Tip Toeing

Toe walking (tip toe walking) is where the heel makes little or no contact with the floor when standing and/ or walking. This is a normal part of development when a child first begins to walk and usually resolves by the age of 3 years, but can be seen in children up to an age of 6-7. A child should grow out of this, but if it persists then it is called toe walking. It is more common in boys and can sometimes be seen in several family members.

What problems may occur?

Walking on tip toes generally does not cause the child any pain or discomfort but may result in permanent
changes to the shape of the foot. It can lead to tightening of the calf muscles and shortening of the Achilles tendon, which in turn leads to the child being unable to put their heel on the ground. Children are able to walk, run, and jump on their toes without any problems. It may be reported that the child appears more “wobbly” on their feet, or that they fall over more frequently.

Causes?

The cause of toe walking is unknown, but the following list indicates some of the reasons why a child may toe walk:

• Short calf muscles
• Weaker trunk muscles (muscles of the body excluding head and limbs)
• Habit
• Neurological (brain)/ sensory problems.

• Encourage the child to place their heel on the ground when standing.
• Activities that would encourage the child to place their heel on the ground such as squatting, walking up hill, silly walks such as penguin walking or walks in flippers,
• Games that lift up toes.
• Ensure good well fitted footwear.

Complete calf stretches below:

• A. Position yourself with your hands against the wall as in picture A) ensuring that toes are pointing forwards and heels are on the ground. Leg at the front should be bent and leg out behind should be straight. Hold the stretch for 20-30 seconds then repeat with the other leg. X 3-5 reps.
• B. Position yourself on step as in picture B) ensuring that you are safe and holding on to banister. Go up on your tip toes and then slowly lower your heels down as far as able. Hold when heels at lowest point for 10 seconds. X 10 reps.
• For both A0 and B) it is recommended that you do these exercises little and often during day with a min 3-4 times a day.

• If child is not managing activities they previously did e.g. walking/ jumping/ stairs etc.
• If the toe walking is asymmetrical (not seen on both sides)
• Suspicion of joint or muscle disease – pain, swelling, stiffness, weakness.
• Night pain or constant aches.
• Child is of school age and is unable to:

• • Stand from sitting on the floor without using hands
  • Squat or stand with their heels on the floor
  • Jump with both feet