Toe Walking Toddlers: Is it Normal?

Editor’s Note: Today’s post is written by Pam Lasky, PT, DPT, pediatric physical therapist and Pediatrics Program Manager.

Facebook, Twitter, and various blogs have made raising kids today a whole new ball game. We are inundated with new baby photos, “my child rolled at 2 months” Facebook statuses, and the baby genius who is walking, talking, and riding a bike by 12 months. As a physical therapist who works with a wide variety of children, I am constantly being asked what the “norms” are.  I wanted to take this time to address one of the most common questions I receive as a pediatric physical therapist.

“My 2 year old walks on their toes: is this normal?”

In all honesty, the answer is no. But it isn’t completely abnormal either. When kids learn how to walk, they usually begin walking on their toes. As their sensory symptoms continue to develop and their muscle tone increases in their trunk and lower extremities, children will lower down and begin to develop a more normal heel-toe gait pattern. This usually occurs around 18 months. There are multiple reasons why a child may walk on their toes.

• Tight calves – Kids may have abnormally tight gastrocnemius muscles. The tighter the calf muscle, the harder it is for the heel to make contact with the ground while walking. This can be easily correctable with a stretching program implemented by parents and a pediatric physical therapist.
• Weak core musculature – It’s hard to admit that a young child has a weak core, but it can be apparent in diminished tone throughout the child’s midsection. If they have weakness, they will usually propel themselves onto their toes in order to walk. Another less challenging fix involves a fun strengthening program and physical therapy.
• Sensory integration issues – This is where it can be more difficult to diagnose. Children that are hyperexcitable also tend to jump right up onto their toes, but that doesn’t always mean they have sensory involvement. If it is purely a tactile issue, you will notice your child going onto their toes when they change from carpet to tile or wet to dry. This may be more of an indicator that there is some tactile defensiveness – or the child’s aversion to touch – which can be seen through clothing, shoes, walking surfaces, and fabrics. Please seek advice from a pediatrician, physical therapist, or more importantly an occupational therapist.
• Sometimes kids walk on their toes for no apparent reason. Their muscles aren’t tight, they have no tactile defensiveness, and they have good tone. If this is the case, these kids should be braced to prevent any potential tightness, and a behavior modification program needs to be addressed with the parent.

Now that we’ve gone through a few of the possible causes, here are some quick and easy treatment tips.

• Massage your child’s calf muscles
• Use positive reinforcement for behavioral changes – sticker books, toy cars, etc.
• Have you child walk in flip flops for short periods of time, which can increase heel contact
• For fun, buy a pair of flippers for the pool and walk safely around the house – you won’t see any toe walking!
• Get good shoes – no Crocs or Uggs
• Play with blocks or color in the crouched position

I hope with today’s blog I have offered some insight into this problem and put your mind at ease. Toe walking is very common in toddlers and most will outgrow it. If your child is a toe walker and you are concerned, speak to your pediatrician and encourage them to give you a referral to physical therapy. Pediatric physical therapists can assist in answering your questions and help get your child on track to break this habit. We know that you have the hardest job around as a parent, and we just want to be there to help!