What Is Toe Walking?
Toe walking is when kids prefer to walk up on their toes rather than stepping through their heels. Sometimes it’s just part of play, but when it becomes their main way of walking, whether it’s 50% of the time or 100% of the time, it’s something we want to take a closer look at.
When your child is walking on their toes, they’re not moving through a normal heel-to-toe pattern. Instead, they’re staying lifted, sometimes even landing midfoot to toe. While that might not seem like a big deal at first, over time it can affect the way their muscles and joints develop.
*An important note: Although we will focus on toe walking in younger children, it can also occur in older kids! (I’ve seen kids from 6 to 13 years old who also toe walk), so keep that in mind.
When Should Parents Be Concerned?
If your child is still consistently walking on their toes after the age of two, that’s a good time to check in. It is important to know that it is completely normal for a child to go up on their toes intermittently in the first 3 months of independent walking. If toe walking persists for over 3 months after starting to walk or after 2 years old, it doesn’t automatically mean something is wrong, but catching it early can help prevent issues later.
Starting early helps us “nip it in the bud.” The earlier we identify toe walking, the easier it is to improve flexibility, strength, and coordination before habits or tightness set in.
What Are the Signs to Look For?
Parents often notice toe walking first, but there are other little signs that can help you understand what’s going on.
- Does your child take off their shoes or socks often?
- Do they avoid walking barefoot on certain surfaces?
- Do they seem to dislike certain sensations on their feet, like grass, sand, or textured mats?
Sometimes toe walking is related to sensory preferences. Some kids want more stimulation, and others try to avoid it. Neither is “bad,” but both are important clues in figuring out why your child prefers to stay on their toes.
What Causes Toe Walking?
There are a few possible reasons. Some kids have sensory sensitivities and don’t like the feeling of pressure on their heels. Others like the challenge of balancing up high on their toes. Other times, it can be related to muscle tightness or weakness that affects how the feet and ankles move.
When a child comes in, we do a full evaluation to see what is driving that movement. I’ll have them stand on different textures, (like sand, squishy mats, or even bubble wrap), to see how they respond. We also look at their flexibility, balance, and how strong their feet and legs are.
If their muscles have tightened from always walking on their toes, that can limit their ankle movement, which we call dorsiflexion. Without good dorsiflexion, it becomes harder for them to get their heels down, and over time that can lead to more serious problems, like needing braces (orthotics) or, in severe cases, surgery to lengthen the tendons.
What Does Treatment Look Like?
If your child is toe walking, your pediatrician may give you a referral, but in a direct access state like Arizona, you can go straight to a Spooner clinic without one. In Texas, you can see a physical therapist for up to 30 days before needing a doctor’s referral.
Either way, the first step is a full evaluation to understand whether this is sensory-based, strength-related, or both.
In therapy, we make it fun. Every session is built around games, movement, and play, because that’s how kids learn best. I want kids to feel safe, encouraged, and excited to move. We’ll do activities like frog hops, bear crawls, or standing on one foot “like a flamingo.” These help stretch and strengthen the muscles in their feet and ankles without it feeling like work.
Parents play a big role too. I send every child home with “homework,” which are actually just simple, playful exercises that fit right into your daily routine. Your child might bear crawl to bed or balance like a flamingo while brushing their teeth. Kids learn by play and imitation, so it helps when parents become involved and do the exercises alongside their kids too. Connection and physical therapy in one!
If we’re not making progress after several months, or if a child’s muscles are too tight to correct with exercise alone, we’ll talk about the next steps, such as orthotics or, occasionally, a surgical consult.
What Should Parents Remember?
Most importantly, toe walking is treatable and often without anything invasive. Early physical therapy helps kids build strength, flexibility, and awareness so kids can move comfortably and confidently.
If your child is over two and still spending most of their time up on their toes, trust your instincts and reach out. The earlier we start, the more likely we can help them move through therapy in a fun, positive way that keeps them on track.
Is your child toe walking, and you’d like to have them evaluated by a pediatric physical therapist? Schedule an appointment today!