Should Parents Be Concerned About Their Toddler’s Toe Walking?

A lot of parents and therapists ask this question: “Should toe walking be a concern?” Based on my experience, a thorough evaluation by a physician and allied health professionals such as Physical and Occupational Therapists is crucial. Most developmental charts would say that children begin walking around 12-14 months with their feet flat. Some children may start earlier or later, but most children are ambulatory by 18 months unless a medical problem existed which would cause developmental delays. Some children however begin walking on their tip toes instead of placing their feet flat on the ground. This pattern usually disappears within a few months of learning how to walk and may be attributed to motor planning a novel skill. Toe walking with no accompanying physical problems is called Idiopathic Toe Walking and resources would peg disappearance of toe walking by 2 to 3 year of ages. Most parents however become concerned regardless and seek medical advice when they observe their child walking on their toes. If upon evaluation, at any point in time that a child is ambulatory, toe walking becomes a concern if heelcord tightness, ankle instability, hypertonicity, weakness, spasticity, sensory seeking behaviors; to name a few, is/are present. At that point, the physician and/or therapist may make a referral to an orthotist for bracing and provide control at the child’s ankles. A stretching and strengthening program would also help if tightness and weakness are present. A therapy plan including sensory integration, balance training, and motor planning is also a common approach. So should toe walking be a concern? Seek a health professional and let the merits of a thorough evaluation guide your decision.