You watch your toddler navigate the world with a happy bounce in their step—literally. They move from room to room on their tiptoes, a common and often endearing sight in early childhood. For many parents, however, this pattern can raise a quiet question: Is this normal, or is it something I should be worried about?

Toe walking is one of the most frequent concerns parents bring to pediatricians and physical therapists. While it’s often a harmless phase that children outgrow, persistent toe walking can sometimes be a sign of an underlying issue that benefits from early intervention. This guide will help you understand the difference between a typical developmental stage and a pattern that warrants a conversation with an expert.

What Is Toe Walking?

Toe walking is a walking pattern where a child walks on the balls of their feet, with their heels not making contact with the ground. It’s very common in children who are first learning to walk as they experiment with different ways to move and balance. For most toddlers under the age of two, intermittent toe walking is not a cause for concern.

If your child sometimes walks on their toes but can also walk with a typical heel-to-toe pattern, can squat down to pick up a toy with their heels on the floor, and seems to be meeting other developmental milestones, they are likely just exploring movement and will probably outgrow the habit on their own.

When to Take a Closer Look: Signs of Concern

The key difference between a passing phase and a potential issue is persistence. If your child is over the age of two and still walks on their toes most of the time, it’s a good idea to pay closer attention.

Here are some signs that suggest it’s time to consult a professional:

• It’s their primary way of walking: Your child walks on their toes more often than not and has been doing so for several months.
• Stiff or tight muscles: You notice that your child’s calf muscles seem very tight, or they have a limited range of motion in their ankle joints.
• They can’t walk flat-footed: When you ask them to “walk like a grown-up,” they seem unable to get their heels down on the floor.
• Poor balance and coordination: They seem clumsier than their peers, fall frequently, or have trouble with activities like running and jumping.
• It’s accompanied by other delays: The toe walking is present alongside delays in other areas, such as speech or social skills.

What Causes Persistent Toe Walking?

When toe walking continues past the toddler years, it’s often referred to as idiopathic toe walking, which means there is no known medical cause. It’s a diagnosis made after ruling out other potential issues.

However, in some cases, persistent toe walking can be linked to underlying conditions:

• Sensory Processing Issues: For some children, especially those on the autism spectrum, toe walking can be a sensory-related behavior. They may not like the sensation of different surfaces on their heels (sensory aversion), or they may toe walk because it provides increased sensory input that helps them feel more organized (sensory seeking).
• Cerebral Palsy: This condition affects muscle tone, coordination, and posture, and can cause stiff muscles that lead to toe walking.
• Muscular Dystrophy: In rare cases, toe walking can be a sign of this condition, which causes progressive muscle weakness.

Why Addressing Toe Walking Is Important

If a child’s toe walking is not addressed, the constant pressure on the balls of their feet can cause the calf muscles and Achilles tendons to become very tight. This can lead to challenges down the road, including:

• Poor balance and an increased risk of falls.
• Difficulty with activities like squatting, running, and jumping.
• Pain in the feet, legs, or back due to improper body mechanics.

How a Pediatric Physical Therapist Can Help

If you have concerns, the best first step is an evaluation with a pediatric physical therapist. They are experts in movement and can determine the cause of your child’s toe walking and create a fun, play-based plan to address it. Physical therapy is the primary and most effective treatment for persistent toe walking.

A physical therapy session might include:

• Gentle Stretching: The therapist will use play-based activities to gently stretch and lengthen tight calf muscles.
• Strengthening Exercises: Fun games like “animal walks” (think bear crawls or frog hops) help strengthen the muscles in the feet and legs needed for a heel-to-toe walking pattern.
• Balance and Coordination Activities: Walking on pillows, jumping over small hurdles, or playing on a scooter board can improve balance and body awareness.
• Sensory Integration: If the toe walking is sensory-related, the therapist might have your child walk barefoot on different textures (like grass, sand, or carpet) to help desensitize their feet.

In some cases, a therapist may also recommend serial casting (a series of casts that progressively stretch the muscle) or braces to help improve ankle motion.

If you’ve noticed that your child is still primarily walking on their toes after age two, don’t “wait and see.” A conversation with your pediatrician or a pediatric physical therapist is a proactive, positive step you can take to address the issue early and ensure your child develops a safe and healthy walking pattern for life.