Idiopathic toe walking

What is idiopathic toe walking?

Idiopathic toe walking is a condition where a child walks on their tip toes with no underlying bone, muscle or joint abnormality. ‘Idiopathic’ means that there is no clear cause.

Why does my child walk on their tip toes?

There are usually 2 main reasons. The first is habit and most of these children have walked this way since learning to walk independently. Another reason is there may be some muscle tightness in the calves. This makes it uncomfortable or difficult to walk with a normal heel toe pattern.

Will this cause any harm in the long term?

Most children grow out of it, or it becomes less obvious as they get older.

Is there anything that can stop my child from continuing to toe walk?

The first thing to help is a home exercise and stretch programme. This will stretch the calf muscles so they can feel more comfortable to do the heel-toe pattern when walking. It will take several weeks of daily stretches to have the desired effect on the muscles. The exercises should be performed at least 3 times a day.

Sometimes, this does not change the walking pattern and if there is significant tightness in the calf muscle, serial casting may be offered to help. This is where plaster casts are put on both feet for around 6 weeks to stretch the calf muscles and help break the habit.

Usually the younger a child is at the first intervention, the better the response to stretches and re-learning a normal walking pattern.

Exercises to practise

If your child experiences any pain or difficulty doing any of these exercises please consult your physiotherapist or consultant.

Here is a printable download wallchart of the idiopathic toe walking exercises.

Calf and heels stretches

Gastrocnemius stretch

Stand in a walking position with the leg to be stretched straight behind you and the other leg bent in front of you. Make sure you have an arch in your back foot and your heel on the floor. With your hands on the wall lean forward and feel a stretch in the calf muscle.

Hold for 30 seconds. Repeat 3 times on both legs.

Soleus stretch

Stand facing a wall in a walking position with the leg to be stretched behind you. Bend the back leg and let the weight of your body stretch your calf without lifting the heel off the floor. Make sure you keep an arch on the inside of your foot throughout.

Hold for 30 seconds. Repeat 3 times on both legs.

Passive calf stretch

If your child is too young to do the calf stretches themselves, a parent or carer can stretch the calf for them.

With the knee straight hold your child’s heel with your hand. Keeping the inside of your forearm along the sole (bottom) of the foot, gently bend it up to create a stretch at the back of the leg. Use gentle pressure. Do not use force.

Hold for 20 seconds. Repeat 5 times.

Balance practise

Practise standing on one leg with your heel on the floor.

Aim to stand for 10 to 20 seconds.

Tightrope walking

Walk placing one foot in front of the other, as if you were walking on a tight rope. Make sure your feet are facing forward, with heels touching the floor before your foot goes flat on the floor. The heel of the front foot should be touching the toes of the foot behind, with no gap between each foot. Walk forwards and backwards like this.

Toe tapping

Stand with feet together, try and tap one foot at a time slowly and quietly, keeping your bottom tucked in. You can do this exercise with your back close to the wall.

Repeat 10 to 20 times, 3 times a day.

Heel walking

Practise walking on your heels around the house with your bottom tucked in as much as possible. Try and keep your toes off of the floor.

Strengthening exercises

You may be advised to do some calf strengthening exercises.

Gastrocnemius strengthening

Stand on one leg. Push up onto your toes and slowly lower.

Aim for 10 repetitions, or until your calf muscle feels tired.

Soleus strengthening

Stand on one leg with your knee bent. Push up onto your heels and slowly lower down.

Keep your knee bent throughout this movement.

Aim to repeat 10 times, or until your calf muscle feels tired.