September 2012

Medical: Why Is My Child a Toe Walker?

Author: Jessi Dolnik

There are a few questions pediatric physical therapists get all the time, and this is one of them. But first let’s determine if your child is a toe walker. All children will try out walking on their toes during their development. If you see your child walking flat-footed more than 25 percent of the time, chances are he/she is experimenting with toe walking. If your child is walking on his/her toes most of the time but stands flat-footed, you can consider the child a toe walker. It is important to discuss any concerns with your pediatrician, but here are some of the common causes:

Proprioceptive input. When your joints move, a ligament or tendon is stretched. Receptors in the ligaments and tendons respond to the stretch by sending a message to the brain. Your brain then sends a message to the appropriate muscle to control that movement. If someone has “loose ligaments,” sometimes that feedback doesn’t get to the brain in time and the person will stumble or fall before the muscles are activated to prevent it. As a result, some children will avoid the stumbling by walking on their toes.
Tight muscles. A child may have tightness in the calf muscles (i.e., the gastroc-soleus complex). This can happen as a result of keeping his/her feet plantar flexed (toes pointed) or because the bones are growing faster than the muscles during a growth spurt. If the gastroc is tight, it pulls the heel upward toward the back of the knee, making it difficult to get the heel on the ground, which can make walking challenging. You can stretch the gastroc and resolve the issue. The hard part is to break the habit of walking on the toes.

Sensitivity. A child may have sensitive feet. The tactile input from the feet (sensations felt from the receptors on the bottom of the feet) can be significantly bothersome to certain children, making them prefer to walk on their toes to decrease this input. A child with tactile input issues may be up on his/her toes on some surfaces or when barefoot, but may be flat-footed on other surfaces. However, the child may be up on his/her toes all the time.

So how do you resolve these issues?
-No matter what you think the origin of the problem is, you should stretch the gastroc. Talk to a pediatrician or a pediatric physical therapist about how to do this safely on a child.
-By massaging the bottom of the feet or trying to step on different items, you help the child desensitize his or her feet. You can try sand, dirt, scarves, sandpaper, smooth pebbles, mulch, pillows, or other items that don’t cause pain but are just different from a smooth floor or rug. Think walking on the beach over dry sand, then wet sand, then some shells, etc.
-Sometimes simply reminding the child to put his heels down when he walks is enough to stretch the muscles and retrain the brain.

Occasionally, more serious issues are associated with toe walking. Consult your pediatrician:
-If you notice that your child has stiff movements throughout his/her legs or in one leg and one arm or throughout the extremities.
-If you child falls/trips a lot.
-If your child started walking on flat feet but is now up on his/her toes.
-If your child stands on flat feet but walks on toes.
-If your child is over three years old and engaging in any toe walking.
-If your child has difficulty with social skills.

Jessi Dolnik, MA, CCC-SLP is the founder of Lowcountry Therapy Center. If you have concerns about your child’s development, call (843) 815-6999 or visit www.lowcountrytherapycenter.com.

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