Archives For play

Let’s Talk About Toes

April 17, 2014 — 5 Comments

This is a guest post by Shannon Kinne, a student physical therapist assistant who is on her last clinical rotation with me.  Enjoy her blog on Toe Walking and comment below on your thoughts and ideas about Toe Walking.  A special thanks goes out to her adorable niece, Madison!  Thanks for being our model!

Toe walking in children can be normal as a child is developing from infant to toddler.  Developing children up through approximately age three can have the inability to strike first with their heel during their gait cycle (medical term for “walking”) as they learn to walk.  You may have seen older children still walking on their toes.  There is not one solid answer for this; therefore, it is important to look into the reasons that may contribute to toe-walking.

Toe Walking

It is important to know that even if a child continues to keep walking on their toes as they get older, it does not mean they have an underlying serious condition.  Children older than three who do not show signs of neurological, orthopedic or psychiatric disorders may walk on their toes due to generalized stiffness of connective tissue, muscle weakness, nerve related issues or a mixture of them.  The main cause for concern in these cases would be muscle soreness, tightening and pain in the calf and in their Achilles tendon.  Constant shortening of the Achilles tendon and/or gastrocnemius and soleus muscles (calf muscles) could turn into contractures (shortening and hardening of a muscle) if left untreated.

Treatments for these types of conditions can depend on the severity of the problem.  Physical therapy and even at home stretching can help to re-train a muscle and assist them into a more normal walking pattern.  Some fun stretches for kids could be animal walks.  For example; ask your child to do a “bear walk” across the room by coming up onto all four extremities, and attempting to keep their heels pushed down towards the floor as they walk.  You can see the stretch they will achieve as this also puts the child’s foot into a more flexed position.  In more severe cases, a child may require casting or splinting to keep the ankle in a more neutral position allowing a constant stretch and re-training of the muscles.  Surgery has also been an option for some children when lengthening of the tendons and muscles are required.

Madison's Bear Walk Position

In some cases, toe walking can be the result of a neurological disorder.   Often they continue to have full range of motion in their ankle; however, they may be experiencing some form of developmental delay.  There seems to be a high incidence of toe walking with children who may have cognitive or mental disorders.  Children with autism often experience sensory issues in which the brain does not receive feedback telling the body which motion they are performing or position they are in.   Cerebral Palsy and Muscular Dystrophy are other known neurological disorders to cause a child to walk on their toes.  Cerebral palsy is caused by a brain injury or brain abnormality which can affect the body’s control of muscle tone, strength and coordination.  Increased tone or spasticity in a muscle does not allow relaxation of the extremities which can cause the child to come up onto their toes.  With muscular dystrophy, this rare disease causes muscle fibers to break down and muscle weakness which can attribute to the toe walking, and can be one of the early signs and symptoms as they begin to walk.

How do you think toe walking can affect a child in the long run?  What ideas do you have to incorporate “fun play” into the process of rehabilitation?



Engelbert R, Gorter J, Uiterwaal C, van de Putte E, Helders P. Idiopathic toe-walking in children, adolescents and young adults: a matter of local or generalised stiffness?. BMC Musculoskeletal Disorders [serial online]. March 21, 2011;12:61.

Anderson, J. M. (2011). Idiopathic Toe Walking. Cincinnati Childrens Hospital Medical Center, 1-17.

Childrens Hospital of Wisconsin. (2014). Muscular Dystrophy. Childrens Hospital of Wisconsin.

Nair, D. (2013). Toe-Walking in Children Could be Sign of Developmental Delay. Mental Health: Counsel & Heal.

Stephen M Edelson, P. (2014). Toe Walking. Autism Research Institute.


The purpose of this blog is to provide resources for parents who want to carry over therapy activities with their child at home. The information provided here does not replace therapy or medical care provided by a qualified therapist or medical professional.
These activities are safe for most children. However, some activities or materials may be inadvisable for children who have certain allergies or medical conditions. It is recommended that you consult your child’s medical provider or therapist before engaging in the activities you have selected.

What’s in a Bucket?

March 5, 2013 — 1 Comment

Everyone thinks you have to buy the most expensive, elaborate toys out there to provide well for your children.  I disagree.

What's in a bucket?

What’s in a bucket?

I think having a few strategic classics will provide endless opportunities for imagination, learning, creativity, and fun!  Today’s pick: a bucket!  Buckets come in all shapes, sizes, and colors, with handles, without handles, there are so many to choose from.  And what house doesn’t have a bucket?  If you don’t think you have one, look closer.  Mom’s Tupperware drawer is a good place to start.  The cabinet of pots have many sized “buckets”.  And dad’s garage must have a can or bucket of some sort that could be shared.  Here are the activities I have used with buckets, baskets, barrels, pots, and containers.

  • Throw a ball or bean bags into a bucket.  Or even better, play basketball!  To incorporate your child’s therapy goals into her play, have her stand on a “mountain” (aka: pillow, piles of blankets, sofa cushions, etc.) to challenge her balance while playing ball.  This can also be used to practice her catching.  You can stand by the bucket and toss her back the ball or bean bag.
  • Make “soup” in your bucket with play food or animals placed on other side of room.  I frequently have kids walk through an obstacle course for my bean bag frogs to make “froggy soup” and then we “stir” it up with a stick or dowel (or a pretend spoon if there is nothing else available).
  • What young child doesn’t love the anticipation of dropping a marble down a spiraled pop tube or even a paper towel tube?  It’s a great cause and effect learning tool waiting for the marble to hit the bottom of the bucket.  To slip in his therapy goals, have him reach way up high to grasp the marble or to put in the pop tube to encourage extending his back.  Or if he is working on strengthening his legs, have him reach up high onto his tippy toes for each marble.Buckets 021
  • If you have multiple buckets, you could stack them up, have action figures hiding inside and launch the flying monkey or roll a ball at it to knock them all over.  I have some kiddos I treat who will do anything to make something crash!
  • Play dress up!  Use a bucket as a top hat, or a purse, or a construction bucket of tools.  Your child’s imagination will take him on all kinds of adventures!
  • Go outside and play!  Take that bucket outside with a shovel or wooden spoon and dig, dig, dig!  Take it to the beach and make a sand castle, or collect sea shells!  Use the bucket to sneak up on someone and pour water on them on a hot summer day!
  • Help dad in the garage!  I know as a kid, my brother and I loved to hang out in the garage with Dad.  He would give us little projects, like sorting his nails, screws, and bolts.  Doesn’t sound like too much fun to us adults, but to kids, they love to explore the grown up world.  Have your kiddo sort anything into buckets or cans, whether it is nuts and bolts, beads, macaroni, beans, etc.

That’s just with a bucket!  Imagine what your kids can come up with.

What activities have you used with a bucket?  What are your kids’ favorites?  Comment to share!  And as always, have a great day!