Toe-walking in children

Orthopaedic Fact Sheet
Toe-walking in children
This fact sheet is intended to assist, not replace discussion with your doctor or health care professional. It is intended as a guide
only. SA Health do not accept any responsibility and will not be liable for any inaccuracies, omissions, information perceived as
misleading, or the success of any treatment regimen detailed in this fact sheet
Toe Walking
Most children begin to walk between the ages of 10 to 20
months. Some children begin to walk with their tip toes instead of
having their feet flat on the ground. This normally resolves within
the first year of learning to walk. It is almost always gone by the
end of the third year.
Idiopathic toe walking
Idiopathic toe walking is when a child continues to walk on their
tip toes above 3 years of age.
This is usually caused by tight heel cords (Achilles tendon) which
prevent the feet to stay flat when walking despite being able to
stand with feet flat on the floor. Other causes need to be
excluded by your Doctor.
Treatment
A daily home exercise program can be helpful in stretching the calf muscles and strengthening
the muscles on the front of the legs for children with idiopathic toe-walking. This will help your
child to walk with a heel-to-toe pattern. The type of exercises will be dependent upon the child’s
age. Remember to have fun while doing these exercises and encourage play to help use these
muscles.
Stretches and strengthening exercises under 6 years of age
Calf Stretch

Place your child on their back with the knee straight
and leg supported on a comfortable surface

Bend the ankle and bring the foot upwards towards
the head. The stretch should not cause pain

Hold the stretch for 15-30 seconds and bring the foot
back to the normal position and repeat 10 times on
each leg daily

Place your child on their back with the knee bent and
bring your child’s foot upwards towards the head
bending the ankle. The stretch should not cause pain

Hold the stretch for 15-30 seconds and bring the foot
back to the normal position and repeat 10 times on
each leg daily
Achilles tendon Stretch
Sit to stand

Sit your child on a children’s sized chair or stool

Place your hands below their knees and apply a
constant downwards pressure to help keep the
heels on the floor

Ask your child to practice standing up while keeping
the heels on the floor

Make this a fun exercise by playing a game to stand
up to reach objects, high five etc.
Stretches and strengthening exercises 6 years and over:
Calf Stretch

Position your child approximately two feet from a
wall or door. Place both of their hands at shoulder
height against the wall

Ask them to step towards the wall with their left foot
while keeping their right knee straight. Make sure
the heel of the right foot stays on the ground. They
should lean into the wall until a stretch is felt on the
back of the right calf

Hold the stretch for 15-30 seconds then repeat the
stretch 10 times on each leg daily

Other exercises include marching on the spot,
bring your knees up high and then back down with
a flat foot, walking uphill, walking on uneven
surfaces, walking on heels only and practicing
squats
Other exercises
Squats
Footwear
Appropriate footwear can help bring your child’s heels further down. When selecting shoes, keep
in mind:



A high cut shoe with a wide sole provides good foot support
Choose a rigid or firm shoe
The back of the heel should be firm
Other Treatments
Idiopathic toe walking in children is not a serious condition and often resolves by itself. In
addition to stretching and strengthening, treatments may include repeated casting of the feet and
ankles, bracing or a combination of the two. Surgical options to lengthen the Achilles tendons
may be suggested in older children and can be discussed with your Orthopaedic Surgeon and
Physiotherapist.
Some children respond well to simple treatment but can relapse when they grow quickly and
repeat treatment is then needed
Summary
 Toe walking is common in children who begin
walking and usually resolves by the age of 2 years
 A home exercise program may help stretch and
strengthen the muscles around the leg to help
encourage a heel-to-toe walking pattern
 Casting, bracing and other surgical options can be
discussed together with your Orthopaedic
Surgeon and Physiotherapist