The Problem with Toe Walking

To be fair, toe walking is a normal stage of development.  I see it a lot when babies are learning to cruise along furniture for instance.  Brand new walkers lead with their toe to take steps.  But after about 18 months, toe walking is not cute and should be addressed by a physical therapist.  Here’s why:

  1. Inefficiency: If you are walking on your toes, you are taking twice as many steps as the typical toddler.  This is exhausting! Not only physically exhausting but mentally challenging as well.  You really can’t concentrate if all you’re thinking about is not falling over.
  2. Skeletal changes:  When we’re young, bones are susceptible to molding. They grow in relation to the force applied to them.  Your heel is meant to be a shock absorber during walking, but if you’re pounding away on the ball of your foot instead (ouch!)  over time you will see a funky looking foot.  This means a wide foot where the arch is very flat (or there is no arch at all) with a skinny heel.  Good luck finding shoes! After about age 3, these bones are set and you’ve got what you’ve got. So early intervention is key!
  3. Muscle Shortening: If kept up long term, toe walking leads to muscles in the lower extremities that are so tight from overuse that you couldn’t get that heel down on the floor if you tried. Again, ouch! Plus how will you wear shoes?!?
  4. Unstable: Walking on your toes is very unstable! Not just at the ankle but it makes the knee unstable too, leading to injuries. Of course, this leads to hip and back pain too.
  5. Can’t stop!: Kids who walk on their toes have muscles that are long where they should be short and vice versa.  This means the muscles can’t work well, and they can’t put on the brakes.  Toe walkers are in constant motion, resulting in more falls and more crashing into things.

Here’s the confusing partToe walking isn’t ever about the toe walking.  It is instead a sign of a bigger problem. In other words, walking on your toes is fulfilling a greater need.  And it’s a need that is worth risking everything mentioned above.  That’s gotta be big! So our job as PT’s is to figure out what that need is.  If we treat only the foot, we won’t see improvement because that underlying need will still be there. Toe walking is very highly correlated to vision impairment and vestibular dysfunction so the “need” could be sensory based.  Or it could be orthopedic or neurological….a skilled PT can help figure it out with you.

Bottom line: If your little one is toe walking past the age of 18 months, please please please don’t “wait and see”. He won’t outgrow it and the potential for change is less the longer you wait.

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