What is Toe Walking?

Before we start talking about toe walking, we need to touch on the different phases of gait (a fancy word for walking). There are EIGHT phases of walking; check out the graphics below to learn more (Kharb et al., 2011)!

Toe walking refers to when the heel of the foot does not touch the ground during the initial contact phase, as well as during the pre-swing phase (Kuihk et al., 2014; Ruzbarsky et al., 2016). Toe walking can be seen among typically developing children as they learn how to walk but typically disappears around three to seven years old (Kuihk et al., 2014; Ruzbarsky et al., 2016)

About 5% of typically developing children toe walk beyond without any underlying concerns (Kuihk et al., 2014).

However, toe walking beyond two years old can be a sign of an underlying health concern, such as neuromuscular disease (Kuihk et al., 2014). Neuromuscular disease refers to an imbalance between the muscles in the lower leg that move the toes upward (think balancing on the heel) and downward (think tip toes) (Kuihk et al., 2014). While toe walking can just impact how it looks when people walk, it can sometimes lead to foot or ankle pain (Ruzbarsky et al., 2016).

Some Do’s and Don’ts of Addressing Toe Walking

DO: See a doctor to ensure there are no underlying health concerns! They may refer you to occupational and/or physical therapy, where more individualized recommendations and interventions can be provided. 

DON’T: Just tell your child to stop walking on their toes. Instructing kiddos to have their heel hit the ground when they walk is often ineffective, likely due to their shortened attention span (Ruzbarsky et al., 2016). As a result, constantly reminding them to walk with their heel hitting the ground can become frustrating for both your child(ren) and you!

DO: Explore your kiddo's senses! A study by Chu and Anderson (2020) found that 75% of individuals who toe-walk face challenges in using vestibular and visual information to assist with balance (click the links to read our blogs on each respective system!). Additionally, some individuals who toe walk experience challenges with proprioception and tactile processing (again, check out the links to learn more!) (Chu & Anderson, 2020). Try out activities that explore each sense to promote your kid’s comfort, such as swinging (vestibular), Where’s Waldo puzzles (visual), climbing (proprioception), or playing in the sand (tactile). Want some more ideas for how to explore each sense in a fun way? Follow our Instagram @senseational_spaces, where we regularly post ideas for sensory play and exploration!

DON’T: Get discouraged! There are many interventions out there to help address toe walking, such as stretching programs, rigid shoe inserts, casting, or fun shoes that squeak when pressure is put on the heel (Ruzbarsky et al., 2016). Refer back to the first “DO”; there are many healthcare professionals trained in this area! 

References

Chu, V., & Anderson, L. (2020). Sensory-processing differences in children with idiopathic toe walking (ITW). The American Journal of Occupational Therapy, 74(4). https://doi.org/10.5014/ajot.2020.74s1-po3205 

Kharb, A., Saini, V., Jain, Y. K., & Dhiman, S. (2011). A review of gait cycle and its parameters. International Journal of Computational Engineering & Management, 13, 78–83. 

Kuijk, A., Kosters, R., Vugts, M., & Geurts, A. (2014). Treatment for idiopathic toe walking: A systematic review of the literature. Journal of Rehabilitation Medicine, 46(10), 945–957. https://doi.org/10.2340/16501977-1881 

Ruzbarsky, J. J., Scher, D., & Dodwell, E. (2016). Toe walking: Causes, epidemiology, assessment, and treatment. Current Opinion in Pediatrics, 28(1), 40–46. https://doi.org/10.1097/mop.0000000000000302