Toe Walking

Parent Q&A

Help with toe walking! Apr 10, 2019 (0 responses below)
Occupational Therapy for Ideopathic Toe Walker Jul 30, 2016 (3 responses below)
  • Help with toe walking!

    (0 replies)

    Hi folks,

    We have a 5.5 year old who toe walks about 50-60% of time when he is on his feet. We are desperately trying to find a specialist who can actually help with this or hear from anyone on this network who has been successful with remedies, any centers or any particular specialist.

    Our kid has sensory processing and integration difficulties for which we see an OT, we have also done visual therapy to improve eye tracking, depth perception etc. and we have tried physiotherapy as well, although for a short time and an hour a week, nothing seems to be making much of a difference. The toe walking definitely has a sensory element to it but now its become a habit and second nature that by default he is on toes unless reminded, which is all the time. As he is growing his peers are starting to notice it and also question it. We dont want to leave it to luck that one day the habit will go away and want to make sure we try everything to help our kiddo. Appreciate any advice/help here.


  • I am wondering if anyone has witnessed success/progress for kids who have undergone occupational therapy for idiopathic toe walking.  It has been recommended for my 8 year old son, but there are no studies supporting efficacy that I can find.  We have seen neurologists, orthopedic surgeons and physical therapists with mixed results. He did casting about a year ago.  I am concerned about long term damage to his bones and joints if this pattern continues.  Braces correct his gait, but he goes back up as soon as they come off. A lot of kids grow out of it, but I am not sure he will.  I am willing to pay out of pocket for services if they will help, but I do not want to buy snake oil.  All practitioners suspect sensory issues are at the root of his gait issues, still I am not sure how to help him with this, other than nag him to come down on his heels.   

    Hi there! Yes, this is a big concern, and it does seem to me that long term walking on toes will cause damage that will cause pain and disability throughout his life (I am a P.T.) I am not sure about O.T. for this, I love O.T.s, have always felt that I should have gone to O.T. school instead, and have worked in a team with O.T.s for many years, but....generally, lower limbs are not their field. Although a lot of our training overlaps, we have tried to leave the specialized upper limb mechanics to them as they have left the specialized lower limb mechanics to us P.T.s. It also seems that you have tried all of the standard treatments. Casting is so difficult, I really wish that you would have seen results from it. There is an old, old modality that in the distant past we used for people who had knee replacements who could not get their quads going again called Biofeedback. It is not a "sexy" new treatment, not a flashy thing, no company will get rich by selling the treatment or technology so it has kinda fallen by the wayside, but... it is very simple- you place a sensor on one muscle and if it contracts then a beep goes off on a small battery powered machine you carry with you. It can be used to remind a person that the wrong muscle is being used (or I think that we set it so that the beeps would happen stronger and stronger as the quad muscle was used more and more as we were trying to encourage the use of that muscle.) But you can also use it to let someone know that a muscle is being activated that you don't want them to use so that they can be aware of it and stop activating it. It might be worth a try- if he is physically able to come down from his toes but it is just a learned movement pattern that he can't stop repeating when he stops thinking about it (our muscle memory is deep- and very subconscious, so I am not surprised by this), then having an auditory reminder of what is happening physically may allow him to change this deeply ingrained muscle habit. I don't know therapists around here who do this, I am a full time Mom right now and not actively practicing P.T. but it seems that some of the older P.T.s who have been around and have lots of experience might know how to do this. It is non-invasive, non-painful, portable, and also should be fairly inexpensive, as medical stuff goes (-: Just start asking P.T.s that you have worked with about this, if they know any other P.T who has experience using biofeedback. I am thinking that the Alta Bates/Summit Outpatient P.T. clinic there on Telegraph might be a good place to ask, too. Or any of the colleges that give P.T. degrees- the Professors who teach are usually practicing P.T.s and know lots of other P.T.s who do rather specialized things. Good luck to both of you!

    You might look into the HANDLE Institute program, stands for Holistic Approach to Neuro Developmental Learning Efficiency. The local practitioner is Sindy Wilkenson, in Lafayette at the Enhanced Learning and Growth Center. 925-934-3500. See if they can help. Good luck.

    Hello my daughter also walked on her toes, since she was 3 until she was 15 and had Achilles Tendon Lengthening surgery or TAL surgery as it is called.  My daughter also has sensory processing issues.  We tried casting twice and a lot of physical therapy.  The surgery was the only thing that worked for her.  She had it about 18 months ago and she had 100% success so far. In retrospect I wish we did the surgery when she was younger.  She started getting severe back pains when she turned 14th from walking on her toes for all those years.   The surgery took almost all the pain away.  The surgery was outpatient.  Recovery was hard the first few months but it was really worth it.  We were hesitant to put her through major surgery but  we researched it and it has the best results of any treatment option.  She had the surgery at Kaiser Oakland.   You do have to be pushy, our regular pediatrician did not know about this surgery nor did the Physical Therapist at our local Kaiser.  You can e-mail us if you have more questions. 

    Good Luck!

Archived Q&A and Reviews


Serial Casting for Toe Walking

March 2010

I took my 4 1/2 year old son to see Dr. Policy of Children's Hospital about his toe walking. My son has been walking on his toes pretty much since he could walk. We had been working with an OT, and hoping he would eventually outgrow the toe walking, but now he is starting to complain of leg pain, and sometimes wakes up in the middle of the night screaming in pain - which is why I made the appointment with Dr. Policy. The doctor is recommending that we try serial casting - which would involve my son having casts on his legs for four to six weeks. Does anyone have any experience with this? It is not a guarantee that this will stop my son's toe walking, so I'm wondering if anyone has had success or failure with this approach. Concerned Mom

Hello, I know I'm not exactly answering your question, but I felt compelled to reply. My cousin was a toe-walker into her teens. Her parents took her to various doctors but never got it figured out. Just recently a doctor finally diagnosed her with being on the mild end of cerebral palsy, something nobody had ever mentioned. The toe-walking was pretty much her only symptom (which is good, since this disease is not progressive). She just had surgery to lengthen her achilles muscles, which is followed by physical therapy. I don't want to scare you, but it's something you might want to look into. For them, it was a relief to finally figure it out. I wish you and your child the best. Concerned

3 1/2 year old has been a toewalker since he started walking

Jan 2007

My son has been a ''toewalker'' since he started walking. His pediatrician told us not to worry but he has never transitioned out of this way of walking and now I am getting more concerned. I have read that this can cause problems as an adult and also once kids get a bit older they tend to get teased a lot. A lot of information I have read has also talked about surgery, something I want to totally avoid. We are working on talking with my 3 & 1/2 year old son and reminding him to walk on his heels instead of his toes and he will do this but rapidly reverts back to ''his normal'' way of walking on his toes. If any parents have experience with this condition and advice on how they transitioned the behavior, please do let me know. Thanks! Marcy

Has your pediatrician evaluated him for causes of the toe- walking, and felt there was no concern? Or did he/she dismiss it? discusses some factors. Also, this newsletter has some archives about the same issue (see below)

I'm assuming by ''toe walking'' you mean walking up on the balls of the foot rather than the full foot. If this is correct, then I was a toe walker and so is my mom. We both have short achilles tendons which causes us to walk on the balls of our feet, especially in the morning. Mine have stretched out over the years so I only toe walk in the morning before my tendons have stretched out. My mom's a bit worse than me as she never did a lot of athletics so didn't stretch them out as much. But neither of us have had any problems with our feet or our backs or any other structural problem that might be attributed to this. I have heard of people getting surgery for it but I guess it depends on the severity of the toe walking. Try having your child stand with the balls of his feet on the edge of a step (facing up-stairs) and drop his heels down as far as they can go. This is the stretch I did for years to try to lengthen my achilles and it seems to have worked for the most part. Still, I'm more comfortable in shoes with a slight heel than in pure flats. Lifelong Toe Walker

Hi there, I just wanted to let you know that there is nothing to worry about. My son, now 11.5, has been walking on his toes since he began walking at 12 months. He has never been teased by friends or classmates, & does not have any physical problems because of it. In fact, he has the most gorgeously defined muscular calves that I have seen on a child! That in my opinion is not a bad trade off. Toe Walking mom

I don't have any experience with this as a parent, but I was a toe-walker when I was young (preschool age). I remember always walking on my tippy toes when barefoot, and my parents always thought it was weird. I think it was just more comfortable for me (less likely to step on something that would hurt my feet if only part of my foot touched the ground???? Not sure.....). Anyway, I grew out of it on my own, I think by grade school. My gut feeling is not to worry. He'll grow out of it. Andi

Almost 6-y-o's idiopathic toe walking

Sept 2005

Does anyone have any personal experience with idiopathic toe walking, aka we don't know why your son walks on his toes? I'm considering surgery for my son to release his tendons so he won't walk on his toes. He walks on his toes most of the time. And all the time barefoot. The doc's at Children's Hospital,Oakland , Pediatric Othropedics are recommending surgery. He's almost 6 yrs. old, has walked on his toes since he was two. He can walk heel to toe sometimes, but is more comfortable walking on his toes. He's otherwise healthy, coordinated and does amazing well balance wise. We've ruled out CP and other syndroms. I hear this happens frequently as does the surgery. Love to hear anyone elses experiences. Many thanks. a concerned mama

One thing Judith Bluestone mentions in her work is that tiptoe walking suggests intestinal irritation, because the meridian runs through the foot. While this may seem far fetched, perhaps it may help you locate a less dramatic intervention than the suggested surgery. Judith's organization is The HANDLE Institute ( Nori

Dear Concerned Mama, This may sound strange, but how well does your child digest his food? It is possible the toe walking is related to a digestive problem. Many times when food is not fully chewed (sometimes because it is very loud to chew and quieter to just swallow) the enzymes needed for digestion are not released properly, food is not fully digested, intestines get backed up, etc. The heels of the foot have a lot of reflexology points for the digestive system, intestines, etc. In my experience, children who toe walk are often doing so to avoid the pain of putting the foot down and stimulating those painful points. Actually pretty smart of them! Feel free to email me if this sounds plausible and we can talk more about it. Good luck, Sindy

I've never heard of this so I can't give any real specific advice, but as a massage therapist, I've done lots of rehab on various surgeries and some of them completely unnecessary. I'm not saying your son's surgery isn't necessary, but PLEASE check out every possible avenue before consenting to cutting tendons. If they don't know why he does it, how can they say surgery is the helpful approach? Have you spoken to pediatric podiatrists? Osteopaths? Physical Therapists? Pediatric Chiropractors? Try going out of the medical realm. Please, NO SURGERY unless you know that it is the only helpful avenue. Does it hurt him to walk heel to toe? It's possible that from toe walking his leg muscles are so tight that it now may be painful or uncomfortable to stretch and use them as in heel/toe walking. That's my 2 cents. I'd be interested to hear the outcome if you care to e-mail me. Meanwhile, good luck. June

Both my sons walk on their toes, and always have. The toe-walking is more pronounced in the younger son, but both do it. After evaluation of our younger son by a developmental pediatrician (for other reasons), we learned that this is typically an issue of brain wiring. The area of the brain responsible for language also tends to dictate toe walking and many kids with unusual language patterns walk on their toes. Many autistic/Aspergers kids walk on their toes too. Not a causal relationship, but a reflection of the proximity of communication centers to walking centers of the brain. Neither of our sons has autism or Asperger's, though both are gifted, have some social issues, and the younger one's language is unusual (i.e., extremely articulate, almost poetic). We have concluded that we just make oddly wired kids.

We did nothing about our older son's toe walking, and little about the younger son's. We have worked on exercises to assure that his achilles tendon does not get short, and have occasionally tried to find high-top shoes than force the heels down some. (A good idea but hard to do now that high tops are out of style.) The older son is 14 now, and toe walking is no issue for him at all. The younger one is 10, and while some kids have occasionally teased him for walking on his ''tippy toes,'' he seems unperturbed.

Hope this helps. Mom of Toe Walkers

If you have ruled out cerebral palsy, then your best bet is the heel cord lengthening. Children's Hospital Oakland, Orthopaedics have an excellent record. This surgery doesn't always fix the problem, but from evidenced based medicine (research)it is the best option. Anon

5 yr old walks on tiptoes

April 2005

My 5 year old nephew has been walking on tiptoes 99% of time, since age 2. His doctor says he does it for fun and nothing to worry about. We are concerned. Anyone have experience with this? anon

Hi I'm a college freshman who toe walks. I've walked like this since I began walking. I walk like this because of needing more sensory feedback. One should try to consult a PT about this. My parents were told not to worry about this when I was a child anon

One of my daughters (now 18) did this until she was about six. From the time she walked she did it pretty much only on tiptoes, we used to call her the little ballerina. However, the doctor said there was no medical reason for her to be doing it (some kids are born with short tendons/ligaments that make it hard/impossible to stand flat - my husband had surgery for this when he was 4 years old which is why we were concerned with our daughter) and that she would probable grow out of it. So we just let her keep doing it, and she eventually stopped, although every once in a while I still see her standing on her toes (subconciously, and she walks normally now.) Since the doctor is not concerned I wouldn't worry about it. If adults are giving him lots of attention for it, it might be encouraging, however, so I would say just ignore it, and he'll probably grow out of it fairly soon. -Mother of former ballerina

You may want to have your son evaluated for Sensory Integration Disorder. Many children who have Sensory Integration Disorder do this because it heightens the sensorial awareness used for walking. Does he also flap his arms sometimes (or a lot?) Please have him evaluated. It's helpful to learn these things sooner than later, and how relieved you will be if it's just a phase! anon mom w/an early childhood specialist in the family