Why Do Children Walk On Their Tip Toes and How Can Physiotherapy Help?

Why Do Children Walk On Their Tip Toes and How Can Physiotherapy Help?

You may never have noticed, but some children tend to walk up on their toes, rather than keeping their heels down. This is referred to as “toe walking”. But why do they adopt this position? In this article, our physiotherapists discuss the potential causes, and how toe walking can be corrected.

Why do children walk on their toes? Toe walking can be associated with conditions such as cerebral palsy, or in children with sensory difficulties, which can be a feature for some children diagnosed as being on the autistic spectrum. Children with cerebral palsy may have tight Achilles Tendons due to rigidity in their muscles, causing them to have to walk up on their toes. Some children don’t have any reason for toe walking, called idiopathic toe walking, which most children may grow out of by age three.

Read on to find out what conditions present in the form of toe walking, and how it can be corrected with physiotherapy.

A child in a toe walking position.
A child in a toe walking position.

Why Does My Child Walk On Their Tip Toes?

In many cases, the reasons are never known why a child may start to walk on their tip toes. Some children walk on their toes from very early on, or as soon as they are on their feet. Others develop their walk in this position as they get older. So, what are the reasons a child may toe walk? We explore potential causes below:

Cold Feet

Although it may sound strange, many children choose to walk on their toes for some of the time as a game or as a way to avoid a cold floor. This isn’t a cause for concern, as long as your child only does it occasionally. You should think about looking into the issue if the child walks like that most of the time, or they struggle to correct their position by keeping their heels down.

Cerebral Palsy

Toe walking can be very common and many toddlers grow out of it. However, it can be associated with other conditions, such as cerebral palsy (CP). Children with CP may have tight Achilles Tendons due to spasticity (rigidity) in their muscles, and this causes them to have to walk up on their toes. 

If you’d like to find out more about cerebral palsy, read our recent blog post where we discuss what effects the condition has on a child and how physiotherapy can help improve mobility. 

Muscular Dystrophy

Muscular dystrophy is a condition in which a group of muscles gradually weaken. Weakened muscles in the feet or calves of your child could cause them to walk on their tip toes. This may be a cause for concern especially if your child walked normally before starting to toe walk.

If you would like to find out more about muscular dystrophy and the symptoms the condition can present, read one of our in-depth blog posts. In the article linked, we also discuss how physiotherapy can help maintain a child’s mobility and muscle strength.

Autism

Some children who seek sensory feedback (for example children on the Autistic Spectrum) may adopt a toe walking position as a sensory strategy. In a recent study, for example, researchers found that 20% of children with autism walk on their toes most of the time. 

However, toe walking alone isn’t enough to diagnose the condition. If your child or toddler toe walks and also experiences speech delay, stereotypic behaviors, or other signs of autism, you may want to get in touch with your doctor for further advice. 

Idiopathic Toe Walking

For many children, there is no definite reason, which is known as idiopathic toe walking. Most children who are idiopathic toe walkers end up with some degree of tightness in their Achilles Tendon and calf. This is because the calf does not get a full stretch when in a pointed position, as it is when toe walking. But part of toe walking can also be attributed to habit, which is often the hardest part to rectify. Therefore, early intervention with orthopedic physiotherapy can be extremely beneficial.

How Do You Correct Tip Toe Walking?

For children who toe walk, there are several methods of physiotherapy treatment that may help correct the issue. We outline the steps below:

  • Diagnosing the Cause

Firstly, a full physiotherapy assessment would be carried out to diagnose the root cause of the issue. The therapist would look at muscle length, particularly around the calf and Achilles Tendon. They would also assess muscle strength, especially the muscles of the lower limb and core (back, hips and abdominals). 

  • A Tailored Physiotherapy Programme

From their diagnosis, your physiotherapist should then provide you with a bespoke  exercise programme that targets muscle lengthening and strengthening. For younger children, this may involve parents being shown how to stretch certain muscle groups and encourage activities that help to strengthen particular muscles. 

For older children, it may be more appropriate for them to be taught how to stretch and strengthen themselves. They may also use a stretching wedge to specifically stretch the calf muscles.

Regular, daily stretching may also be recommended by your physiotherapist in order to gain some length in the muscles and therefore allow your child to be able to put their heels down more easily. 

  • Further Intervention

For some children, stretching alone may not be enough. These children may require further intervention that can include serial casting (regular plaster casts being applied to the ankles over a period of 4-6 weeks to gain a consistent stretch), splints (made of plastic, they hold the ankle in a certain position, therefore preventing toe walking) or in very severe cases surgery.

Private Paediatric Physiotherapy For Toe Walking From Therapy Stars

If your child is regularly toe walking for unknown reasons, you should take suitable next steps to ensure it is corrected before serious issues arise and cause problems with your child’s ability to walk.

Here at Therapy Stars, we have a team of registered physiotherapists who can help diagnose toe walking causes, along with other orthopedic conditions. Our children’s physiotherapy can help to rectify the problem by implementing various exercises and techniques, bespoke to the needs of your child. 

We are more than happy to simply offer advice and expertise on the best course of action for your child, simply get in touch with our friendly team on admin@therapystars.co.uk or 01948 830583. 

Tip Toe Walking FAQs

When Should My Child Grow Out of Toe Walking?

Toe walking is common in children learning to walk, and usually isn’t a cause for concern. However, your child should stop toe walking by the age of three as they develop balance. If your child is toe walking past this age, you may want to seek a physiotherapist to help rectify idiopathic toe walking, or to potentially diagnose another condition causing your child to toe walk. 

Does Toe Walking Mean Autism?

Although uncommon, toe walking is used as a strategy by autistic children who seek sensory feedback. However, toe walking could be idiopathic or caused by something else, meaning autism is only a likely cause if your child also experiences other Autistic Spectrum Disorder symptoms, such as communication issues, repetitive body movements, or poor eye contact.

Is Walking On Tip Toes a Sign Of ADHD?

Just as toe walking is higher in children with neurodevelopmental conditions, such as autism, there is also a connection to learning disorders. Recent studies found that there are significant levels of idiopathic toe walking found in children with ADHD. However, the connection between the two is not yet known. ADHD could be a cause of your child’s toe walking if they also show other signs of ADHD.