Toe walking

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Has anyone had experience with toe walking in children? My DD is now 4 but since she's been old enough to walk she has always tended to tiptoe / toe-walk. Initially our family doctor said she would grow out of it but by 3 years old, she still hadn't so our Dr. referred us to a physiotherapist. For a few months we worked with her but eventually the physio said she wasn't seeing any improvement.

We went back to our family doctor who then referred us to a podiatrist who x-rayed my DD's feet and ankles and found no abnormalities. Then we were referred to an orthopaedist who recommended putting my DD's legs in plaster casts for 4 weeks to see if she would improve. She improved with this treatment so they then recommended that she wear leg braces for a year.

I got her fitted for leg braces and they were very uncomfortable. At 3, it was a huge hassle getting her to wear them and to find shoes that she could wear over the braces. It was becoming very traumatic for all of us in the family and upsetting for my DD so I discontinued using the braces after a couple of months.

Since then, she still walks on tiptoe a lot of the time but can walk flat on her feet when I ask her to. It seems to be more of a habit than a physical problem. Her preference is for tiptoe but she is not unbalanced or uncoordinated in any way and does gymnastics and ballet without any problems. The physiotherapist suggested that her need to toe-walk might be driven by a weak core so any core-strengthening exercises would help. That is the only useful advice I've had.

Should I be doing more? Should I put her in braces? Or will she just grow out of it as her core strengthens naturally and she gets out of the habit? Has anyone else had DC who toe-walk consistently?

Does it matter?

I toe walked until my mid teens. I don't know whether my parents ever wondered why, it was just an idiosyncrasy. A couple of friends helped me train myself out of it by constantly reminding me at my request when I was 14.

I had overly muscular calves because of it (I think) but otherwise it never really mattered.

Hi, my ds is now 11 but was consistently walking on tip toes until 10 when he had an operation on his leg. His was a bit more complicated as he has one leg slightly longer so was on tip toes to even them out. He had plaster stretches probably about 7 times before he had the strayer release operation. He was never offered the leg braces until after the operation. One important aspect is whether your dd can actually get her heels on the floor still- ds couldn't do this in one leg from 4 until 10 which was worrying. We're so glad he had this surgery as it's made all the difference. Feel free to dm me and we can chat more if you like.

When she stands does she stand with her feet flat? Are both her legs the same length?

Toe walking can be a sign of hip dysplasia. Have they x-rayed her hips?

If they have done all their tests and don't know why then it is probably habit.

I had a friend at school who walked with her feet pointing outwards rather than straight. No reason for it. Eventually, she trained herself to walk with straight feet because she was being picked on

My 5 year old has done this since the age of about 18months.
We have tried leg casts (serial casting) physio etc. She has orthopaedic shoe boots for school (Paedros).
She does ballet as was suggested it would help strengthen core etc. There is no anatomical reason for it just a habit that is now ingrained. After 3 years + of various treatments/approaches we are not much further forward. She can put her feet down flat and walk But it takes more effort and she quickly reverts to her toes.
She does try hard to stop but it is so much easier for her on her toes. Hoping she will.miraculously grow out of it.
Orthpeadics weren't too concerned and just advised continuing physio and stretching tomorrow muscles supple. Possibility.of an operation when she is older if needed to stretch tendons.

I don't know, blueskies - that's why I'm asking. I'm wondering does it matter or if I am overthinking it.

Thanks, @Lolly86 and @MrsJamin - we are on a similar path right now with surgery being mentioned as a last resort but that seems extreme to me unless she is in real need of it. I worry we would put her through a lot of medical intervention and not see much difference at the end of it anyway. Hip issues are something I've been wondering about. They focused on her ankles and feet so far and found no problems. I may mention hip issues to her doctor at the next check-up to see what she says. She does seem to have some core weakness but hopefully ballet / gymnastics will help that.

She can stand with her heels down when I remind her @hannah1992 - what I often do, as advised by physio, is put my hands on her hips and 'root' her to the floor, reminding her 'on your heels' or 'flat feet'. She's back up on her toes in minutes though! I'm beginning to think that she is doing it out of habit, but how do you break the habit?? I notice too that DH has overdeveloped calves and a tendency to toe-walk so maybe it is a genetic thing.

It could be genetic. I don't think there is anything you can do apart from reminding her to stand flat feet etc. Hopefully she will just grow out of it. She is still very young so once she start to get older perhaps she will have more control herself over it.

Yeah there are genetic predispositions, my DH has tight calves and so I think it comes from him a bit. As long as you keep in the system and keep having it reassessed then you'll get good advice. Surgery for a strayer release (lengthening of the calf muscle) did seem drastic and it was a big disruption, but it was SO worth it. Keep doing stretches. She will be fine, its not a huge problem as they get into adolescence and get heavier so there's more weight pressing heels down. As I said, I can give you more info on DM as I would prefer not to say too much on an open forum.

Thanks so much, hannah and MrsJamin. I guess I will keep reminding her to walk heels down and do stretches. Good to know that surgery can be a worthwhile option eventually if we need it.

Ours isn’t a toe walker but leads with his cries so his foot comes down toe then heel rather than the other way around. He seems to be growing about of it with constant reminders to walk properly. A lot of things are just habit with children.

DS toewalked from early on, and like your DD we had him checked out and there was nothing physical contributing to him doing it - it was just habit.

He's 11 now, and still very slightly favours the front part of his foot when walking (looks more "bouncy" IYKWIM) but it doesn't impact him in any way (really good and able sportsman, etc).

My cousin walks in exactly the same way, so I wonder if it's genetic?

If it's just habit, just keep reminding her regularly "heel-toe walking, DD". That helped DS a bit, but she'll grow out of it.

DD is 3 and has also favours toe walking, she's been seen at the hospital and had hip xrays but I'm assuming these are clear as her follow up from the Dec appointment is in June.
She can walk on her feet and does if reminded so I think with her it is habit.

The main issue if left is the muscles, tendons and ligaments could become tight and shorten meaning in the future it could turn into a physical issue where a child can no longer put their heel down
This can also affect the grow plate in the heel.

My older DD at 7 was diagnosed with Severs where toe walking happens as a result of inflammation within the growth plate as the bones and tendons grow at different rates, due to the pain a child will toe walk causing a circle to form as the muscles tighten which then pulls more on the plate and so on.
Luckily my 7yr old with physio and avoiding high impact activities avoided needing splints.

So it's really down to weighing up the discomfort and some level of struggle now or taking the risk and waiting to deal with the potential outcomes later on.

@youlemming yup its the shortening of muscles that can be the problem. A lot of children tip toe walk, and yes you don't see many adults tip toe walking but I do know several who have calf pain from tight muscles. If anyone is considering surgery I would really encourage you to listen to the advice of your orthopaedic doctors, it really benefited my son and we are so glad he had it before his adolescent growth spurt.

Yes, @youlemming - that is my main worry. That if she keeps toe-walking, her calf muscles will shorten and tighten and we will end up needing surgery. If we need it, we need it, of course, but I'd rather avoid major intervention and just encourage her out of the habit now.

It does seem to come from my DH's side. He still toe-walks sometimes if he is in his bare feet, and has overdeveloped calf muscles. His father also has large calf muscles and an oddly crooked posture. I wonder if something is wrong with how the hips develop because hernias also run in that side of the family. Neither of them have or had problems walking or playing sport though so hopefully even if she has inherited this odd posture from them, it won't affect her too much.

My brother toe walked all the time when he was younger, my mum nagged him about it all the time and he did grow out of it.

I remember being told that if he carried on the tendons, etc would grow wrong and he might need an operation but it didn't come to that.

I also walk on my toes if I'm barefoot and toe-heel if I'm walking slowly. I have really high arches as well, don't know if that's related?

My granddaughter does this but not always. She also has very pronounced knock knees. The dr told her mother they were within normal range but when she runs there must be 45cms between her ankles. She’s a very tall seven and a half. Surely this needs treatment?