Improving quality of life for the differently abled Children & Adults


by Melissa Marviglia,PT,DPT                                              
PT Department Supervisor
Idiopathic or not?

Toe walking is a persistent problem for many of our clients here at LIFE. When you do a search for toe walking on the Internet to find out more information, you will often find that it is described as being “idiopathic”, which means “unknown cause”. Toe walking “just happens” and doctors do not know why. They also say that it is typical for a child to walk on their toes as an infant and that they will simply grow out of it by age 2. When the toe walking persists beyond age 2, then they say that the child has simply developed a habit. As a pediatric physical therapist, I find this to be very frustrating because there definitely are “causes” or reasons for toe walking in children, it is not a typical walking pattern at any age, and finally it is not simply a “habit” that needs to be broken.

What are potential causes of toe walking?

• Core Instability
• Sensory seeking or avoiding
• Foot/ankle instability and alignment problems

Core instability

When a child does not have good core strength and the ability to rotate in their trunk/hips/shoulders, they will not be able to take a long enough step to put their heel down first as they walk. This is because they cannot shift their weight onto the opposite foot long enough to lift their other foot up, swing it through and put their heel down first. Therefore, they lock their knees out for stability to compensate for their weak core and they have to rise up on tiptoes in order to walk with efficiency. You will also notice that a child who is toe-walking does not have a typical arm swing (opposite arm/leg together). This is also due to the lack of trunk/hip/shoulder rotation.

Core instability and lack of trunk rotation can be caused or worsened by an infant not having enough tummy time and crawling time. Crawling is crucial for developing shoulder, core, and hip muscles as well as developing the reciprocal pattern necessary for a typical walking pattern. Premature standing and walking in baby walkers, exersaucers, and the bouncy jump-up seats that are suspended in a doorway can also promote improper muscle patterns. When infants are placed in these, they are learning how to stand in an abnormal neuromuscular pattern of pushing up on their toes. Their hip muscles do not develop properly, and they do not need to use their core muscles to stand. In short, they learn to stand and walk by locking out their knees and walking on tiptoes.

Sensory seeking or avoiding

There are two theories about the sensory reasons why a child toe-walks. One is that a child is avoiding putting their whole foot down on the ground, so they walk on their toes. This is a possibility for some, but usually only holds true when they are barefoot and are walking across a surface that they do not tolerate. The other theory is that a child is seeking out more sensory input or stimulation by walking on their toes. The toes are the most sensitive part of the foot. So when a child is walking high on tiptoes, they are getting a tremendous amount of proprioceptive and tactile input. For children who tend to be sensory seekers, this is a great way to get input. For children who have poor body awareness, being on their toes provides them with more sensory information as to where their bodies are at in space.

Foot/ankle instability and alignment problems

Some children have collapsed arches and ankles that are not in typical alignment. This can be due to low muscle tone, loose ligaments, and/or genetics. When the foot/ankle is in this position, the Achilles tendon is not lengthened in the way it should be with a typical walking pattern. So, the tendon, or “heelcord” as it is also called, becomes tight. The unstable foot/ankle is also cause for a child to rise up on their toes to become more stable.

In conclusion, I hope that I have answered some questions as to why a child may be toe walking. In my next article I will discuss what can be done to address this persistent, but not “idiopathic” problem. If you have any questions about your child, please ask one of our P.T.’s or O.T.’s

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