Toe walking is a common concern that you may face as your child grows from a toddler to an increasingly independent child. There are many factors that can contribute to toe walking and some potential underlying factors for toe walking that include decreased core strength and control, poor ankle/foot stability, and/or sensory seeking behavior.
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A normal walking pattern requires at least 10 degrees of ankle dorsiflexion (toes pointed up). Even greater dorsiflexion is required for going up and down stairs, hills, or squatting down to pick something up of the floor! Your child needs to have enough ankle movement to be able to stand flat footed on the floor as a bare minimum requirement.
How to identify
We recommend that you have your child evaluated by a Pediatric Physical Therapist if your child continues toe walking past 2-3 years of age. It’s important to remember toe walking can be a typical part of development (up to about 3 years old). Here are a few things to look for when identifying toe walking concerns:
- walking up on tip-toes, the heel does not hit the ground first, as seen with typical walking
- experiencing other gross motor difficulties such as poor balance, weakness, or decreased coordination
- unable to keep up with peers or participate in sports or other fun games as a result of toe walking
- unable to come down to flat feet when attempting to attempting to due to very stiff ankles and/or tight calf muscles
- complains frequently of pain at feet, ankles, knees, or hips.
- you notice that your child’s ankle movements are getting tight
If your child exhibits a combination of these concerns, they may benefit from further PT evaluation.
Why it matters
Toe walking can be related to diagnoses such as autism, cerebral palsy, or kids with hypermobility disorders. More commonly, however, toe walking is classified as “idiopathic”, meaning there is no clear known cause for the toe walking pattern. Persistent toe-walking can create stiffness in joints and muscles and cause pain, setting them up for continued aches and pains into adulthood. Toe-walking may also affect your child’s walking pattern and balance in a way that limits their ability to keep up with their friends.
A prudent question to ask yourself when considering physical therapy services for your toe-walker is “why” you are concerned about a toe walking pattern. Do you suspect there is more going on? Are you concerned because toe walking is different than how other kids are walking? Are you concerned about limitations with physical activities?
How treatment helps:
At Connect the Dots, toe walking physical therapy is adapted to the specific needs of your child and focuses on:
- Motor Planning and Coordination
- Gait Training
- Returning to play and other activities that are important to your child
Schedule an appointment with a pediatric physical therapist to determine if your child may benefit from PT services. Things that warrant an evaluation completed by a pediatric PT include: a change in the way your kiddos foot hits the ground, the way their feet look, or a complaint of pain in the lower legs or feet from your child. Keep an eye on whether toe walking starts to interfere with any of the activities your child participates in, including day-to-day walking, playground play, or sports.
At CTD, your child will be evaluated by a pediatric physical therapist who will review your child’s developmental history with you. A portion of the evaluation with be committed to games and activities that will allow the therapist to assess your child’s walking and other movements during play. They will also complete tests and measurements of various muscles and joints. Finally, the therapist will review their general assessment with you and collaborate with you and your child to develop a specialized plan of care for your child.