Idiopathic toe walking (ITW) is a habitual walking pattern that results in weight-bearing occurring through the front of the foot and an absent heel strike. This may look like a child walking high on their tip toes, or hovering their heels during steps.

When learning to walk, occasional toe walking is a typical motor milestone. However, toe walking can become problematic when it becomes a regular, dominant movement pattern. We recommend an assessment for children who are walking on their toes >50% of the time or tightness in the calves is being noted. ITW can lead to contractures or significant tightness of the Achilles tendon near the heel, making it challenging for the child to bring their heel to the ground for the heel-toe walking pattern and complete other motor skills.

As they grow and become more accustomed to walking on their toes, this condition becomes more challenging to address and we recommend seeking a physiotherapy assessment as soon as the issue is noted.

How Physiotherapy Can Help

Physiotherapists use a variety of interventions and approaches to help children with ITW. Some strategies include:

• Strengthening muscles to help the child walk and play with heels down
• Lengthening the calf muscles to allow more range of motion at the ankle
• Sensory work to help the heel feel comfortable contacting the floor and help the child feel comfortable with their posture involving full foot contact
• Motor control interventions to help teach a heel-toe walking pattern
• Balance and proprioception work with full foot contact
• Potential referrals to orthopedist for devices to support goals