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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

Information:

The exercises listed below should be done 3 times per day.

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

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.

Person stood with hands flat on a wall with one leg behind them, straight, and the other in front bent at the knee

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

Facing a wall with both feet facing forward, With an arch in both feet, and both heels on the floor. Squat down, keeping knees over toes and both heels on the floor, as far as possible until you feel a deep stretch in both calves.

Soleus stretch

Stand in a walking position with the leg to be stretched behind you. Keep an arch in your back foot and your heel on the floor. Hold on to a support. Bend the leg to be stretched as far as possible until you feel a deep stretch in your calf.

Person stood with hands flat on a wall with one leg behind them, bent a little, and the other in front bent at the knee

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

Passive calf stretch

If your child is too young to perform 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.

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  • Hold for 20 seconds.
  • Repeat 5 times.

Balance practise

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

Photograph of person with hands on their waist keeping one leg straight and raising the other at the knee

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.

Illustration of person's legs with toes touching heels

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.

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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.

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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.

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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.

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

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Disclaimer

Please note this is a generic information sheet relating to care at Sheffield Children’s. The details in this resource may not necessarily reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If you have specific questions about how this resource relates to your child, please ask your doctor.

Resource number: PT10

Resource Type: Article

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