Concerns and Challenges Related to Toe Walking in Children

| Autism autism spectrum child development toe walking

Toe-walking simply refers to a walking pattern in which a child walks on their tiptoes without their heels contacting the ground. Sometimes a child’s toe-walking is related to their medical diagnosis, as is often the case in cerebral palsy or muscular dystrophy. Other times, a child’s toe-walking may be more habitual or occur for an unknown reason. This is called Idiopathic Toe-Walking. Idiopathic toe-walking always occurs in both feet. Toe-walking can occur in typically developing children, however has also been found in children with speech delays, autism, low muscle tone, or general developmental delay.

When does toe-walking become a problem?

Toe-walking is a natural part of a child’s development. When children are learning to walk, they often explore with a variety of foot positions and gait patterns—this often includes toe-walking. Toe-walking may even persist up to 6 months after the start of independent ambulation.

Idiopathic Toe-walking is of concern if a child is over two year of age and continues to toe-walk frequently. Toe-walking is often more exaggerated when asked to walk barefoot. The child may even be able to walk with flat feet when asked or when wearing shoes.

Toe-walking can lead to problems such as:

  • Tight Calf Muscles and Joint Contractures
  • Decreased Foot and Ankle Range of Motion
  • Poor Balance
  • Frequent Falls
  • Appearance of Clumsiness or Lack of Muscle Coordination
  • Delayed Gross Motor Skills

How can physical therapy help Idiopathic Toe-Walking?

Physical therapy treatment for toe-walking often includes:

  • stretching
  • range of motion exercises
  • strengthening
  • balance training
  • gait training
  • parent education

Your physical therapist will also assist in developing a home exercises program to incorporate stretching into your daily routine.

Early identification of toe-walking and implementation of a stretching program can help prevent joint contractures. In more severe cases, other treatment options may include orthotics, serial casting, or orthopedic surgery to lengthen the Achilles Tendon.


Contact Mary Compton, our pediatric physical therapist, for a therapy evaluation for your child.

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