Toe walking is NOT a part of normal development. In fact, research shows quite the opposite. Instead, toe walking is a visible symptom of other problems that have just not become evident yet. As with most developmental issues, it is best dealt with quickly and efficiently in order to reduce the chances of bigger problems in the future. Unfortunately, it is becoming more common, with long term consequences of pain and dysfunction. Our ability as physical therapists to help without surgical intervention is significantly decreased after the age of 4. 

Signs when toe walking is cause for concern:

Toe walking signs that you may notice are: your child walking on their toes much more than their heels, or showing infrequent heel to floor contact. They may have a “bouncy” walk, stiff ankles, “look like a ballerina”, or a strong presence for “tip-toe walking.” Toe walking may be cause for concern if:

  • The first part of the foot to come into contact with the ground is the front of the foot and your child has been walking independently for longer than 6 months. 
  • Your child dislikes their feet being touched, clothing tags bother them, and/or they don’t like their hair brushed.
  • They are clumsy, fall often, bump into things, or “trip over their own feet.”
  • They love spinning and similar activities more than other children.
  • They are either experiencing, or have a history of, delayed milestones.
  • Ankle flexibility is getting tighter and they have difficulty standing on flat feet even if they try.
  • Your child was premature and/or low birth weight.
  • Your child has difficulty with speech, language and/or learning.

Signs when toe walking may not be cause for concern:

How do you know if your child is demonstrating a part of normal development and not actually toe walking? Walking on toes in normal development is very short lived, and looks very different to problematic toe walking. Toe walking may not be cause for concern if:

  • Your child takes a few steps on their toes and then returns to flat foot.
  • The toe walking is reducing in frequency.
  • Your child has only been walking independently for several weeks.

What you can do if you are concerned:

  • Talk to your child’s pediatrician regarding your concerns.
  • With or without a referral from your child’s pediatrician, you can consult a pediatric physical therapist.  You should seek a physical therapist with specific experience and success in treating toe walking.

About the Author: Courtney Gore - PT, DPT