Idiopathic Toe Walking

What is Idiopathic Toe Walking (ITW)?

Idiopathic means a condition which arises spontaneously or the cause is unknown. Therefore Idiopathic Toe Walking (ITW) is walking on the toes when a child or young person’s health and development are normal.

How common is idiopathic toe walking?

Idiopathic toe walking is seen in around 1 in 20 toddlers but this usually resolves without treatment by age 5-10 years.

When should my child see a healthcare professional? 

  • You should consult a healthcare professional, such as your GP or health visitor if:
  • the toe walking is linked with pain, falling over, or difficulties with physical activities that used to be fine
    toe walking is only on 1 leg
  • your child was born prematurely, has speech delay or there is a history of toe walking in the family
    your child cannot get their heels down when requested in standing or walking
    getting heels down makes standing or walking looks awkward

What will a healthcare professional do?

They will ask some questions including how frequently your child walks on their tip toes each day and look at your child’s walking and legs to consider if your child needs further assessment such as a referral to the children's physiotherapy service.

What happens if your child is referred to the children's physiotherapy service?

They will ask further questions about the symptoms your child is experiencing and carry out a physical examination.

What will a physiotherapy examination involve?

A physiotherapist will look at the appearance and feeling of the child's legs and feet, and consider their physical skills and ability.

What might the physiotherapist find and suggest as next steps?

If following an examination the physiotherapist considers the child to have good flexibility in the joints and muscles, and good physical skills when balancing, jumping, kneeling and walking, then we will discharge you and provide advice.

If we find tightness or stiffness in the joints or muscles, or some difficulties with physical skills we will consider a number of options, including:

  • Discharging you with advice which may include exercises to do at home
  • Exercises to do at home to relieve tightness, stiffness and improve physical skills
  • Arranging a follow-up appointment
  • Making a referral to an alternative service

If your child toe walks, these activities can help with flexibility while they are still growing.

  • Heels down stepping
  • Heels down standing
  • Squatting
  • Bear crawling
  • Standing stretches
  • Floor stretches 

A small child walks barefoot on their tiptoes on an orthopedic mat