When parents see their young children walking on tiptoes, they may first think it is very cute and then might feel a slight bit of concern. When children walk on their tiptoes occasionally, it is usually not a sign of something more serious but just a developmental adaptation. Before 3 years of age, it is completely normal and possibly just a leftover mechanism from when your child was learning to walk. If walking on the tiptoes continues after 3 years of age, it may be a good idea to have the child evaluated for coordination issues, problems with muscles or developmental concerns. This piece will tell you why children walk on tiptoes and what to do when your children walk on tiptoes.
Children Walking on Tiptoes–Is It Normal?
When babies are in the uterus, they are curled up into a ball with their heels tightly pushed against their buttocks and toes downward. This leads to a very tight Achilles tendon that needs adequate time to stretch out after they are born.
At around 12 to 14 months of age, toddlers begin to walk. As this happens, they may walk on the tips of their toes and slowly begin to walk flat footed. After about 3 to 6 months of walking, walking on tiptoes tends to disappear. When toddlers reach the age of 3 they will almost always have feet flat on the floor when standing, but might still run or walk on their toes.
Babies that continue to walk on tiptoes after age 2 or 3 may have a slight chance of having developmental concerns. This sign is often seen in autistic children and children with cerebral palsy. However, there are usually other signs that accompany these disorders.
What Causes Children Walking on Tiptoes?
It is usually not much cause for concern and should go away within the first 2 or 3 years. If it continues, the causes could be attributed to one of the followings:
| Causes | Descriptions |
|---|---|
| Short Achilles tendon |
Some children have an inability to completely stretch the Achilles tendon, which results in an extended period of children walking on tiptoes. This condition will not allow them to stand flat on their feet. |
| Cerebral palsy |
One of the few types of cerebral palsy can affect the feet and walking. Spastic cerebral palsy can cause severe muscle stiffness. This may affect the muscles around the feet and make walking difficult. Brain hemorrhage from being born premature can cause cerebral palsy and walking issues. |
| Periventricular leukomalacia |
Some premature babies can have issues using muscles because of nerve damage in the brain brought on by premature birth. This can lead to toe walking and other difficulties with movement. |
| Spastic Hemiplegia |
This happens when cerebral palsy pulls the Achilles tendon up too tight and children need to walk on their toes because they cannot place their feet flat. |
| Autism and language delays |
When there is toe walking, along with speech difficulties and social delays, this may be a sign of autism. |
| Idiopathic toe walking |
If there are no other symptoms and your child can move the ankle joint normally, the doctor will usually diagnose idiopathic toe walking. This just means there is nothing serious behind the toe walking and it is unexplained. |
Idiopathic Toe Walking
Any child over the age of 3 that continues to walk on their tip toes needs to be evaluated by a physician. If any other condition causing toe walking has been ruled out, children walking on tiptoes after age 3 are diagnosed with “idiopathic toe walking”.
Children who suffer from idiopathic toe walking generally show the following signs:
- Walk on tiptoes of both feet.
- Seem like they are constantly walking on their tiptoes.
- Keep their knees locked and straight when walking.
- Stand with both feet flat at times.
- There is a history of other children in the family that walk on their tiptoes.
How Can You Help Your Children with Home Exercise Programs?
Doing home exercises on a daily basis for children with idiopathic toe walking is very beneficial. Home exercise goals aim to stretch-out the muscles in the calves and bring more strength to muscles in the fronts of the legs. This will help toe walkers walk more normally from heel to toe and stand flat on their feet.
Stretches can help loosen tight calf muscles and increase the range of motion to the ankles. After stretches are done, then your child needs to perform exercises and activities that focus on using the stretched out muscles. These stretches and exercises should be done for the entire time that your child walks on tiptoes.
Depending on your child’s age, exercises and stretches will be tailored to their level and fun for both you and your child.
The table below contains exercises for children who walk on their tiptoes:
1. Exercises for Children under Six years
| Exercise | Descriptions |
|---|---|
| Calf stretch |
1. Your child needs to lay on his or her back on a firm surface. 2. Keep the knee straight and bend the foot up to point towards the knee. Bend it up at the ankle joint as much as your child can tolerate without pain. 3. Return child’s foot to resting position and repeat up to 10 times on each side. |
| Achilles tendon stretch |
1. Your child needs to lay on his or her back on a firm surface. 2. Bend your child’s knee and gently point the toe upwards towards the knee. 3. Hold this position gently for 15 to 30 seconds or as long as your child can tolerate without pain. Return child’s foot to resting position and repeat 10 times. |
| Sit to stand |
1. Your child should be sitting in a small chair so that their feet are touching the floor. 2. Hold both of your child’s legs below the knees and push their feet flat to the floor. Have your child stand up while doing this. 3. You can make this exercise fun by adding in games such as blowing bubbles, singing songs and placing a mirror in front of the chair. |
2. Exercises for Children over Six Years
| Exercise | Description |
|---|---|
| Calf stretch |
1. Place your child standing facing a wall about two feet away. 2. Have him or her place their hands onto the wall at the level of the shoulders. 3. Have them step into the wall with the right foot, keeping the left leg in the same spot and the left heel flat on the floor. 4. Hold the stretch for 10 to 15 seconds and repeat with the opposite side. 5. Repeat this stretch 10 times. |
| Squats |
1. Have your child stand up with feet a hip width apart and flat on the floor. 2. Your child should lower themselves with chest straight, but bend at the hips and knees. 3. Come back up to standing and repeat 10 times. |
| Other Exercises |
1. Walk only on the heels keeping the toes pointed up while walking. 2. March in place raising the knees and placing the feet flat on the floor with each step down. 3. Walk on uneven surfaces or uphill. |
When to See a Doctor
It becomes a concern when children show the following signs after the age of 3 years old:
- Your child has lost motor skills they could at one time perform.
- Most walking is done on the tiptoes.
- Unable to bear own weight flatfooted.
- Muscles seem stiff and tight.
- Cannot perform most small motor functions such as buttoning and zipping.
- Your child is uncoordinated, stumbles and falls and has unbalanced gait when walking.
What A Doctor May Recommend?
1. Do a Thorough Assessment
Your pediatrician will need to do a thorough assessment of your child’s development of motor skills and function of the brain. It is very important to catch any conditions that cause toe walking early in order to order physical therapy and other treatments to prevent permanent damage to joints and muscles.
2. Physical Therapies
A short Achilles tendon can be treated with stretching exercises and physical therapy. Therapists can also prescribe a brace called an “ankle-foot orthosis” to keep the foot at a 90 degree position at all times. This means your child will wear the brace 24/7 except for therapy sessions and bathing.
3. Serial Casting
Doctors can also cast the legs in a treatment called “serial casting”. They use casts of different sizes and positions to help the tendon stretch and improve range of motion to the ankle. Physical therapists believe that actively stretching the ankle is better and casting keeps the ankle in place. The casts cannot be removed for bathing or to perform exercise.
4. Surgery
In cases where the Achilles tendon does not respond to other treatments, surgery may be performed to lengthen the tendon.
5. A Neurological and Developmental Evaluation for Autism or Cerebral Palsy
For autism or cerebral palsy, treatment needs to be aimed at the neurological effects of these diseases. In order to properly treat this condition, a neurological and developmental evaluation will need to be performed to determine the best measures to take.
Want to see how a doctor treats children walking on tiptoes? See the video below:
How to Prevent Children from Walking on Tiptoes
Here are some things you can do right at home to help prevent children from walking on tiptoes:
| Methods | Descriptions |
|---|---|
| Stretching |
Toddlers may not have enough flexibility in the muscles of the calves, ankles and heels. Stretches can help loosen and lengthen the muscles and tendons in the lower leg and ankles. Have your child lay on a firm surface and push the ankles up and hold for 10 to 15 seconds. You can do this same stretch, but bend your child’s knee up while holding the foot up for 10 to 15 seconds. This exercise should not be done to the point that it causes pain for the child. |
| Weights |
Ankle weights can help prevent your child from walking on tiptoes. Make sure these are properly fitted weights done by a therapist and never use adult sized weights. This can help prevent toddlers from walking on tiptoes and assist them with learning to walk flat-footed. After some time using the weights, the tendons can lengthen and your child will get a feel for walking flat footed. |
| Proper shoes |
Shoes with good sturdy soles and support will help prevent children from walking on their toes. Make sure shoes have good ankle support and support for the top of the foot. Make it fun by allowing your child to choose his or her own shoes. Have them wear shoes in the house for most of the day to prevent them from walking on their toes. Make a game by using the shoes for dancing or marching around the house. |
| Tactile training |
This is where learning to walk flat-footed can get fun. Have your child go barefoot and use different tactile things to help your child understand the feeling of walking. Have them stand flat-footed in the grass, sand on the playground or use a tray of rice. You can also have them lie flat on the floor and use a board covered in sandpaper or burlap. Rub the board up and down on his or her flat feet. They will learn the sensation of having the entire feeling all over the foot instead of just on the toes. |
