing can also be employed in order prevent the child from standing on their toes. In less extreme cases, rigid boots or high top footwear can sometimes provide similar benefit.
In exceptional and very severe cases, when all other methods have failed, the heel tendon may need to be lengthened by surgery.
Shoes Can Make a Difference!
The following shoes may be able to curtail your child’s wish to toe walk:
- Flat shoes: Refrain from using shoes that have any wedges or elevated heels; the position will shorten the calf muscle from the get-go and may result in more toe walking.
- Squeaky shoes: Some shoes come with squeakers in the heels; making planting the heel on the floor extra fun for your child! A squeaky treat for every solid step taken.
- High top shoes: If your child attempts to toe walk while wearing high backed footwear, the back of the shoe will push against the heel tendon, making toe walking uncomfortable, and facilitating normal walking on flat feet.
- Shoes that light up: Some brands of footwear are equipped with lights placed at the back of the foot; the more your child walks with the feet touching the ground, the more the lights will light up.
Patience is a Virtue
Most of these options require time, patience and perseverance. Your child may continue to toe walk from time to time, even in the midst of your efforts. It can be fruitful to engage the expertise of your pediatrician and/or physical therapist to support and guide you through the process.
Ultimately, it remains a challenge to pinpoint the reasons behind toe walking and finding out how to correct toe walking in children. Each child is unique and will react in different ways to any given intervention. In other words, what’s effective for one, may prove futile for another. However, with proper support, patience and a quality therapy team, toe walking is treatable in many children.