Toe Walking in Children: A Holistic Perspective from a PT and Mom

As a physical therapist and a mom of a toe walker, I know firsthand how concerning it can be to see your child walking on their toes without an obvious reason. Idiopathic toe walking (ITW) is when a child continues to walk on their toes beyond the typical toddler years without any known neurological or orthopedic cause. Some kids naturally grow out of it, but for others, it sticks around—leading to pain, balance challenges, and long-term posture issues that affect the child's quality of life. But what I’ve learned both professionally and personally is that toe walking isn’t just about the feet. It’s often connected to sensory processing, core stability, and mental health.

 Not all toe walking looks the same, and not all cases happen for the same reasons. Some children have tight calf muscles that make it physically difficult to put their heels down while others do not have any tightness.  A child may seek out the sensation of toe walking, while others may avoid putting their heels down due to discomfort, which is where sensory processing can also play a role — Some children maintain a flat-footed stance when standing but lift slightly when stepping, while others may bounce higher on their toes. For many kids, toe walking isn’t just physical—it’s a way to regulate their nervous system and the mental health piece should be considered. 

There is a lot of variety and that is why a holistic approach to treatment is essential. Physical therapy (PT)  is a key piece of the puzzle, focusing on stretching tight muscles, strengthening weak areas, improving gait patterns with serial casting, lower extremity braces, and/or orthotics. But children who toe walk also benefit from occupational therapy (OT) to address sensory sensitivities that may contribute to the habit. Some children avoid heel contact because they’re seeking more sensory input, while others find it overwhelming. Additionally, mental health support can be crucial, as anxiety and rigid movement patterns often go hand in hand. 

As parents, it’s important to recognize that our child’s toe walking isn’t a reflection of something we did wrong, nor is it a simple habit they can just "stop doing." It requires a team approach that looks at the child as a whole. 

I like to think of treating toe walking as solving a puzzle—each therapy provides a different piece that helps complete the bigger picture of why a child is toe walking and how to support them. PT works on the mechanics of movement, OT addresses sensory and motor planning challenges, and mental health support helps manage any anxiety or behavioral patterns that contribute to toe walking. When all the pieces fit together, children have a greater chance of developing a more natural, comfortable walking pattern and avoiding future complications.

By addressing toe walking from multiple angles, we ensure that our children have a solid foundation, not just for how they walk but for how they engage with the world around them. If toe walking persists despite therapy, a referral to a physiatrist or orthopedic specialist may be necessary to assess for underlying structural issues and determine if additional interventions are needed.

If your child is a toe walker, know that you’re not alone. Trust your instincts, seek out a well-rounded team, and remember that progress takes time. Whether through structured therapy, playful movement activities, or mindfulness techniques to ease anxiety, every step counts—heel strike included!

Dr. Alexa Stevens is a pediatric physical therapist currently practicing at Bumblebee Pediatric Therapy based in NW Washington DC.

The content in this blog should not be used in place of direct medical advice/treatment and is solely for informational purposes. All activities/exercises posted in this blog should be performed with adult supervision, caution, and at your own risk. Bumblebee is not responsible for any injury while performing an activity/exercise that has been posted on this blog. If you have any information on the content of our blog, feel free to contact Alex Koller, at alex@bumblebeepediatrics.com

Works Cited

Barcelos, F. M., Blumetti, F. C., Generoso, T. O., Angeli, L. R. A., & Santos, L. D. L. (2024). Idiopathic toe walking: What’s new? An integrative review. Journal of Foot & Ankle, 18(1), 21–30.

Donne, J., Farrell, M. J., Kolic, J., Powell, J., Fahey, M., & Williams, C. (2022). Two-point discrimination responses in children with idiopathic toe walking: A feasibility fMRI study. Science Progress, 105(4), 368504221132141. https://doi.org/10.1177/00368504221132141

Hines, D., Armstrong-Heimsoth, A., & Schoen, S. A. (2024). A pilot study of idiopathic toe walking: Measures and outcomes. American Journal of Occupational Therapy, 78(Suppl. 2), 7811500076p1. https://doi.org/10.5014/ajot.2024.78S2-PO76

Kaiser, M. L., Schoemaker, M. M., Albaret, J. M., & Geuze, R. H. (2015). What is the evidence of impaired motor skills and motor control among children with attention deficit hyperactivity disorder (ADHD)? Systematic review of the literature. Research in Developmental Disabilities, 36C, 338–357. https://doi.org/10.1016/j.ridd.2014.09.023

Morrow, E., Harris, J., Gelfer, Y., Cashman, J., Kothari, A., & FOOTT-UK Collaborators. (2024). Health-related quality of life in idiopathic toe walkers: A multicenter prospective cross-sectional study. Journal of Pediatric Orthopaedics, 44(4), e357–e360. https://doi.org/10.1097/BPO.0000000000002620