Sure we go up on our toes to reach objects out of our
reach, when we are trying to be quiet and not be noticed, when we are trying to
step over puddles, etc.  Walking on our
tip toes becomes a problem when the majority of the time we are walking,
running, jumping, etc. is on our toes. 
Toe walking or tip toeing should be something we do occasionally and not
all of the time. 

does this become a concern for children?
  Toe walking becomes a concern if it continues
past the age of two years and is the main way a child walks, runs, jumps,
plays, or gets around their everyday environments.  Continual toe walking can be as simple as a
habit a child has developed or can potentially point towards something
happening within the muscles, nerves, tissues, and joints of the body.

do some children toe walk when others do not?
  Sometimes toe walking is related to a child
having sensory problems.  It could be
they do not like how the ground feels on their feet, so they begin toe walking
to try and limit the amount of time they actually touch the ground with their
feet.  They may have proprioceptive
concerns which mean the way their bodies are positioned in space feels more
secure when they are up on their tiptoes. 
The same is also possible for children with vestibular (or equilibrium)
concerns who end up toe walking.  They
feel more secure and ‘balanced’ on their toes. Another possibility is children
who have difficulty with motor control and feel more in control of their body
and balance when they toe walk than when they are flat footed.  Most of these areas lead to a child
developing a habit of walking on their toes, which is difficult to break,
especially the longer they walk on their toes. 


If a
child continues to walk on their toes, what are the potential problems which
they may encounter?  
concern children face with long time toe walking typically is tightening of
their calf muscles.  The longer a child
walks on their toes, the greater the possibility for their calf muscles and
their heel cords (muscles and tendons attached to our heels) to become
increasingly tighter and potentially form contractures (significant muscle,
tendon, and ligament tightness in which the child no longer has the ability to
move out of a toe walking position, i.e. they actually become ‘stuck’ in this
position).  If a child ends up with a
contracture of the calf and heel cord, the only solution at that point is
surgical correction.  If a child presents
with a moderate tightening, then serial casting may need to be performed (wearing
of casts for at least 4 weeks in a position to allow a long term stretch to the
muscles, tendons, and ligaments) to help decrease the muscular tightness.  Occasionally, there may be a neurological
reason for a child who walks on their toes. 
This would require meeting with and having tests performed by a

can you do to help your child if they do walk on their toes?
  There are many ways to help if your child
walks on their toes.  If you have
concerns and your child has never received any form of therapy, contact your
primary care physician with your concerns. 
They will then be able to make a referral for your child to receive an
evaluation by a therapist.  Typically,
your child will be referred to a physical therapist to determine how your
child’s toe walking is impacting their everyday life and to help with ideas to
help decrease and eventually extinguish their toe walking habit.  If your child currently is receiving other
therapies and you have concerns, talk to your provider.  They can help your child receive the most
appropriate intervention and let you know how to go about getting the necessary

Vanessa Bishline, PT, MPT                                                                                 

Licensed Physical Therapist
Clinic Therapist, TherapyWorks