Toe Walking!!!

What is Toe Walking?

Toe Walking occurs when children walk on the toes or balls of their feet.

There are several underlying reasons why children Toe walk:

  • Physical: If children have a short Achilles tendon (the tendon which links the lower leg muscles to the heel bone), this can prevent their heel from touching the ground.
  • Neurological: Some neurological conditions, such as Cerebral Palsy or Muscular Dystrophy can impact a child’s posture, muscle tone and motor control.
  • Sensory: Children may toe walk to place more pressure through a smaller surface area of the foot to gain extra tactile (touch) or proprioceptive (movement) sensory input. Conversely, children may toe walk because they are sensitive to the tactile (touch) feedback of the ground under their feet and are attempting to avoid or minimise this feedback.
  • Visual: Standing on one’s toes changes the angle of vision and this can provide a better awareness of surroundings but also be indicative of visual motor difficulties.
  • Regulation: Children may toe walk when they are particularly anxious or heightened, in an attempt to self-regulate or calm themselves down.
  • Habitual: Children who continue to toe walk may do so due to habit and or because the muscles and tendons in their legs have tightened over time.

Different health professionals will look at toe walking differently. Our experience is that many Physiotherapists will treat toe-walking by prescribing lower limb stretches and casting. If a child is prescribed serial casting and the underlying reason for why they are toe-walking hasn’t been addressed, the child will proceed to toe walk again shortly after as their muscle rebuilds.

Occupational Therapists are equipped to explore toe walking by observing the client, gathering information, and determining a treatment plan to target the underlying reason for toe-walking. For a majority of the children we see at OTFC, the underlying reason for toe walking is commonly linked to sensory regulation. Our OTs can address this through a range of sensory integration-based activities and strategies.

As OTs, we consider:

  • The underlying reason for the toe walking.
  • If the toe walking is physical or neurological in nature, we would refer to a suitable Paediatrician.
  • If there is decreased range of motion (i.e. the child cannot move or flex their lower limbs or feet), we may refer to a Physiotherapist for continued support.
  • If there are underlying sensory and regulation causes, we would tailor our therapeutic activities to address this in sessions.
  • If the toe walking is persistent and impacting the child’s walking ability and motor skills, we may refer to a Paediatric Podiatrist. The Podiatrist may recommend suitable footwear or determine whether specialised orthotics may support the child, along with stretches. Podiatrists would also affirm that serial casting would not be their first port of call when treating toe walking.
  • Referring children to an appropriate behavioural optometrist to rule out any visual motor difficulties causing the toe walking.

It is difficult to suggest generalised OT games and activities for toe walking, as the types of activities depend on the underlying reasons why the child toe walks. Having said this, during therapy sessions, the OT may:

  • Assist the child to regulate their senses and emotions well/support the child’s anxiety so the child is less likely to toe walk.
  • Prescribe activities and games on an incline (i.e. walking up a ramp or balance beam) to give the lower limb muscles a stretch.
  • Engage the child with tactile (touch-based) stimulation on the feet (i.e. shaving cream or dried beans on the bottom of the feet).
  • Prescribe jumping, stomping or animal walk activities.


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