Watching little ones learn to walk can be such an entertaining experience: Seeing them light up at their own mobility, observing their many trials and errors, and admiring their persistence in always trying again, despite the hundreds of falls. With the acquisition of walking, we usually see toddlers hold their arms up high, keep their feet gripped onto the ground’s surface in a wide stance, and waddle side-to-side. But every once in a while, a child will begin walking up on tip-toes instead of on flat feet, something commonly referred to “toe walking.”
Toe walking is common with some underlying diagnoses, such as autism, cerebral palsy, and other neuromuscular disorders. However, toe walking can also occur in isolation, which is referred to as idiopathic toe walking (ITW)—in other words, it occurs for no specific known reason. Despite not knowing exactly why ITW occurs, there are many theories, and as such, ways to hopefully prevent toe walking. While toe walking isn’t particularly harmful at a young age, it can lead to balance and coordination issues, pain, and postural deficits later in life, which is why it’s important to try and prevent it. The following are ways to hopefully prevent the acquisition of toe walking.
Avoid positioning equipment
Toe walking is frequently thought to occur when babies lean forward and rely on external support to hold up their bodies when learning to stand and walk. For example, when a baby is in an exersaucer or a jumper, they learn to lean forward into the support, and their body becomes accustomed to leaning forward during those early standing experiences. Thus, when the child begins to stand independently, they also lean forward and end up on their toes due to their body preferring to position itself so far forward beyond their feet. By avoiding positioning equipment, babies learn to rely on their own musculature to stand and walk, which requires them to keep their heels in contact with the ground.
Avoid walkers and push toys
In order for babies to gain the appropriate balance for walking acquisition, babies must learn to keep their heels in contact with the ground and their booties pushed back over their heels. Think about a mini squat or a typical athletic stance—this is how babies learn to maintain the balance required for independent standing and walking. Babies will gain this balance by allowing them to explore their environment uncontained. While it seems counterintuitive, infant walkers and push toys actually prevent babies from gaining the appropriate balance needed for independent walking. By utilizing walkers and push toys for long periods of time, little ones typically have their first experiences with stepping up on their toes.
Encourage barefoot exploration
Until babies are up and walking independently, shoes are not necessary. Shoes should be used to protect baby’s feet from the environment, and this isn’t necessary until he or she is walking. Until then, it’s important for babies to explore the environment barefoot, as this allows them to experience different textures and surfaces. Being allowed that exploration will allow little ones to desensitize to various textures, and without that desensitization, some little ones may prefer to walk on tip-toes to avoid contact with those textures.
Encourage core activation
In order to maintain that mini squat position for proper walking, babies must have a very strong core. This core strength is built by being allowed lots of tummy time, learning to crawl independently, and rolling around on the floor. Once again, it’s important to allow babies independent exploration of their environments, uncontained by positioning equipment.
Talk to your primary care provider if you’re concerned
As previously mentioned, there can be other reasons why little ones learn to walk on their toes, and your primary care provider can rule out other diagnoses or refer you to appropriate providers. Physical therapy (PT) can be very important for the treatment of toe walking. In PT, little ones will learn how to appropriately activate their core to hold them in the proper postures needed for walking on flat feet. PT can also address any tightness in the ankles or other muscle imbalances that may be contributing to toe walking.
Additionally, PT can advise on the need for bracing or other interventions, such as serial casting, that can help treat toe walking before it becomes painful or leads to other complications. PT can also advise on other services, such as occupational therapy, that can be helpful in addressing any sensory contributors to toe walking. Surgery is recommended to treat toe walking in rarer cases; however, by practicing the above tips and seeking care early, toe walking can successfully be treated conservatively.