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  • Writer's pictureDr Inyang Takon

Toe-walking in Children - When Should Parents be Concerned?

Toe-walking in young children is common and can sometimes be seen when children are learning to walk. In most children, this resolves by age 2. Persistent toe-walking can occur in some children after this period. Parents are sometimes unsure of when to seek help and whether toe-walking is a cause for concern. Below is some useful information on toe-walking to help guide parents and professionals on when to seek help.

What is Toe-walking?

Children who toe-walk, bear weight on their forefoot and lack heel contact on the floor. Toe-walking is common before age 2. Persistent toe-walking can result in tightness of the calf muscles and limitation of movement across the ankle joint. Children who toe walk can keep up with their peers during physical activities. Some children may have a family history of toe-walking. Children who toe-walk can still place their feet flat on the ground but tend to adopt the toe-walking posture when they walk or run.

What is the cause of Toe-walking?

Many children who toe-walk are said to have Idiopathic toe-walking (no identified cause) however rarely, toe-walking could be secondary to neurological or developmental conditions. Toe-walking could also be habitual. Children with toe-walking may develop tightness at the ankles and knees which further affects their whole gait.

Toe-walking typically affects both legs however in a few cases, the child’s toe-walking may affect one leg. Idiopathic toe-walking occurs after 2 years of age. The child may have tightness of the ankles but have normal movement at the knees.

Some children with neurological causes of toe-walking may have tightness in knees and ankles. Children with Cerebral Palsy, neuromuscular disorders, and problems with the nerves supplying the feet can develop toe-walking.

Speech and language difficulties have been found in a large number of children with toe-walking hence children with persistent toe-walking should be assessed by a Developmental Paediatrician.

What should parents do when they are concerned?

Children who continue to toe walk after age 2 should be seen by the family doctor who will carry out a general assessment of the child to see if there are factors in the birth history that could explain the toe-walking. A referral can be made for further assessment if they are concerned about the child’s toe-walking

Your child will most likely be referred to a Paediatrician for a general developmental review. They will then review your child’s birth, medical, and developmental history and ask about any family history of toe-walking. They will carry out a neurological examination to assess the child’s gait, muscle tone, and check if there is evidence of tightness in the child’s ankles, knees, and hips. The Paediatrician will also review your child’s development. Some children with toe-walking can have additional developmental difficulties such as language and learning problems. The child’s toe-walking may be part of the presentation of developmental delay.

Toe-walking whilst sometimes seen in some children with developmental disorders such as Autism Spectrum Disorder and sensory difficulties is by no means indicative of.

Can Toe-walking be corrected?

Toe-walking can be corrected if identified early. Early treatment involves stretching the joints using exercise recommended by the Physiotherapists. The therapists may recommend a home exercise programme to help stretch your child’s calf muscles and increase movement across the ankle joint.

The physiotherapist may also recommend your child has a cast boot to help with stretching the ankle joint. If there is no improvement from stretching and casting, or the child has severe tightness at the joints, the child may need to have surgical interventions. More recently Botox injections into tight muscles have reduced the need for any operations.

Our doctors will be able to help with an assessment if you have any concerns.

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