A very freshly walking toddler will often walk on their tippy toes as they are finding their balance.

It is typical of early gait development and absolutely nothing to worry about in the first couple of months of walking.

But…..

If your child has been up & walking full-time for more than 3 monthS & they are still up on their tippy toes for the majority of the time (a few steps is fine), it is very likely that they will continue to toe-walk.

• There can be underlying neurological and ‘sensory’ causes of toe-walking, and this is why it is important to get your own child checked for toe-walking if you notice it becoming part of their ‘normal’.

• But there is also ‘ideopathic toe-walking’ which basically means ‘toe-walking for no reason’…. the thing is…….there is almost always a reason. And this is the why older ideopathic toe-walkers are some of the trickiest patients to manage….because that reason doesn’t just disappear. It hangs around. And traditionally, they are left to ‘just grow out of it’. We physios see them when they don’t. And some of them are well on the road to getting surgery.

• We know that without intervention, 50% of children who are ‘ideopathic toe-walkers’ will continue to toe-walk, and in one study, 85% of parents of toe-walkers reported their children had issues such as falling, limping, having flat feet, poor balance, and bunions. For those big ‘ol movement nerds like me, there is a fantastic review of the literature here in this article that discusses the ins and outs of it.

• So that 50% that continue to walk past childhood? What happens to those guys as adults? Contrary to popular belief, adults can also continue to toe-walk (though they might be good at hiding it, & they’re heavier so it’s harder for them to be so bouncy), but the movement patterns remain.

• Some ‘ex’ toe walkers manage to get by without any negative repercussions… but we as physiotherapists often see these adults in the clinic complaining of back pain & chronic issues with their ankles, plantar fascia, achilles, calves & hamstrings. A ‘sway’ back is also common, & this can then lead to issues with core & glute activation: a recipe for back, hip and knee injury.

• So this is the thing Mums and Dads…The long and the short of it?

DON’T JUST WAIT & SEE

• There is a big lack of education in the general medical world about toe-walking. ‘Wait and see’ has been standard advice for ever.

A therapist will have a much better chance of quickly getting your little one back down onto their heels if you get in BEFORE they are 2. I personally don’t believe in waiting until children are 3. And certainly not waiting until they are 4.

• In an ideal world, we would love to see your little one as soon as they start developing those ‘atypical’ patterns. Well before this toe-walking has become an entrenched ‘habit’. It can be as simple as giving a toddler who looks like they might be ‘at risk’ of toe-walking a couple of easy exercises to practice at home with Mum and Dad for a few months. Or popping a little insert into their shoes for a short while. That’s it.

• For those who haven’t sought help early? It’s ok. It’s NEVER too late. We physios are stubborn things and can always find something to work on.

• Many kids toe-walk because of underlying WEAKNESS. They compensate by toe-walking, & this causes the achilles to tighten (not the other way around….it is incredibly rare to be born with tight achilles tendons.)

** Just as a side note though,  premmy babes ARE one group of babies that definitely are at higher risk for toe-walking. Aside from the fact that their neurological system can be very fragile, they also (quite simply) never got ‘squished’ enough to push their heels up against the uterine wall in the last trimester (because they were born before they got big enough to do so). So if they didn’t get to push their heels down in utero, then why would they feel comfortable pushing their heels down onto the ground? So moral of that story is, keep an eye on your ex-premmy’s movement patterns from early on.

• Now back to the treatment…….so if the primary problem for your child’s toe-walking probably isn’t tight achilles?

This means stretching calves & just telling your child to walk with ‘heels down’ won’t do a THING.

•  What does work then? Well we do a lot of cool stuff; Shoe modification, casting and orthotic management, kinesio-taping, sensory work……the list goes on.

• But probably our biggest goal of treatment for toe walkers is STRENGTHENING. Strengthening the core, the trunk, the glutes (and the deep calf muscles actually) & it is NEVER too late to start getting stronger!

If you are concerned about your child’s movement patterns, make sure you see a physiotherapist as well as your GP or paediatrician.

And if you get the old ‘just wait and see’ response, then go and see someone else (or show them this blog if you like).

• And (here she goes again...) start tummy time from week 1. Baby strength all starts from there.

Please share this article with anyone you think might benefit!

Love Alana xx

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