Concerns we help with
Toe walking means a child walks on tiptoes with the heels off the ground. It can be normal when a child is first learning to walk. If it continues past age 2, happens most of the time, or shows up on one side only, talk with your pediatrician or a pediatric physical therapist. Earlier help is usually simpler.
Toe walking is when a child walks on tiptoes, without the heels touching down. It can be normal for a new walker. Many children also pop up on their toes for a few steps when excited, nervous or cold, then come back down. As walking matures, the heels should come down. When toe walking continues, it is worth finding out why.
Toe walking can have several causes, including:
Over time, staying up on the toes can let the calf muscles and heel cord (Achilles tendon) get tight, which makes it harder to get the heels down.
One tip from our therapists: listen to your child's steps on a hard floor. They should make an even beat most of the time. More signs are in Put Your Best Foot Forward.
Our guidance is simple. If toe walking continues past age 2, ask a physical or occupational therapist to take a look. Bring it up with your pediatrician too, who can check for medical causes.
Reach out sooner, at any age, if your child toe walks on one side only, has pain, has tight or stiff legs, seems uncoordinated, or falls a lot.
Our therapists find that the earlier a child is seen, the faster treatment tends to go. Early treatment may also help a child avoid serial casting or surgery to lengthen the Achilles tendon later on.
The first step is finding the cause. A BDI physical or occupational therapist looks at how your child walks and moves and what may be behind the toe walking. Treatment depends on what they find, and our PTs start with conservative care.
Physical therapy can include gait (walking) training, muscle strengthening, balance training and a home exercise program. If something needs extra attention, our therapists will refer you to the right healthcare professional.
For some children, shoes or braces are part of the answer. BDI's physical therapists can check your child's alignment and recommend an orthotic during a screening or physical therapy visit. For custom bracing they refer families to orthotist (brace specialist) Gwen Ansier at Hanger Clinic, whom they consult with regularly; she is listed on our trusted professionals page.
If the ankle has become too tight, BDI offers serial casting. This noninvasive treatment uses a series of lightweight casts to gently stretch the ankle and improve foot alignment. Most children walk on the casts and keep up with reasonably typical activities. Casting does not replace therapy, which continues afterward to build a new walking pattern.
It can be. Many new walkers spend some time on their toes, and children of any age may rise onto their toes for a few steps when excited, nervous or cold. As walking matures, the heels should come down. If your child is still toe walking past age 2, or does it most of the time, ask your pediatrician or a pediatric physical or occupational therapist to take a look.
Some children do, especially new walkers. But our therapists advise against waiting once a child is past age 2. Staying on the toes can let the calf muscles and heel cord tighten over time, which makes heels-down walking harder. The earlier a child is seen, the faster treatment tends to go, and early treatment may help avoid casting or surgery later.
There are several possible causes. They include sensory processing differences such as sensitivity to touch, a history of torticollis, a difference in leg length, balance (vestibular) differences, and underlying medical conditions. For some children no cause is found, and this is called idiopathic toe walking. Finding the likely cause is the first step, because it guides what kind of help will work best.
Serial casting uses a series of lightweight casts to gently stretch a tight ankle and improve alignment. At BDI, most casts are made of a soft, flexible material that families can remove at home, and most children walk on them. Every child is different, so the number of casts varies. Our casting team says children are in casts for 6 to 12 weeks on average, and measurable improvements often come within a few casts.
They can for some children. Orthotics (braces or shoe inserts) and shoe modifications can help by dynamically stretching tight muscles, activating the right muscles, evening out leg lengths and supporting the arch. BDI's physical therapists look at your child's walking and, when bracing might help, refer you to orthotist Gwen Ansier at Hanger Clinic, whom they consult with regularly.
This guide is for education and is not a diagnosis or a substitute for care from your child’s doctor. If something about your child’s development worries you, talk with your pediatrician or call us and we’ll help you think it through.
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