Walking on the toes or balls of the feet is also known as toe walking. Toe walking is fairly common in children who are just starting to walk. It is a walking pattern where a person walks on the balls of their feet instead of with their heel touching the ground.
When children begin walking, they try different foot positions and walking on their toes may be part of this. By 3 years of age they should walk with a heel-toe pattern. More than half of young children who toe walk will stop doing it on their own by about age 5. Some children keep type walking on and off just for fun. Toe walking out of habit is also known as idiopathic toe walking and can sometimes run in families.
If your child is growing and developing normally, toe walking on its own is unlikely to be a cause for concern. Certain underlying health, medical or developmental conditions can cause a child to walk on their toes. These conditions include cerebral palsy, muscular dystrophy, and autism spectrum disorder. These conditions are sometimes diagnosed before the child starts walking. But sometimes the child’s toe walking is the first sign of this medical or developmental condition. If your child is toe walking, it is important that they are screened for these conditions.
WHEN SHOULD I BE CONCERNED?
If you child is toe walking and-
*stumbles and walks awkwardly
*walks on toes most of the time (over 50% of the time)
*has stiff muscles
*Was born prematurely
*Has previously walked flat footed and has begun to toe walk
*Has fine motor skills that don’t seem to developing normally
*Can’t seem to bear weight on a flat foot
*Loses motor skills that they already had
Idiopathic toe walking can cause
- Contracture of the Achilles Tendon – this is when the Achilles tendon gets so tight that the child can no longer get their heels to the ground. Having a tight Achilles Tendon is problematic in growing legs. When children grow, their bones grow first, and then their muscles slowly stretch and lengthen to match. But if the calf muscle and Achilles Tendon is already tight, it pulls strongly on the growing bone, which can cause pain in the muscle and tendon. This can also mean that the muscle tightness gets worse – which means the toe walking gets worse.
- Pain in the feet – this can be due to the feet over stretching as a result of trying to get the heel to the ground or taking excess weight through the ball of the foot. Normally when walking, we land with our heel first. The heel takes our body weight as we initially load our leg, and then we rock our body weight forwards over the whole of our foot. Children (and adults) who walk on the balls of their feet take all of their weight over the ball of the foot, which contains much smaller bones and many more ligaments. These bones are not designed to take all of our body weight and the ligaments can over stretch in an attempt to get more of the foot in contact with the ground for balance.
- Low back pain – this is in compensation for their body weight being forwards when standing and walking on their toes.
- Difficulty walking up hills – due to the tight calf muscles and Achilles Tendons. In severe cases, children may have difficulty standing still and going up and down stairs because they do not have the balance when they are so high up on the balls of their feet.
WHAT SHOULD I DO NOW?
If your child walks on his/hers toes it is best to see a GP or podiatrist to screen for any underlying medical or developmental conditions.
A full biomechanical assessment would be done by our podiatrists to assess what the underlying issue is. Treatment could include gentle stretching, strengthening exercises, orthotics, footwear advice, in shoe padding/wedging or referring onto a specialist. Our podiatrists would also work with other members in your team such as GP, physiotherapists and paediatricians to help manage the more complex cases.