Sometimes the quirky things children do are just cute and don’t indicate anything. Other times, unexpected behavior might be a red flag of an underlying issue. Is toe-walking one of those?

Imagine a tiny, bright-eyed three-year-old tip-toeing joyfully from room to room. You can’t help but be delighted at this adorable child and view the toe-walking as part of a sweet feminine package.

The identical behavior in an equally adorable little boy draws an indulgent smile and the conviction that he will soon grow out of it.

The same child walking on tippy toes at six or seven years old starts to raise concerns.

Children’s development tends to unfold in predictable ways. When we see unexpected behavior, particularly behavior which doesn’t go away, we need to take a deeper look.

That is not to say that all unexpected behavior is a developmental issue. Rather, it serves as a signal to investigate further.

Toe-walking should be investigated for a variety of reasons, not the least of which is safety and an enhanced ability to participate in fun activities such as dance or sports.

What’s the Issue?

For walking and standing, the feet must feel the weight of the body together with feeling the point of contact on the ground.

When it comes to the older child, toe-walking or walking on tippy toes may indicate a muscle problem that stems from an improper message coming from the brain to the lower leg. Often these children have difficulty fully integrating sensations in their feet and ankles.

Here’s a brief rundown of the body’s normal process (physiology) of walking.

When we walk, one leg swings in the air and the other maintains contact with the floor. Once the foot hits the ground during walking, the shorter muscles located deep inside the arches of the foot have a different function than the long muscles that come from the calf. The calf muscles travel across the ankle to reach the toes. The sensations and actions of all the muscles must work together to achieve smooth, effortless walking.

As a young child is learning to walk, the stretch experience of the foot muscles helps all the walking muscles learn their job. The stretch sensation that occurs when the foot contacts the ground informs all the walking muscles to become a little stiffer, so the knee and other joints remain stable and don’t suddenly give way.

(See below for quick definitions of basic muscle terms.)

In an infant, this total tightening pattern of the leg muscles plays an important role in the beginning stages of standing and, eventually, walking. As children’s muscles mature, the muscles must distinguish the total tightening muscle pattern from the dynamic muscle actions. To walk, one must successfully blend and alternate between dynamic muscle motion and tightening/stabilizing action.

As young children mature and develop skill in walking, their ability to know which muscles need to be stiff and which muscles need to be loose and dynamic improves.

The knee joint should be maintained fairly stiff and stable, but the ankle joint needs to be much more nimble and dynamic. Successfully separating out the job of the knee from the job of the ankle, allows for improved function. The speed of walking picks up. Navigating stairs and uneven terrain with sloped surfaces improves.

Why Do Children Walk on Tippy-toes?

The stretch experience that occurs when the foot hits the ground is the result of a stretch to the small muscles located deep in the arches of the foot.

This stretch experience can sometimes be misinterpreted by the brain. When this problem happens, an inappropriate tightening of various groups of muscles throughout the lower legs result. The tight muscle groups cause the heel to lift and will shift the body weight to the front of the foot. Toe-walking feels very compelling and mandatory to these children.

Toe-walking is not an indication of a learning difficulty in the classroom. Academic concerns regarding this walking dysfunction relate to the student’s difficulty accessing the classroom and school campus in a safe manner.

See these Strategies to Try for a few toe-walking solutions.

(Quick Definition: The technical term for a total tightening pattern of muscles is isometric muscle action. Isometric muscle action involves no movement of joints, but rather a tightening of the muscles involved in the action. Dynamic muscle actions are either concentric –  a contraction where the muscle shortens and uses strength to move weight; or eccentric – a contraction that occurs when the muscle lengthens to lower the weight. Think of a bicep curl, where the wrist is in a total tightening pattern, i.e. isometric, and the bicep muscle action is dynamic as it raises the weight and lowers it.)

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Suzanne Cresswell Administrator
Suzanne Cresswell is an occupational and physical therapist who has worked with unique learners for over three decades. Suzanne works to educate and provide proven solutions and strategies to those that parent, instruct and work with unique learners. By creating an understanding of unique learners and their learning behavior, she helps parents, teachers and the students themselves find the ability in learning disability.
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