Therapy Approach to Toe Walking

Have you noticed your little one walking on their toes? Is your little one learning to stand or walk? Or have they been walking and just started going up on their toes or walking on their toes?

There could be several reasons as to why your little one is going up on their toes to stand, play, or walk. Here are a few reasons I have noticed as a pediatric physical therapist:

1. Sensory related: Your little one may be trying to avoid certain textures to their whole foot and is going up on their toes to walk or play. This can be related or not related to sensory processing disorders.
2. New stander or walker: Your little one may be exploring their environment and how their body feels in space, which is called proprioception.
3. Medical condition: Certain medical conditions can cause abnormal ankle alignments or limited ankle range of motion that can lead to toe walking (club feet, cerebral palsy, or muscular dystrophy, to name a few).

However, most toe walking is idiopathic, which means that the exact cause is unknown. Nonsurgical approaches to help with toe walking include serial casting (series of short leg walking casts to progressively stretch the muscles over several weeks) and ankle-foot orthotics (custom fitted braces worn on foot for a period of months). In addition, an evaluation and treatment plan from a physical therapist and/or occupational therapist can help. A physical therapist and an occupational therapist can both help with the side effects from toe walking. Each therapist will have a different treatment approach and reason for treating toe walking.

An occupational therapist can treat any sensory-related issues due to toe walking, including sensory seeking or sensory avoidance. They can help the child and family develop a sensory diet to help with over- or under-stimulation in the environment.

A physical therapist can also treat toe walking, but more so for assessing balance, range of motion, mobility, strengthening of lower extremities, and trunk control. When a child has been standing or walking on their toes for extended periods of time, the calf muscles can get tight, which will limit the range of motion in the foot and ankle. This can make it difficult to go and up down stairs, squat to pick up toys, and stand on 1 foot to dress, depending on the age of child. Therapy can also help prevent frequent falls due to the child not being able to clear toes or foot while walking. As a physical therapist, we work on active stretching of the calf muscles while the child is playing, like standing on a wedge and drawing on a white board or chalk board, pulling Squigz suction toys off a mirror wall, or climbing up a slide! We also do passive stretching of the calf muscles, which is when the therapist moves the foot and ankle up and towards the body in order to achieve more range of motion within a comfortable range.

If you have noticed your little one standing or walking on their toes more than 80% of the day, they may benefit from an evaluation by a physical therapist and/or an occupational therapist for a multidisciplinary and team approach. Please mention this to your child’s pediatrician and request a referral for a PT or OT evaluation.

-Whitney Castle, PT, DPT

References

OrthoInfo. (2021). Toe Walking.https://orthoinfo.aaos.org/en/diseases--conditions/toe-walking/

Children's Health Center of Atlanta. (n.d.) Toe Walking. https://www.choa.org/~/media/files/Childrens/medical-professionals/physician-resources/toe-walking.pdf?la=en