Tip Toe Walking in Paediatric

Most children have normal developmental toe walking, but this usually disappears by 24-26 months of age. When a child primarily walks on the balls of the feet and has no part of heel touching the ground, we term this as toe walking.

Causes

• Idiopathic toe walking-is when children age 36months or more walk on their toes and there is no documented neuromotor cause for the same.
• Neuromotor reasons-tightness of multiple muscles of the lower limbs that may be caused due to early injury to the growing brain
• Isolated muscle tightness of gastrocnemius or soleus muscles-commonly named as the calf muscle
• Muscular dystrophy
• Sensory processing disorders-Proprioceptive seeking/tactile defensive
• Poor core strength or hypotonia/Hypertonia
• compensation for other muscular tightness or weakness
• or the child is just learning to get his balance in walking and may need just monitoring and no further treatment

Symptoms

• Walks on toes
• Runs on toes
• Problems in squatting
• Poor balance and frequent tripping

When should the caregiver be concerned?

• Child trips and falls often over obstacles
• Toe walks on one side
• Unable to squat to stand effectively
• Unable to stand in a place with the heels touching the ground

Treatment

• Physiotherapy and Home exercise program
• Orthotic prescription
• Serial casting

Most children recover with the above conservative approach. Some may need further investigations and treatment if presenting alongside with other conditions.

When toe walking persists above 24months, it is recommended to consult your physician.

If treated early we can prevent overloading other weight bearing joints like low back, hip, knee, and ankle that may cause bone growth issues/ abnormal joint loading/ over stretched ligaments/habitual toe walking may cause tightness in the calf muscle thereby causing further injury and or poor biomechanics for the growing child.

To know if your child needs therapy, it is wise to consult your paediatrician or visit the paediatric physiotherapist who can assess and assist you further.

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BY: Nawvi Gopalakrishnan

Pediatric Physiotherapist