Written by Dr. Erica Martin PT, DPT, PCS


When children walk on the balls of their feet, without the heels touching the ground, or on their tippy toes, this is referred to as toe walking. Many children will walk on their toes and it is normal and those children usually stop. Others will toe walk and it is associated with an underlying physical condition, impairment or sensory disorder.  Oftentimes, it is hard for parents to know when they should be concerned and what they should do. 


Is Idiopathic Toe Walking really idiopathic?


In the absence of a neurological or orthopedic diagnosis, toe walking before the age of two is oftentimes normal. When these children persistently toe walk after that age, they are often diagnosed as idiopathic toe walkers (ITW). We at Dynamic Solutions believe that toe walking is never idiopathic. We know there are multiple reasons children walk on their toes. With a comprehensive evaluation, we can figure out why.


When should my child see a therapist for toe walking?

A child who continues to walk on their toes after the age of two, or a child who is under two but always walks on their toes, should see a pediatric therapist for evaluation. Early intervention is key to prevent symptoms related to toe walking and for faster resolution.


“How do you treat toe walking?”

Treating toe walkers is not just about stretching and strengthening. Intervention can be very complex and a thorough assessment helps us to individualize treatment strategies for each child’s specific needs and reasons for toe walking. You must address the why along with the movement disorder (toe walking). We consider many factors and their role in toe walking including integration of the sensory systems, postural control and stability, lower extremity alignment and heel loading/ weight line training.

Some of our favorite interventions include FES during treadmill training, auditory feedback, wedge progression for heel loading, providing proprioceptive input, dynamic postural control exercises and kinesiotaping.

“What is a muscle contracture?”

Triceps Surae Muscle Contracture or contracture of the gastrocnemius is a symptom of toe walking. After a child toe walks for a prolonged period, their calf muscle can become so tight that it no longer has the length to allow the child to put their heel down. Once this occurs, they have no other option but to toe walk. 


At dynamic solutions we offer non-surgical treatments to manage and prevent these contractures including serial casting, prolonged stretching, resting nighttime bracing and orthotic recommendations.


If you are concerned about your child’s toe walking, the expert pediatric therapists at Dynamic Solutions can provide an evaluation to determine the cause and provide the appropriate treatment.


If you have any more questions about toe walking, or would like to schedule an evaluation with one of our pediatric physical therapists please email us at info@dynamicsolutionstherapy.com.



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