You watch your child walk across the floor on the balls of their feet and immediately want to call your pediatrician; but wait, this may be more common than you think. Toe-walking is often associated with neuromuscular conditions including cerebral palsy and muscular dystrophy. It is also a common gait pattern in children diagnosed with autism due to the increased sensory input they receive through the balls of their feet. This gait pattern can be considered normal development when your child is first learning to walk because children ambulate on different areas of their feet.
Many children feel more stable and comfortable walking on the balls of their feet. By the age of 2, children should be walking with total foot contact. If they are continuing to walk on their toes, this may be habitual. When should you be concerned?
Consult with your pediatrician if your child displays stiff muscles, falls frequently, has a decline in motor skills, has pain when trying to walk with total foot contact, is uncoordinated, has delayed speech and fine motor skills or has recently started toe walking after walking with a flat foot or heel to toe foot progression.
What can you do to at home to promote improved gait pattern? Below are some exercises and tips to promote a flat foot and heel to toe foot progressions.
Increase Heel Contact
As stated above, many kids like the sensory input that they receive when contacting the ground with the balls of their feet. A great way to provide sensory input at the heel is add sound when the heel comes in contact with the ground. You can do this by adding toy squeakers to the bottom of their shoes. Another great and affordable option is the Ikiki shoe. This shoe has a built in squeaker at the heel that can be turned on and off as needed. Lastly, have your child walk backwards to increase heel contact with the ground. You can make back walking more difficult by having them walk backwards while pulling your hands or a wagon.
Children that walk on their toes typically display good calf strength, however, they have weakness of their intrinsic foot and anterior lower leg muscles. Some good exercises to address foot musculature include having your child pick up marbles with their toes, curling a towel underneath their toes and performing balance activities on unstable surfaces. Another great way to address intrinsic foot musculature is having your child walk around barefoot. Some exercises to target the shin area include having your child walk on their heels like a duck, scooter board propelling with heels only touching the ground and sitting while placing a small toy or bean bag on the top of their foot while marching in place.
As your child continues to walk on their toes they may display increased tightness of their calf muscles. Have your child stand on a stretching wedge or at an incline while playing with toys or place a piece of paper on the wall and have them draw a picture.
When you observe your child toe-walking, make sure to correct them. Use verbal prompts to promote a heel to toe foot progression, i.e “heel, toe, heel, toe.” Do not forget to give them verbal praise when they are ambulating with proper foot contact.