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Pediatric Pointers

Parents ask, "Is it okay that my child still walks on their toes?" Not as a primary walking or "gait" pattern after the age of 2 years. In young children, walking flat footed, rather than the "new walker" tippy toe walk shown here, should be developed by age 18 to 24 months. Children typically are skilled walkers with a smooth heel-toe rolling pattern by age 3. Toe walking is appropriate and may be present as babies learn their upright balance or in the first 6 months of newly independent walking.

Children who primarily walk on their toes tend to trip often and have difficulty with balance skills, including standing on one foot, which may make it harder for them to go up and down stairs, stand in one place to wait in line at school, stand on one foot to kick a ball or put on pants standing up. Children who toe walk expend 53% more energy than children who walk flat footed.

It is important to have your child evaluated by their PCP and a pediatric physical therapist if they continue to use toe walking as a dominant pattern of walking after the age of two.

Early identification and treatment of children who toe walk is needed to prevent shortening of the ankle muscles (heelcord) and decreased ankle stability (causing decreased balance and tripping with frequent falls and potential for injuries). Children who continue to walk on their toes as a primary means of ambulation could develop muscle contractures of their calf muscles that would later require casting or surgery. Because children are growing and their bones are being molded by the forces that are placed upon them, further foot/ankle, knee, and hip deformities can occur with persistent toe walking.

Therapy for children who toe walk may consist of age-appropriate activities to stretch calf muscles and other foot/ankle structures, evaluating foot/ankle alignment to assess any need for shoe orthotics, specific play activities to strengthen and stretch the ankle muscles, balance activities to activate the ankle muscles and gait training or walking practice on terrains including the treadmill forward, backward and sideways.

Pediatric physical therapists can make stretching and strengthening fun and effective during play that encourages therapeutic exercise, balance reactions and heel toe walking, and families will need to incorporate therapy into their daily activities in a fun yet consistent manner. These concerns are easier to address in the early stages (soon after the age of 2 years or after mastering independent walking for at least 6 months) and outcomes are best when treated at the early ages.

With any questions about a child’s motor skills such as creeping, walking, jumping, running, or outdoor play, consider contacting your child’s PCP with your concerns and request a referral to York Hospital’s pediatric physical therapists at (207) 384-7260; information can be found on our webpage at

www.yorkhospital.com/services/pediatric-rehabilitation.

— Kirsten Berthiaume, PT

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