Kids that toe-walk after they have fully mastered walking and running (usually 24-30 months) are often accused of avoiding the feeling of their feet on the floor. It certainly looks that way. The truth is usually not so simple, and the solution not so easy to achieve. Getting a toe-walker to use a heel-toe gait pattern means you have to address the reason they choose to use this pattern, and manage any loss of movement at their ankles that has developed.
The great majority of children that I have treated who toe-walk are actually seeking more sensory input, and are getting it by teetering around on the balls of their feet. The vestibular input as they sway, and the proprioceptive input of all that joint pressure and muscle contraction is what they really crave. Touching or not touching the floor has very little to do with it. If a child is a true tactile avoider, it is probably not just on the soles of their feet. Avoiders dislike the feeling of clothing on their skin, food in their mouths, even water splashing them in the bathtub. You know if you have a tactile avoider. Life is a real challenge.
Sensory seekers come in a few different flavors. Some have low muscle tone and are looking for a blast of information that they don’t get when walking with flat feet. Is Low Muscle Tone A Sensory Processing Issue? Some are more drawn to the swish and sway movement as they walk. They love to flip upside down and spin around just for the fun of it. A lot.
Some sensory seekers toe-walk and then intentionally crash into furniture or people. They can use this pattern as a two-fer. They get both the fun of the proprioceptive input and they avoid the challenge of controlling their deceleration as they arrive at their destination. I have worked with toddlers that simply cannot walk to a chair, turn around and sit without ending up on the floor. You can almost see the wheels in their head turning as they decide ” I usually fall anyway. How about just crashing intentionally and making it a game? She will just catch me and I get a hug!”
Because toe-walking is normal (yes, normal!) for very young children just learning to walk and run, it can be ignored long enough to result in shortening of the ankle tendons and weakening of the muscles that move the toes up toward the knee. At this point, a child may not be able to achieve full range of movement easily. Enter the physical therapist for stretching and strengthening.
Here are some simple strategies to address toe walking in it’s early stages, before the Achilles tendon has shortened significantly.
Duck walking: everybody likes ducks. Pretending to be a duck, pointing toes up and out to the side while quacking, is a cute and fun exercise.
Squats: Yes, squats. You can go mega and have a child stand on a 1-3 inch thick book then squat down to pick something up. Big stretch, plus some vestibular action as their head dips down.
Jumping: They have to land on a flat foot with heel contact, and jumping along a path made by tape can be a really fun game.
Choose a high-topped shoe: Go old-school and try a high top sneaker (trainers, tennis shoes, or whatever you call them in your area). First of all, it looks seriously cute on little kids, and it will act as a soft brace to prevent some of the toe-walking. The hard core toe-walkers may actually need an orthotic, so if you still see a lot of pronounced toe walking, consult your pediatrician and see a physiatrist. They can recommend corrective inserts that do more than prevent a child from coming up on their toes. A good orthotic can help a child strengthen the muscles that he wasn’t using while toe-walking.
Give them more vestibular and proprioceptive input: If a child really needs does more sensory information, then there are fun ways to deliver the goods. Swinging, rolling down a hill, climbing walls, yoga, and other absolutely fun activities should be available to them. Of course, a targeted sensory “diet” is a great idea. Well thought-out and intensive activities created by an occupational therapist to satisfy a child’s interests and needs can result in hours of typical movement and positioning for school and play.
Parents and therapists: please submit a comment and add activities that have worked for your children!