Understanding Tip-Toe Walking in Children: A Guide for Parents

by Caroline Africh

As a podiatrist, one of the common concerns parents bring to my attention is tip-toe or toewalking in children. While it can be a normal phase in early development as children learn to walk, persistent walking on the toes can sometimes indicate underlying issues that may require attention.

This blog aims to educate parents on the causes, implications, and management of tip-toe walking in children.

What is Tip-Toe Walking?

Tip-toe walking, also known as toe walking, is when a child walks on the balls of their feet with their heels off the ground. It’s common in children to experiment with walking on their tippy toes or ball of the foot, especially as they develop their balance and coordination. Toe walking is common in toddlers under 2 but typically resolves by age 3-4.However, if this walking pattern continues beyond the age of 2 or 3, it may warrant further evaluation.

What Causes Toe Walking in kids?

There are several reasons why a child might walk on their tip toes:

Habitual Tip-Toe Walking: Often, children tiptoe simply out of habit. This is known as idiopathic or habitual toe walking and is typically benign.
Tight Achilles Tendon: Some children may have a short or tight Achilles tendon which links the lower leg muscles to the back of the heel bone, this makes it difficult for them to walk with their heels down.
Muscle Weakness or Imbalance: Conditions such as cerebral palsy can lead to muscle tone abnormalities, resulting in toe walking.
Sensory Processing Issues: Children with sensory processing disorders, including those on the autism spectrum, might prefer the sensation of walking on their toes.
Neurological Conditions: In rare cases, toe walking can be associated with neurological and developmental disorders such as autism spectrum disorders that affect muscle control and coordination.

When to Seek Medical Advice

It’s important to consult a healthcare provider if your child:

Continues to walk on their toes beyond the age of 2 or 3.
Exhibits stiffness, tightness, or difficulty moving their ankles and feet.
Can not bring their heels to the ground without difficult or does not place their heels on the ground even when prompted.
Shows signs of discomfort or pain.
Has a history of neurological or developmental conditions.

Toe Walking in Children Diagnosis

A thorough evaluation by a orthopaedic podiatrist or pediatrician can help determine the cause of tip-toe walking. This may include:

Physical Examination: Assessing the child’s range of motion, muscle strength, and gait.
Medical History: Reviewing any relevant medical or developmental history.
Imaging: In some cases, X-rays or other imaging studies may be necessary to assess bone structure and joint alignment.

Treatment Options

The treatment for tip-toe walking depends on the underlying cause:

Observation: For idiopathic toe walking, regular observation and monitoring may be sufficient, especially if the child shows no signs of discomfort or developmental delays.
Stretching and Physical Therapy: Exercises to stretch the Achilles tendon and strengthen the calf muscles of the lower leg can be beneficial. Physical therapy can also help improve gait and balance.
Shoe Inserts/ Orthotic Devices: In some cases, custom orthotic devices, braces or heel raises may be recommended to support proper foot positioning and encourage heel-to-ground walking.
Casting or Bracing: Serial casting or bracing may be used to gradually lengthen a tight Achilles tendon. An ankle-foot orthosis (AFO) can be helpful for some children to promote a flat-footed gait pattern.
Surgery: In severe cases where conservative treatments fail, surgical intervention may be necessary to release a tight Achilles tendon or address other structural issues.

Encouraging Proper Walking

Parents can encourage proper walking habits in their children through:

Barefoot Time: Allowing the child to walk barefoot on safe surfaces can help strengthen foot muscles and improve balance.
Appropriate Footwear: wearing shoes that mimic barefoot walking are advised and encouraged in this age group.
Positive Reinforcement: Gently reminding and encouraging the child to walk with their heels down.
Engaging Activities: Activities such as walking on uneven surfaces, climbing, and balancing exercises can promote proper foot mechanics.

While tip-toe walking in children is often a phase that resolves on its own, persistent toe walking may require evaluation and intervention. Understanding the potential causes and knowing when to seek professional advice can help ensure your child’s foot health and overall development.

If you have concerns about your child’s walking patterns or foot health, feel free to reach out to our clinic for a comprehensive evaluation and personalized advice.

For more detailed information and personalised guidance, don’t hesitate to contact our clinic or visit our website.

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FAQS

What is toe walking and why do some children do it?

Toe walking is a pattern of walking where children walk on their toes instead of placing their heels on the ground. It’s pretty common in kids, especially those who are learning to walk. Many children outgrow this phase, but some might continue to do it for longer due to factors like idiopathic toe walking or underlying conditions.

What does idiopathic toe walking mean?

Idiopathic toe walking is when there's no clear medical reason for a child to walk on their toes. Basically, it's just how some kids prefer to move! It’s often seen in healthy children and usually doesn’t require any treatment.

When should I be concerned about my child's toe walking?

If your child is still toe walking after age 2 or if it's associated with other developmental disorders, it’s a good idea to consult a pediatrician. They can help diagnose toe walking through a physical exam and check for any underlying medical issues.

Could toe walking be related to the achilles tendon?

Absolutely! A short achilles tendon can contribute to toe walking. If it's too tight, it can make it hard for a child to put their heel down when they walk. Stretching and nonsurgical treatments can help lengthen the tendon and improve their walking pattern.

Are there any developmental disorders linked to toe walking?

Yes, some children who toe walk might have developmental disorders or neurological issues that impact their walking. It's important to rule out these conditions if toe walking persists, so a professional evaluation is key.

How can I help my child if they're toe walking?

There are a few things you can do! Encouraging flat-footed walking through playful activities, using walking casts, or physiotherapy can help stretch the muscles and tendons. Your pediatrician can suggest the best approach based on your child’s specific situation.

Will my child grow out of toe walking?

Many children who toe walk do eventually outgrow it, especially if it's idiopathic toe walking. However, if it’s linked to an underlying condition, they may need more support to help them walk more typically.

How can a pediatrician diagnose toe walking?

A pediatrician will typically conduct a physical exam to observe your child’s walking pattern. They might ask about your child's development and any other symptoms to determine if there’s an underlying condition contributing to the toe walking.

What are some nonsurgical treatments for toe walking?

Nonsurgical treatments can include physical therapy aimed at stretching the achilles tendon, exercises to strengthen the foot and ankle, and sometimes the use of braces or walking casts to encourage a more typical walking pattern.

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Written by Monique Milne Podiatrist at Well Heeled Podiatry

Suite 1/ 362 Hampton St, Hampton, VIC 3188

Phone: (03) 9603 0334

contact@wellheeledpodiatry.com