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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.