8 Exercises to Improve Your Child’s Walking Pattern
Adapted from the post “Why Does My Child Toe Walk?”
By Caitlin Lipscomb, PT, DPT
Walking on the toes or the balls of the feet, also known as toe walking, is common in children who are just beginning to walk. As they gain more practice with walking, most children will outgrow this toe walking pattern and begin to walk flat on their feet. But, what if they don’t? Physical therapy can help!
Data shows that there is a higher incidence of toe walking in males as compared to females, and that a family history of toe walking often exists.
What causes toe walking?
Many children find early on that they get around efficiently with a toe walking gait pattern. Eventually, muscle memory takes over and they continue to toe walk as they age. This causes their calf muscles to grow stronger and tighter, making it easier and easier to walk on their toes (and more difficult to walk on flat feet). They do not develop adequate muscle strength and control in the appropriate muscle groups used for “heel-toe” walking.
Other Factors Can Contribute to Toe Walking
Some children are hypersensitive. They may not like the feeling of different surfaces on their bare feet. This may cause them to rise up on their toes to avoid the feeling.
For children who may be hyposensitive, or “sensory seekers”, toe walking increases the force of impact felt during walking. This motivates the child to continue walking this way.
Although it is not clear what specifically causes the abnormality in the child’s gait pattern, research has shown that many children who toe walk also have speech delays and other developmental delays.
Toe walking can also be caused by a number of underlying neuromuscular or musculoskeletal conditions, such as cerebral palsy and club foot.
Idiopathic Toe Walking (ITW) will have a bilateral and symmetrical presentation (toe walking on both feet), as opposed to some other neurologic conditions which may cause unilateral or asymmetric toe walking (toe walking only on one foot).
How do you treat toe walking?
If your child continues to toe walk as they progress beyond the toddler years or you have an older child that toe walks, it is best to consult with your doctor and a physical therapist for a personalized treatment plan.
Our KTL physical therapists can help you and your child with the following:
Stretching tight muscles
Strengthening weak muscles in the legs and core
Improving weight bearing on the heels in various positions
Increasing standing balance on two-feet and on one-foot
Retraining walking patterns
Progressing gross motor skills with appropriate pattern
Obtaining foot orthotics or ankle braces to block toe walking pattern (if needed)
If you have questions or concerns, consider scheduling an assessment for your child.
If you would like to work on toe walking at home, you can try the following exercises to promote a “heel-toe” walking pattern. It is also best to pair these exercises with frequent positive verbal reminders, “Walk with flat feet.”
The Exercises
HAMSTRING STRETCH
Have your child lie on their back with their legs straight. Have them kick one leg up to a 90-degree angle. Support at the top of their thigh with one hand, then gently push at the back of their ankle in an attempt to straighten their leg. Hold for 30-60 seconds as tolerated on each leg. Your child should feel a “pulling” feeling in their hamstring muscle at the back of their thigh.
SQUATS
Have your child stand with their feet flat and positioned shoulder-width apart. Have them complete a deep squat, keeping their toes and knees pointed straight ahead, and then return to standing. Repeat 10 times. You can place puzzle pieces on the floor for your child to pick up and place them in a puzzle board to make it more fun. If your child struggles with a squat, kneel behind them and have them bring their bottom to your leg in order to give them more assistance.
STANDING ON ONE FOOT
Keeping their toes straight ahead, have your child stand on one foot for 5-10 seconds. If they are unable to do this independently, have them balance their foot on a ball. Complete on both feet. Increase the time as they are able. If this is too easy, you can try standing on one foot on an unstable surface, like a pillow.
WALKING ON A CURB OR BALANCE BEAM
Have your child walk slowly along a curb, wooden board, or even a line like it is a balance beam. Encourage them to take large steps and walk with a “heel-toe” pattern. Children who toe walk will attempt to rush through this activity, taking small steps, and shuffling their feet. Hold their hand if they struggle with this activity.
HEEL CORD STRETCH
Have your child lie on their back with their leg straight. Use one of your hands to stabilize their heel and use your other hand to gently push their toes toward their shin. Hold for 30-60 seconds as tolerated on each leg. Your child should feel a “pulling” feeling in their calf muscle.
HEEL WALKING (AKA “DUCK” WALKING)
Have your child walk forward 25-50 feet only bearing weight on their heels. Their toes should not touch the ground at all. You can pretend to be a duck and yell “quack quack!” to make it more fun.
BRIDGES
Have your child lie on their back with their knees bent and their feet planted on the ground. Have them squeeze their bottom to lift their hips up into the air to make a “bridge”. Their shoulders, hips, and knees should be aligned in a diagonal line. Do not let them push up onto their tippy toes. Hold for 3-5 seconds and have them lower their bottom back to the ground. Repeat 10 times.
SEATED TOE TAPS
Have your child sit on a child-sized seat or stool. Their hips and knees should be at a 90-degree angle and their entire foot should be contacting the ground. Have your child “tap” their toes repetitively on the ground. You can place playdough or another squishy surface under the balls of their feet to motivate them to tap up and down. Complete 10-20 times.
If your child is older than 2, struggles with these exercises, and continues to toe walk, it is best to consult with your doctor about a physical therapy referral.
Make an appointment sooner if you notice that your child has extremely tight leg muscles, has frequent trips and falls, or begins to toe walk unexpectedly (with no previous history of toe walking).
Keep in mind that toe walking can be challenging to address, and it may take months or even years for your child to re-train their body to walk exclusively with a heel-toe pattern. Your patience and loving care as they work on these things is the most important thing you can give to them!
ABOUT THE AUTHOR
Caitlin Lipscomb, PT, DPT Physical Therapist
Caitlin has been practicing as a physical therapist for five years and her entire career has been spent in pediatrics. She has a special interest in the use of adaptive sports and community recreation to enhance gross motor skills in children of all ages.