Treating Toe Walking in Children: What Parents Need to Know
It's adorable when your toddler tiptoes around the living room like a tiny ballet dancer. But when those tiptoes become the only way they walk—and weeks turn into months—you might start wondering: Is this normal? Should I be worried?
Here's what we want you to know: toe walking is super common (affecting about 5-12% of children), and in many cases, it's totally harmless. But persistent toe walking beyond age two deserves attention. The good news? Early physiotherapy can prevent long-term complications and help your child develop healthy walking patterns.
At Capria Care Collective in Coquitlam, we've helped countless families navigate toe walking concerns with compassion and expertise. Let's talk about what's normal, when to worry, and how we can help.
What Exactly Is Toe Walking?
Toe walking (sometimes called equinus gait) happens when kids walk on the balls of their feet without their heels touching the ground. While this is totally normal when toddlers are first learning to walk, it becomes a concern when it persists or worsens.
There are three main types:
Idiopathic Toe Walking (ITW): This is the most common type—no identifiable medical reason, just a strong preference for walking on toes. These kids can walk flat-footed when you ask them to, they just choose not to.
Toe Walking with Underlying Conditions: This occurs alongside diagnoses like cerebral palsy, autism spectrum disorder, muscular dystrophy, or sensory processing issues.
Structural Toe Walking: This is when shortened Achilles tendons or calf muscles physically prevent the heel from reaching the ground, even when the child tries.
Research shows that early identification and treatment—especially for idiopathic toe walking—leads to better outcomes and prevents those muscles from becoming permanently tight.
Normal Toddler Experimentation vs. Real Concern
Most kids experiment with toe walking between 12-18 months. It's part of exploring movement and building strength—totally developmentally appropriate!
But how do you know if it's crossed the line from cute phase to something that needs attention?
Toe Walking That's Probably Fine:
Your child can walk flat-footed when you ask them to
It happens sometimes, not constantly
Your toddler is under 18 months and newly walking
No stiffness when you gently move their ankle
No other developmental concerns
Toe Walking That Needs a Professional Look:
Continues past age two
Happens more than half the time they're walking
Your child can't or won't walk flat-footed when asked
You feel tightness when moving their ankle upward
The pattern is getting worse over time
Other developmental delays are present
Only one leg walks on toes
Family history of toe walking or neuromuscular conditions
If your child fits the second category, let's chat. Contact us to book an initial assessment—we're here to help you figure this out.
Why Do Kids Toe Walk?
Understanding the "why" helps guide treatment:
The "No Clear Reason" Category (Idiopathic)
Many kids toe walk without any identifiable medical cause. Theories include:
They just like how it feels (sensory preference)
It's become a habit after initial experimentation
Family history—toe walking runs in families
Retained primitive reflexes
They think it makes them faster (spoiler: it doesn't, but try telling them that!)
Neurological Reasons
Sometimes toe walking is an early sign of conditions affecting the nervous system, like cerebral palsy. Studies indicate that persistent toe walking can be the first noticeable symptom of neurological involvement, making early assessment crucial.
Sensory Processing and Autism
Children with autism spectrum disorder have higher rates of toe walking. Sensory processing differences may make toe walking feel more comfortable. We often work alongside occupational therapists in Surrey to address both movement patterns and underlying sensory needs.
Physical Tightness
Prolonged toe walking can cause actual shortening of the Achilles tendon and calf muscles. This creates a structural problem where the heel can't reach the ground anymore. Early intervention prevents this progression—which is exactly why we're big believers in not waiting to see if they'll "grow out of it."
What Happens During Assessment
When you bring your child to see us at our Coquitlam clinic, here's what to expect:
Gait Analysis
We observe your child walking in various situations—barefoot, in shoes, on different surfaces, at different speeds. We're looking at:
How much time they spend on toes versus flat-footed
Whether both legs do it or just one
If they can walk heel-to-toe when you ask
Their running, jumping, and stair climbing patterns
Range of Motion Testing
We measure ankle flexibility—specifically, how far the toes can move toward the shin (dorsiflexion). Normal is about 10-20 degrees beyond neutral. We test with both straight and bent knees since different calf muscles are involved.
Strength and Balance Check
Testing ankle, hip, and core strength helps identify weakness contributing to toe walking. Balance testing shows if they're relying on toe walking for stability.
Neurological Screening
Basic checks of reflexes, tone, and coordination rule out underlying conditions. If we have concerns, we'll recommend seeing a pediatric neurologist.
How Physiotherapy Treats Toe Walking
Treatment plans are totally individualized based on what we find in assessment. Here's what might be included:
Stretching Programs (The Foundation)
Daily calf and Achilles stretching is essential. We'll teach you:
Standing calf stretches against a wall
Seated stretches with a towel or band
Passive stretching techniques for younger kids
Weight-bearing stretches on an incline
Research shows that consistent daily stretching over 8-12 weeks significantly improves ankle range of motion in kids with idiopathic toe walking.
Strengthening Exercises
Building strength in muscles that support flat-footed walking:
Strengthening the front shin muscles (tibialis anterior)
Hip and core work for stability
Eccentric calf exercises for control during heel strike
Balance activities requiring flat-foot contact
Serial Casting
For moderate to severe tightness, we might use short-leg walking casts for 4-6 weeks. The casts hold the foot in a position that gently stretches the calf muscles continuously. It's one of the most effective interventions for creating lasting change.
After cast removal, intensive physiotherapy maintains those gains.
Bracing and Orthotics
Ankle-foot orthoses (AFOs) might be prescribed for nighttime wear. These maintain ankle position and provide ongoing stretch. Custom orthotics can sometimes help, though evidence is mixed.
Gait Re-Education (AKA Making It Fun!)
Teaching conscious flat-footed walking through:
Visual feedback with mirrors
Games and activities requiring heel contact
Walking challenges and competitions
Positive reinforcement for flat-footed steps
We get creative—"walking like a dinosaur" or "making elephant footprints" works way better than constantly saying "don't walk on your toes!"
Sensory Integration
For kids with sensory differences, we collaborate with occupational therapists to address underlying sensory needs while working on the movement pattern itself.
Timeline: How Long Does Treatment Take?
Mild cases: Kids with full ankle flexibility who just choose to toe walk might resolve in 2-3 months with consistent stretching and retraining.
Moderate cases: Those with mild tightness typically need 3-6 months, potentially including serial casting.
Severe cases: Significant contractures or underlying conditions may need 6-12 months or longer. Some might require surgical lengthening if conservative treatment doesn't work.
Here's the thing: earlier intervention means shorter treatment duration. Kids treated before age four generally have much better outcomes than those who start later.
Your Home Exercise Program (The Real MVPs)
Success depends heavily on what happens between our sessions. We'll provide:
Daily stretching routine: Usually 2-3 exercises, 3-4 times daily, holding each stretch 30-60 seconds.
Activity modifications: Guidance on encouraging flat-footed walking during daily activities.
Footwear recommendations: Appropriate shoes that provide ankle support without being too stiff.
Environmental strategies: Setting up your home to encourage flat-footed walking (like placing interesting items at heights requiring standing flat to reach).
Tracking tools: Charts or apps to record exercises and track progress.
Pro tip from our Port Moody parents: Setting phone reminders or linking exercises to existing routines (after meals, before screen time) makes consistency so much easier.
Special Considerations for Athletes
For kids in sports or dance, toe walking needs special attention. Ballet dancers, gymnasts, and other athletes may develop toe walking habits from training. While these activities aren't harmful, we ensure kids can still achieve full ankle range and walk flat-footed when appropriate.
Sports-related toe walking may need:
Pre and post-activity stretching protocols
Strengthening programs to prevent imbalances
Cross-training for varied movement patterns
Education about proper biomechanics
When Surgery Becomes Necessary
In about 10-25% of idiopathic toe walking cases that don't respond to conservative treatment, surgery might be considered. This typically happens when:
The child is over age 8-10
Significant fixed tightness limits ankle motion
Conservative treatment for 6-12 months hasn't worked
Quality of life is impacted
Surgical options include Achilles tendon lengthening or gastrocnemius recession. Post-surgical rehabilitation with physiotherapy is essential to maximize outcomes—we guide this process for Port Coquitlam families.
What Happens If Toe Walking Isn't Treated?
Without intervention, chronic toe walking can lead to:
Structural changes: Permanent Achilles shortening, calf contractures, foot deformities, altered bone growth patterns
Functional limitations: Difficulty running, reduced walking endurance, balance problems, pain, trouble with stairs
Social and emotional impact: Self-consciousness about gait, teasing from peers, reduced physical activity participation, lower self-esteem
These potential complications are exactly why we encourage early evaluation.
Supporting Your Child Through Treatment
Treatment requires patience and persistence:
Make it fun: Transform exercises into games, challenges, competitions. Stickers, charts, and rewards work wonders.
Stay consistent: Success depends on daily exercises, not just weekly sessions.
Be patient: Change takes time. Celebrate small wins.
Use positive language: Instead of "don't walk on your toes," try "let's walk like elephants!" or "show me your flat feet!"
Involve caregivers: Ensure teachers and daycare providers understand and can support treatment goals.
Manage your stress: Kids sense anxiety. Take it seriously without projecting worry onto your child.
Most Kids Get Better—Really!
Most children with idiopathic toe walking who receive appropriate physiotherapy achieve normal walking patterns. However, some need ongoing management:
Recurrence: Some kids revert during stress, growth spurts, or when relaxed. Brief "refresher" courses typically resolve this quickly.
Partial resolution: A small percentage maintain subtle gait differences, though usually not enough to cause problems.
Maintenance programs: Some benefit from ongoing monitoring and periodic stretching.
We emphasize realistic expectations while staying optimistic. Most families see significant improvement within the first few months, which makes continuing with home programs so much easier.
Taking the Next Step
If your child toe walks persistently beyond age two, don't wait to see if they'll outgrow it. While some do eventually walk flat-footed without intervention, many develop tightness that becomes harder to address over time.
Getting an early assessment may prevent more intensive intervention later.
Ready to get answers? Book an initial assessment at Capria Care Collective in Coquitlam, or call us at (604) 764-9839.
Your observations matter. Trust your instincts, seek professional evaluation when concerned, and commit to the treatment plan if recommended. With appropriate physiotherapy, the vast majority of children achieve normal walking patterns—preventing long-term complications and ensuring they move confidently throughout childhood and beyond.
We're here to help your child find their footing (literally!). Let's figure this out together.
Capria Care Collective
101 1060 Austin Ave, Coquitlam, BC
(604) 764-9839
Convenient parking • Welcoming space • Parent-focused care
References
Engström, P., & Tedroff, K. (2012). The prevalence and course of idiopathic toe-walking in 5-year-old children. Pediatrics, 130(2), 279-284. https://publications.aap.org/pediatrics
Alvarez, C., De Vera, M., Beauchamp, R., Ward, V., & Black, A. (2007). Classification of idiopathic toe walking based on gait analysis. Gait & Posture, 26(3), 428-435. https://www.sciencedirect.com/journal/gait-and-posture
Dietz, F., Khunsree, S., & Montgomery, C. (2012). Idiopathic toe walking: Evaluation and treatment in the pediatric population. Journal of the American Academy of Orthopaedic Surgeons, 20(5), 292-300. https://journals.lww.com/jpo
Williams, C. M., Tinley, P., Curtin, M., Wakefield, S., & Nielsen, S. (2013). Is idiopathic toe walking really idiopathic? Journal of Child Neurology, 28(1), 71-78. https://journals.sagepub.com/home/jcn