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  • Alice Hill

Toe walking

Updated: Jul 27, 2020

Toe walking children

What is toe walking?

Toe walking happens when children walk on their tippie toes. A ‘typical’ walking pattern is where the heel makes contact first, followed by the toes. Children who are ‘toe walkers’ do not put their heel down first.

What is idiopathic toe walking?

The word ‘idiopathic’ means ‘unknown cause’. Idiopathic toe walking happens when children walk on their toes beyond the age of 2 but there is no known reason. Nearly 5% of healthy children are idiopathic toe walkers. These children are able to stand with their heels on the ground and walk in a heel-toe pattern when they are asked to do so, but prefer to walk on their toes. The toe walking pattern can then become a habit.

Is toe walking sometimes normal? When should I seek help?

Toe walking is sometimes seen in infants less than 2 years of age who are learning to walk. When the child is otherwise developing normally, there is usually no need for concern. When toe walking persists beyond 2 years of age, the underlying cause should be investigated. Persistent toe walking can lead to shortening of the calf muscles and stiffness in the ankle and foot. It can also cause problems with balance and increase the risk of falling.

Is toe walking always ‘idiopathic’?

Although toe walking is often idiopathic, sometimes there is another underlying cause. Persistent toe walking can also be seen in children with Cerebral Palsy, Autism, Muscular Dystrophy and some other conditions. If your child is otherwise developing normally there is probably no need to be concerned, but if you are concerned about other aspects of their development, or if toe walking persists longer than 2 years of age, you should see your child’s GP, Maternal Child Health Nurse, Paediatrician, Paediatric Physiotherapist or Paediatric Podiatrist.

What can be done to treat toe walking?

The treatment for toe walking depends on the child’s age, the severity and whether it is idiopathic or if there is an underlying cause. Treatment for idiopathic toe walking may include stretches, splinting, and in more severe cases, botox injections to relax the muscles and possibly surgery to lengthen the tight calf muscles.


Van Kuijk, Annette, A.A., Kosters, Ralf., Vugts, Martin. Geurts, Alexander C.H. (2014). Treatment for idiopathic toe walking: a systematic review of the literature. Journal of Rehabilitation Medicine, vol, 46, no.10, pp: 945-957.

Oetgen M.E. & Peden, S. (2012). Idiopathic toe walking. Journal of the American Academy of Orthopedic Surgeons, vol. 20, no. 5, pp. 292-299.

Pomarino, D., Ranirez Llamas, J. & Pomarino, J. (2016). Idiopathic toe walking, Foot & Ankle Specialist, vol. 9, no. 4, pp. 301-306.

Van Bemmel, A.F, Van de Graaf, V.A., Van Den Bekerom, M.P., Vergroesen, D.A. (2014). Outcome after conservative and operative treatment of children with idiopathic toe walking: a systematic review of literature. Musculoskeletal Surgery, vol. 98, no. 2, pp: 87-93.

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