When a child learns to walk, instinctively, they will begin walking with their feet flat on the ground. As they practice, it’s not uncommon for them to move back and forth between toe walking and walking heel to toe. But if your child is still toe walking after the age of two, it’s recommended to talk to your pediatrician. They may then recommend seeing a physical therapist if toe walking persists.

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Why do some children toe walk?

There are several reasons that children begin walking on their toes. Simply put, some children may feel more stable on their toes than walking heel to toe. If sensory reasons are the cause, the child may have difficulty tolerating pressure through their heels. They may also prefer the sensations they receive from their joints locking out. Another reason a child may walk on their toes is due to a lack of range of motion in their calf muscles (gastrocs).

When to see a specialist

As your child’s coordination and muscles develop, they will begin walking with a flat foot/mid-foot contact. On average, this starts around 18 months of age. According to our pediatric physical therapist, Anne Kender: “If your child still walks on their toes beyond age 2-3, it’s recommended that you talk to your pediatrician.” While many children outgrow this condition, toe walking can be a sign of a neurological disorder, like cerebral palsy.

What are the long-term effects of toe walking?

As you can imagine, toe walking places a great load on the muscles and tendons. Many children who walk on their tiptoes once they become independent may develop foot deformities. This may occur as early as the age of four. These children may demonstrate:

• Ankle range of motion restrictions
• Impaired balance
• Poor postural alignment

If left untreated, toe walking can put your child at further risk for contractures (i.e., shortened muscles), foot deformities and balance issues. In severe cases, your child may need surgical interventions if deformities or contractures are present. Fortunately, physical therapy interventions are often an effective way to help your child.

Physical therapy for toe walking

Physical therapy for toe walking can assist your child in achieving a heel-toe walking pattern. It may also correct any range of motion restrictions, muscle imbalances and postural deformities.

Upon your first visit, your physical therapist will identify the child’s origin for toe-walking. Once the source of the issue is identified, the therapist will determine a care plan.

Treatment methods typically include:

• Stretching
• Strengthening of lower extremities and core
• Balance retraining
• Sensory integration techniques
• Serial casting
• Orthotic training
• Home exercise program

After you finish physical therapy for toe walking, what’s next?

Once your child has successfully completed their PT treatment, you will receive a home exercise program. For children with an established heel-to-toe pattern their home program will be minimal. That is, if they no longer demonstrate weakness or range of motion restrictions.

For children with neurological conditions, they may require intermittent services throughout their lifetime. This additional therapy will help them maintain gains, especially around growth spurts.

Is your child toe walking? ATI may be able to help.

If you are concerned about your child walking on their toes, we first suggest talking with your pediatrician. They will help you determine the next course of action. Should physical therapy be required, don’t hesitate to contact your nearest ATI physical therapy clinic. Our therapists will work with you to see what pediatric therapy options are available for your child.

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For all physical therapists, the goal is to help their patients improve their musculoskeletal health. Whether it is building strength, improving balance, increasing flexibility or another focus, physical therapists work with patients to improve how they move about in their daily life.

The same is true for pediatric physical therapists. Pediatric physical therapists often work in tandem with pediatric occupational therapists to help even the youngest patients learn how to use their bodies and make everyday activities easier.

Get Your Free Physical Therapy Screening

Want to learn more about how physical therapy can help your child? Get a free screening and let us help you start the path to recovery today.

GET MY COMPLIMENTARY SCREENING

Understanding Pediatric Therapy

Pediatric therapy looks a bit different from “regular” physical therapy. For example, an adult may come to treatment with acute knee pain. In this situation, the therapist would have the patient complete a series of modalities or exercises that specifically targets the knee and the areas around it to strengthen, increase mobility and relieve pain.

Pediatric therapy will look much different from an adult session. Instead, a pediatric session uses a play-based approach to address areas of concern.

“The children we treat as pediatric specialists tend to have a comorbidity that limits their ability to stay on task, follow directions or actively participate,” says Carrie Becher, OTRL. “We must be very creative in introducing activities that not only target the problem area but that also keep the child engaged and are age appropriate.”

Unlike adult physical therapy sessions, which may last for a limited number of sessions. A large percentage of children that receive therapy services do not rehabilitate in a short episode of care. Instead, these patients receive long-term treatment over the course of their childhood.

What happens during a Pediatric PT/OT visit?

Most therapy sessions will appear as though the child is playing. In order for the child to earn the benefits of therapy, they need to actively participate and be engaged in their treatment. Each activity is chosen specifically for that child in regard to their therapeutic needs. Our therapists assess each one of their patients to determine what kind of care plan is appropriate for them.

Most children enjoy therapy sessions and look forward to coming.  At ATI, our therapy facility has swings, a zipline, monkey bars, bikes, skates, balance beams, crash mats, floor mats, balls, play kitchen, music toys and fine motor activities. All of these tools help keep our littlest patients excited and engaged in their treatment.

What reasons would my child need to visit a Pediatric PT/OT?

Rather than seeking out therapy because of an injury like many adults, young children may seek out treatment for other reasons. Parents typically seek care because their child is struggling or failing to meet developmental milestones. Such milestone delays may include:

• Motor: Rolling, sitting, crawling, etc.
• Sensory: Visually tracking objects, a regular sleep schedule, increased sensitivity to texture, etc.
• Communication: Babbling, stuttering, hesitancy to speak, etc.
• Feeding: Holding/using utensils, drinking from an open cup, ability to chew a range of food textures, etc.

If you feel that your child may need to seek pediatric physical therapy, it is important to consult your child’s primary doctor. They will work with you to determine the appropriate course of action.

If your doctor encourages you to try therapy, seek out a pediatric therapist first. “I would highly recommend taking a child to pediatric therapist versus a therapist who’s daily patient care is with the adult population,” Becher says. She then wants to assure parents that pediatric occupational and physical therapists have extensive training treating children. Coupled with their experience, these therapists are prepared to develop a proper care plan and offer treatment that is right for your child.

Scheduling an Appointment for Your Child

As previously mentioned, if you feel that pediatric physical or occupational therapy is right for your child, it is important to consult your child’s physician first. If you have already been encouraged to seek out physical therapy, ATI offers pediatric care at a select number of clinics throughout the country, and our therapists are prepared to help your child understand their body and make their everyday life easier.

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