Idiopathic Toe Walking

• Most children begin walking at 12 to 15 months of age. Often, in the early stages of walking, children try different foot positions for walking. Walking up on their toes may be part of this.
  • 2-year-old children should walk with their feet flat on the ground.
  • 3-year-old children should walk with a heel-toe pattern.
• If your child continues to walk up on their toes, we call it toe walking. This means your child walks on the balls of their feet, and there is no contact between their heels and the ground.

• There can be medical reasons for this type of walking pattern and a doctor can rule these out.
• Idiopathic toe walking:
  
  • Occurs when your child walks on the balls of both feet, but a doctor has found no medical reason for it (idiopathic means no known cause).
  • Can occur in healthy and typically developing children.

The cause of idiopathic toe walking is unknown. Possible factors include:

• Sensory processing: increased response to touch sensations (tactile processing) or how they sense their body’s position in space (proprioceptive processing)
• Maintaining balance (vestibular processing)
• How their brain thinks about what they see (visual processing)
• Flexibility of leg and foot muscles
• Overall body strength
• Parents or siblings who have a history of toe walking (family history)

The options are:

• Watch and wait: In some cases, idiopathic toe walking may go away on its own.
• Physical therapy: Your child may benefit from strengthening, orthotic management and a home exercise program.
• Stretching braces: We might have your child use these at night.

The options are:

• Physical therapy: strengthening if needed, orthotic management and a home exercise program.
• Occupational therapy: your child may have sensory processing differences, and we will evaluate if they need treatment.
• Orthotics: wearing plastic braces on your child's feet/ankles during night or day to maintain flexibility or block the toe walking.
• Serial casting: a series of casts to stretch your child’s Achilles tendons followed by daytime braces.
• Orthopedic surgery: we may recommend a surgery to lengthen the heel cord (Achilles’ tendon) when your child is age 8 or older.

• Bracing and serial casting effectiveness declines as your child ages and the tendons stiffen.
• Botox injections into muscles are not effective in treating idiopathic toe walking.
• Talk with your child’s healthcare provider to learn about treatment options that may be best for your child.