Idiopathic Toe-Walking: What Parents Need to Know

By: Scott Harvey, MPT

Toe-walking in children without known cause (idiopathic) may seem harmless but in reality can have long-term effects if not addressed early. Here’s what you need to know about idiopathic toe walking (ITW) and how early intervention can help:

What Is ITW?

• ITW is when a child consistently walks on the front of their foot with no heel contact or heels rising more than typical.
• It affects 5-24% of children and is not part of normal development.
• Causes may include:
  • Musculoskeletal issues.
  • Neuromotor or sensory dysfunction (e.g., vestibular challenges).

When Is Toe-Walking Normal?

• New walkers (12-18 months) may toe-walk briefly to improve stability for balance.
• By 18 months, most children transition to a consistent heel strike while walking.

When to Be Concerned

• If your child continues to toe-walk beyond age 2 without improvement.
• If your child can walk with a heel-to-toe pattern but prefers toe-walking.
• If there’s no medical diagnosis to explain the toe-walking.

Why Early Intervention Matters

• Persistent toe-walking can lead to:
  • Painful muscle, ligament, and joint problems.

• Bone deformities in the feet, which are difficult to reverse after age 5.
• Reduced ankle mobility, balance issues, and fatigue.

• Early physical therapy helps:
  • Identify and address underlying causes.

• Prevent habitual toe-walking from becoming permanent.

• Early therapy makes gait retraining easier and more effective.
• For older children, physical therapy and orthotics can still improve outcomes, but intervention may take longer.

Key Takeaway

If your child is still toe-walking six months after they begin walking independently, don’t wait to seek help. Have your child referred for a physical therapy evaluation. Early intervention can prevent long-term issues and supports your child’s overall healthy development.

C&FD physical therapists are available for a complimentary 15 minute phone consultation to discuss any concerns you may have. If you live in the Charlotte area and are wanting to reach out for a consultation you can call us at 704-332-4834 or request an appointment online.