But will they really grow out of it ? Part 2: Toe walking

Toe walking is when a person walks with the front part of their feet making the initial or only contact with the floor. Some toe walkers do get brief heel contact when walking with a bouncy gait but, on the other extreme, some toe walkers are unable to get heel contact even when stationary.

Sometimes parents/caregivers are told by doctors or, anecdotally, by family or friends that their children will grow out of toe walking, flat feet, or w-sitting. When should parents/caregivers be concerned or intercede? The truth is some kids do outgrow any or all those things on their own, but some do need intervention.

Toe walking can be caused by physiological changes such tightness in the muscles of the posterior calf that join with the achielles tendon and/or tightness in the ligaments in the feet and ankles that may block dorsiflexion (the toes moving up toward the calves and away from the floor). Toe walking can also have neurological causes such as Muscular Dystrophy, Autism Spectrum Disorder, spinal cord injuries, or Cerebral Palsy. Finally, research shows that toe walking can be caused by sensory processing difficulties such as seeking increased proprioception from the ankles leading to maintaining calf activation or sensory aversion leading to attempts to keep the heels from touching the ground.

Children (and adults) who toe walk more than 50% of the time or are limited in their ankle mobility and are unable to keep their heels on the ground during a controlled squat to flex the knees to 90 degrees are people who show a need for skilled physical therapy intervention. Additionally, children with known sensory processing difficulties may need occupational therapy to assist with strategies to help with sensory regulation in addition to a potential need to correct postural changes with physical therapy.