Toe walking is a pattern of walking in which a child walks on the toes or balls of the feet, without touching the heel to the ground.
Toe walking is common to see in children before the age of 2 when they are learning to walk. After age 2, kids learn to walk with a heel-to-toe pattern. In this pattern, a step lands on the heel of the foot, rolls forward on the ball of the foot, and raises the heel to push off with the big toe (Spark people, 2019).
Heel to toe pattern
In some cases, toe walking is caused by an underlying condition:
A short achilles tendon
Autism spectrum disorder (ASD)
Cerebral palsy (CP)
Muscular dystrophy
A spinal cord abnormality
Neurological conditions
Toe walking is typical to see in Autistic children. In many cases it is related to a sensory processing dysfunction in vestibular system, which is responsible for motion, coordination, balance, and spatial orientation.
Vestibular dysfunction in children can lead to motor skill delay, lower muscle tone, incoordination, lack of balance, postural instability, gait dysfunction… etc.
Untreated vestibular dysfunction in children can lead to delayed milestones such as sitting and walking and poor motor coordination later in life. (Mansour Y, et al, 2014) In infants, we may see development delay in milestones, such as sitting, crawling, and walking.
In children, we may see some clumsiness and difficulty with climbing stairs, jumping. You may also see some incoordination, lack of balance and fear of height or movement.
Examples include:
Difficulty with going up and down stairs
Delay in crawling, walking, running, or jumping
Clumsiness, such as tripping over, falling on the ground, bumping into objects, or dropping things frequently
Poor balance and coordination
Afraid of height or movement
How can Occupational Therapy help?
OT works on vestibular stimulation and sensory integration to help stimulate and improve coordination, spatial orientation and sensory regulation of motion and balance.
Toe walking may be a sensory related symptom. Exercises are beneficial and important to improve a child’s coordination and balance in the vestibular system. Children need to play and explore the world. Offer them opportunities with playing, physical activities, sports, outdoor activities are good options to help children with toe walking.
Some examples for physical activities:
Swimming, baseball, basketball, soccer…etc.
Play throwing and catching, kicking a ball, throwing balls at target
Fun activities like dancing, “animal walk”, jumping in squares, jumping on one leg
Animal walk – crab walk, bear walk
Photo credit: Chicago Therapy
Practice, Practice, Practice!
Children can improve their motor skills and sensory processing in coordination and balance through practicing and exercising.
Everyone has their own pace. Therapy goals end with success and function, not perfection.
It may take only 10 tries for some people to succeed, and it may take 20 or even 100 times for other people to succeed. There’s nothing impossible. We all have different starting lines in life, but we all have the potential to be successful and functional in life.
Resources:
Accardo PJ, et al. (2014). Toe walking in autism. researchgate.net/publication/312714636_Toe_Walking_in_Autism
Mansour Y, et al. (2021). Central auditory and vestibular dysfunction are key features of autism spectrum disorder. frontiersin.org/articles/10.3389/fnint.2021.743561/full
https://orthoinfo.aaos.org/en/diseases–conditions/toe-walking/
https://www.mayoclinic.org/diseases-conditions/toe-walking/symptoms-causes/syc-20378410
I am proud to be an occupational therapist. Ella Wu, OTD, OTR/L Doctor of Occupational Therapy