As adults, we don’t think about the nuances of walking – most people are lucky enough to just get up and go. As children learn to walk, they are working hard to find their balance and coordinate their movement. With continued practice, they’re soon walking and running all over without a care in the world. However, sometimes parents notice that their child is not walking using their entire foot (heel to toe) like adults do – they’re instead walking on tip toes, known as toe walking. After spend hours scouring child development blogs to determine if this is normal or something to be concerned about, the answers can be inconclusive.
Toe walking is something most children do when they first start learning to walk. It’s a new action for them but they often outgrow it by age three. It is a common part of child development and nothing to be too worried about. But if your child is still walking on their toes by age four, you may want to have them evaluated.
What Causes Toe Walking?
Toe walking doesn’t always have a specific cause. Some children do it because it’s fun, easier, or the floor feels weird on the curvature of their feet. Sometimes it runs in families or is developed out of habit. Other times, it is caused by a more specific and serious health condition.
Muscular dystrophy causes muscles to weaken and deteriorate over time. It is more common in males than females but can affect both. As muscles get weaker, it can be harder for children to keep their feet flat on the floor and they may be more comfortable walking on tip toes.
Cerebral palsy is a movement disorder where children have difficulty controlling muscle movement. Their arms and legs may appear very loose and floppy, or very rigid and stiff. This can affect walking and cause them to be toe walkers.
It is not entirely clear why some children with autism defer to walking on tip toes, but one belief is that it is due to sensory processing issues. Children with autism may not like the tactile sensation or pressure of walking with their full foot, so they stay on their toes. It may also be due to motor coordination issues.
Short Achilles Tendon
The Achilles tendon runs from the back of your calf down to your heel and attaches at the heel bone. It is what helps pull your heel up as you walk. If the Achilles tendon is too short, it may prevent children from flattening their foot on the ground, hence their tendency for toe walking.
What Are Possible Effects of Walking on Tip Toes?
Toe walking is often a brief part of child development that children do on occasion and then grow out of as they become more confident in their walking skills. Parental concerns often surround how it will affect their child’s balance or physical development. These are valid concerns and reasons to get toe walking evaluated as children get older.
Increased Risk of Tripping or Falling
Walking on tip toes can increase risk of tripping or falling because there is less stability and contact with the ground. It is easier for children to hurt themselves on uneven surfaces, like area rugs or stairs.
Developing Tight Calf Muscles
Because toe walking shortens the calf muscles, they can become tight and stiff. Children may continue walking on tip toes because it’s more comfortable and doesn’t put tension on these muscles like straightening them to walk heel-to-toe would. Physical therapy can help to gently relax and stretch the muscles to reduce toe walking and promote proper form.
Developing Stiffness, Tightening, or Pain in the Achilles Tendon
Just like calf muscles can become tight, so can the Achilles tendon. When it is constantly pulled tight to keep the heel up and the child on their toes, they may develop pain or stiffness when trying to stretch it to walk more normally.
Idiopathic Toe Walking
When walking on the toes becomes habit and something your child does frequently after age three, and it isn’t caused by a condition such as cerebral palsy or muscular dystrophy, it is often referred to as idiopathic toe walking. One study found that idiopathic toe walking occurred in around five percent of five-and-a-half-year-olds in Sweden. However, by age 10, 79 percent of them had grown out of it. Children with idiopathic toe walking will often stand on flat feet, but once they walk or run, they raise up onto their toes.
Should Parents Worry About Toe Walking?
Parents’ concerns about children walking on tip toes or not meeting child development milestones is a common motivator for seeking professional help and having children evaluated. Medical providers may use a toe walking tool to determine if the cause is idiopathic or the result of another medical condition. Fortunately, there are many therapy services and exercises that can be done to help your child reduce toe walking.
Practice Appropriate Exercises
Physical therapy can be huge step toward addressing toe walking and improving mobility. A physical therapist may recommend a home exercise program so you can help your child relax and stretch their muscles so walking heel-to-toe becomes more comfortable. This can include stretching the calf muscles and Achilles tendon, increasing ankle range of motion, and practicing going from sitting to standing on flat feet.
Seek Professional Reassurance from Therapeutic Movements
A developmental assessment can help determine if your child’s toe walking is something to be concerned about – especially if they are older than three or four years old. The professional therapists at Therapeutic Movements can work with your child to improve range of motion and lengthen muscles safely and effectively to correct toe walking.
While walking on tip toes isn’t usually something of immediate concern in toddlers, it is an issue to keep an eye on as your child grows and hits more growth milestones. If you are concerned, seeking professional help can be reassuring to your child’s development and help with early detection of potential problems.
Learn more about us and how we can help with toe walking and other gross motor functions. Contact us today.