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Should I Be Worried About My Child Toe Walking?

Toe walking refers to a child who walks on his tip toes or doesn’t contact the ground with his heel first when taking a step. This is considered “normal” until sometime between the ages of 2 and 3.  Beyond that age, without any definitive medical reason, it is considered idiopathic toe walking, or toe walking without a known cause – simply a habit the child has developed.

Toe Walking Causes

The definition of toe walking is simple, but what’s not so simple about habitual toe walking is WHY?  There are many possible reasons that children might develop a toe walking pattern and the research does not definitively point to one specific cause.

Are they exhibiting tactile defensiveness in their feet?  Is there a proprioceptive or vestibular problem? Or could toe walking be a warning sign of a neurological disorder like cerebral palsy or muscular dystrophy? Could it be a sign of autism? Is the child’s calf musculature so tight that he can’t put his heel down? Is this simply a habit that could eventually lead to tight calf musculature and the inability to put the heel down?

Not every child who walks on his toes has a serious diagnosis coming down the pike. I have seen several kiddos that simply outgrow the toe walking pattern. Some research indicates that children will outgrow it by the age of 5.

Most often, if a child is showing no signs of developmental delay other than toe walking, he will outgrow this pattern and continue with typical development. As therapists, we are more concerned when toe walking is accompanied by additional sensory processing concerns or other developmental issues.

Treatment for Toe Walking

Many parents wonder how to stop toe walking in their children. Therapeutic treatment for toe walking depends on what the cause is, how strong of a habit it is (do they ever contact the ground with their heels, or are they on their toes all the time?), how tight the gastrocnemius muscles (calf muscles) have become, and what other changes have occurred in the child’s foot and ankle muscles as a result of walking this way.

Treatment methods can include stretching, serial casting (a series of casts applied over time that gradually stretch the heel cords), or botox injections (used to temporarily paralyze the calf muscle so that it is easier to stretch). Bracing can also be used to limit movement, preventing the child from getting up onto his toes (in milder cases, stiff boots or high-top tennis shoes can sometimes have the same effect). In rare and severe cases, surgical lengthening is also an option for treatment.

If the toe walking is caused by a sensory issue related to the child’s inability to tolerate the feeling of the ground on his feet, sensory interventions can be introduced and may include the Wilbarger brushing protocol, proprioceptive input via vibration or deep pressure to the feet or shoulders.

Ultimately, the reasons behind toe walking are often difficult to determine. Even after 8 years of experience in pediatrics, I find this to be one of the most difficult issues of child development to get to the bottom of and to treat.

There are many conflicting views about which treatments work and which ones don’t.  My opinion is that every child is different and will respond differently to any given treatment.  What works for one may not work at all for another.  Either way, toe walking is definitely something to be aware of and to monitor.

What Should You Do?

If your child is over the age of two and walking on his toes regularly, it wouldn’t hurt to consult your pediatrician. You may simply be told that he or she will outgrow it and that may be true…or maybe not. Are there other sensory processing or developmental concerns?  Are you noticing other motor concerns? Are your child’s heel cords getting so tight that he can’t even stand on flat feet if he tries?

If you’re concerned, be sure to speak up at your next appointment with your pediatrician. Be an advocate for your child – you know him better than anyone!  Get things taken care of before something small turns into something that will take more serious measures to correct.

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Patient Reviews

Crystal Scheibe

Great place, glad we found them. Been going to Medina over 2 months now and he loves Lauryn and Kyler. Wish they had more ABA therapy places available... live in Wooster and long drive everyday.

Karrie Swan LaRock

My 11 year old son has dyslexia and has made noticeable gains in working At LLA THERAPY. Katie is strong in her approach toward him and also keeps him comfortable enough to perform well. We will continue visiting both the Fairlawn and Hudson offices and recommend them highly.

Ron Monroe

My 9 year old just completed about 9 months of weekly speech sessions (due to his stuttering) with Matt Hagge at LLA and we are thrilled with the experience and results. What I thought might be a negative (what kid really wants to go to speech class?) was made very positive by Matt, and my son never hesitated or complained when we talked about class. He really enjoyed it and really took what Matt taught him to heart. His speech has been greatly improved and we definitely recommend LLA. Thank you so much!

Heather Dougherty-Pantoja

My son’s Occupational Therapist, Jess, is an amazing OT! She gives practical tips on working with my son at home and school!

Terri Apgar

I cannot say enough good things about LLA Therapy. My daughter was a client of Teal Simmons’ for approximately 2 years and was just released from speech therapy! She was diagnosed with Apraxia in 2015 and worked with Teal twice a week. Through Teal’s application of PROMPT therapy, my daughter had age-appropriate speech after one year. All of the staff we interacted with at LLA were absolutely wonderful. They really care about what they do and making sure your child achieves their goals.

Kelli Geisler Davisson

LLA Therapy has been an excellent experience for my son as well as my family! My son always asks, "When can I go see Ms. Jeannine again, is it Monday??" He has also made huge gains in only 5 months! I would highly recommend LLA and have already shared my experience with friends looking for services!

Victoria Hansford-Price

We are so grateful for our Speech Therapist Ms.Teal. We have seen a great improvement with our sons confidence and communication abilities since we have started "Prompt" therapy. What we love the most about LLA and Ms. Teal is that Kohl feels comfortable and relaxed which has played a critical role in his progress. Thank you Ms. Teal for all you have done.

Laura Lee Hogsett

They have helped in numerous ways. Speech, OT and behavioral. I've had numerous compliments on my son's progress thanks in very large part to LLA. I would recommend LLA before I recommend our local children's hospitals, though they are good, they don't have the staff that LLA does.

Amy Furukawa

We had a great experience with Matt Hagge at LLA! Our Middle School age son was becoming very conscious of his voice, which is nasal due to a cleft palate. Matt helped him to better form his sounds and project his voice in a way that makes the unavoidable nasality less noticeable.Our son is more confident and outgoing & even took on a speaking role in the church play. Matt has the perfect personality to relate with our son, and we would recommend him to anyone needing speech therapy services!

Jessica Havalotti

LLA Therapy has been an excellent experience for our daughter. I would highly recommend LLA. Miss Grace was so amazing and I can't believe how quickly our daughter showed improvement. Thank you!
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