Toddlers walking on their toes may appear cute and funny, especially when they are just beginning to practice walking on their own. However, if toe walking becomes a habit and it continues into their childhood, this can point to something concerning.
You might wonder, is it normal for kids to walk on their toes? Are there ways to stop toe walking on children? Let’s learn a bit more about toe walking, its possible causes, and some tips about how to stop habitual toe walking in young children.
What is toe walking?
As its name suggests, a child who is toe walking uses the toes and balls of their feet to walk instead of the typical heel to toe walking pattern. You’ll notice that their heels don’t touch the ground and they constantly walk on their tiptoes with or without their footwear. Some children may also have difficulty with putting their heels on the ground due to shorter calf muscles and tendons that are required to support walking.
Why do kids walk on their toes?
Toddlers who are learning to walk will normally try several foot positions to support their weight while walking. It is quite common for children under the age of two to walk on their toes as they learn this new developmental skill. However, some children don’t outgrow the habit and may continue tip toe walking beyond toddlerhood. If your child is still toe walking after the age of three, then it may be a good decision to mention it to your pediatrician so that a proper assessment can be done.
What causes toe walking?
The majority of children walk on their toes without any underlying medical reason at all, and they simply do it out of habit. The term for this is habitual or idiopathic toe walking.
In some rare cases, toe walking is a sign of a medical problem that needs to be monitored or intervened. Some of the possible medical causes of toe walking are the following:
- Cerebral palsy– a condition wherein a brain damage affects the child’s posture, balance and movements.
- Muscular dystrophy– an inherited condition that weakens the muscles of the body overtime.
- Spinal cord problems– some abnormalities or injuries in the spinal cord can affect one’s ability to move their limbs and may cause toe walking.
If toe walking is suspected to be a sign of a more serious medical problem, it will require advice and treatment from a pediatric doctor that specializes in neural and muscular disorders.
How is toe walking diagnosed?
To accurately determine the cause of toe walking, doctors will need to conduct an interview, a thorough physical examination and run diagnostic tests that can help determine the root of the problem.
Your pregnancy history and familial medical conditions will be a part of the interview, along with the symptoms that you notice in your child. Some of the things that will normally be asked regard:
- A family history of neurological or muscular disorders.
- Pregnancy complications.
- Family history of toe walking.
- The child’s developmental milestones.
- Frequency and characteristics of toe walking.
- Complaints of muscle weakness, leg pain and difficulties in keeping up with peers.
As for the physical exam, the doctor will often observe the child’s normal walk versus their “best walk”. While the normal walk is already observed even before the child notices it, the best walk is done by instructing the child to walk while trying to put his heels on the ground.
Your doctor may also check for any sign of muscle tightness, as well as the differences in the right and left legs and feet in terms of size, length and range of motion. Simple neurological tests may also be implemented like the tests for reflexes, sensation and strength of the lower limbs.
If no familial history or any related medical reason is found, your doctor may diagnose it as idiopathic toe walking.
How To Stop Toe Walking
If your child seems to be extra fond of toe walking and you would like to seek ways on how they can overcome this habit, then here are some exercises that can help.
These exercises can help stretch the calf muscles and ligaments that are needed to support walking. Stretching can be done in the following ways:
While lying down on a firm surface:
- Straighten one knee and leg, and support it using your hand. Place the palm of your other hand facing the sole of the foot. Then, carefully flex the toes upwards for around 15 to 30 seconds, up to where the foot’s range of motion will allow. You can repeat this exercise for the other leg.
- For the next exercise, use the same position. But this time, instruct your child to slightly bend his knee. With your hand as support, gently flex your child’s foot upwards to stretch the tendons that are located on the ankle. Do this for another 15 to 30 seconds, then repeat with the other leg.
- Here, you’ll need a wedge where your child can stand. You can buy one that is specifically used for this exercise or improvise a board that is elevated by wood planks or books on the other side.
- Make sure that your child’s knees are straight and the heels are bent while standing on the wedge. You can do this for as long as it is tolerable for your child.
- Encourage fun activities while doing this exercise such as board games or guessing games.
These exercises can help build stronger calf and leg muscles and subsequently improve balance while walking. Here are some foot and leg strengthening exercises that you can try at home:
The scooter board exercise
This is a fun exercise using a scooter board that you have at home. Let your child sit on the scooter board with both their feet on the front, their heels on the ground, and their toes lifted in the air. Tell him or her to move the scooter forward using their heels only.
The penguin walk
The signature penguin walk can be a great exercise for your child at home. Let him watch video clips on how penguins walk. Then, tell him to walk on his heels just like how penguins do. You can assist your child until he learns how to balance himself using his heels. You can also do the penguin walk together and make a game out of it.
Pick a bean bag
Bean bags may sound old-school, but they’re fun for children to play with. They can also be used to strengthen your child’s legs and feet.
First, your child can do this exercise while sitting. Ask her to pick the bean bags using her toes and place them one by one in a bin or basket. Then, gradually let your child do the exercise while standing. As your child gains more strength, she can eventually do the exercise all by herself during playtime.
Sit and Stand
This is a simple exercise that can help prepare your child for a typical heel to toe walk. Here, you’ll need a child-sized chair or stool where your child can sit with his feet flat on the floor. Hold and provide firm pressure on your child’s heels so that they are kept on the ground. Then, ask your child to stand and sit repeatedly. You can incorporate fun games while doing this exercise like reaching upwards for a toy or having a little song and dance.
When doing these exercises, make sure to monitor your child’s level of comfort, and do not push them to the point of being uncomfortable. Stretching and strengthening exercises shouldn’t hurt or make your child uncomfortable at all. If your child verbalizes pain, stop doing the exercise. It would also be best to seek advice from your child’s doctor or physical therapist on how to do these exercises appropriately to prevent undue pain and injuries.
According to the American Academy of Orthopaedic Surgeons, children aged 2 to 5 years old who are able to walk with their feet flat on the floor may be given additional non-surgical treatments like serial casting or bracing to help lengthen and stretch the muscles and tendons in the calf.
On the other hand, for children who are older than 5, the calf muscles and tendons may already be too tight to allow them to walk with their feet flat on the ground. In this case, surgical lengthening of the Achilles tendons may be advised to help the child walk from heel to toe.
Overall, toe walking can be normal for toddlers who are just learning how to walk. However, doing it beyond toddlerhood may impact their normal gait and balance, which is why intervention is necessary.
The best way to stop toe walking is to seek early consultation upon recognizing the symptoms in a young child. With prompt diagnosis, changes can be made that will help your child overcome habitual toe walking as early as possible.