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What is Toe Walking?

Toe walking, also known as equinus gait, is a condition where a child walks on the balls of their feet or their toes, with little or no contact between the heels and the ground. Toe walking ranges in severity from mild to severe depending on the percentage of time spent toe walking, how high the heels are off the ground, and the negative impact of the toe walking. Toe walking is a common occurrence in young children who are learning to walk, but if it persists beyond the age of three or four, it may be a sign of an underlying neurological or muscular condition. Physiotherapy is an effective treatment option for toe walking, helping to improve muscle strength, balance, and coordination, and restore normal gait patterns.

What are the causes of toe walking?

Toe walking sometimes runs in families. There are several possible causes of toe walking, including:

  • Tight calf muscles: When the calf muscles are too tight, it can limit ankle movement, leading to toe walking.

  • Neurological conditions: Toe walking can be a symptom of certain neurological conditions, such as Cerebral Palsy, spinal cord injuries, or Muscular Dystrophy.

  • Developmental delays: Some children may continue to toe walk due to developmental delays or autism spectrum disorders.

  • Hereditary factors: In some cases, toe walking may be hereditary.

As you can see, there are many different conditions which could be causing your child to toe walk. Keep in mind that some of these conditions are relatively rare. A physiotherapist can assess your child and determine which of these conditions is most likely to be causing your child’s toe walking. A physiotherapist may refer you to a paediatrician to make a diagnosis.

How Can Physiotherapy Help?

Often toe walking will resolve on its own. Physiotherapy is an effective treatment option for toe walking that persists, with a focus on improving muscle strength, balance, coordination, and mobility. Here are some of the physiotherapy techniques used to treat toe walking:

Stretching exercises:

  • To help relieve tight calf muscles, a physiotherapist will prescribe stretching exercises that can be performed at home. These exercises can help to improve ankle range of motion and reduce the need for toe walking.

  • Weakness in the muscles of the feet and lower legs can contribute to toe walking. A physiotherapist can prescribe strengthening exercises that target these muscles to improve strength and control.

Balance and coordination exercises:

  • Toe walking can be a sign of poor balance and coordination. A physiotherapist can design exercises that challenge these skills, helping to improve balance and coordination and reduce the risk of falls.

Gait training:

  • A physiotherapist can work with a child to improve their gait pattern, helping to promote a normal heel-to-toe walking pattern.


  • The use shoes with a stiff sole or high-top boots may help reduce or stop toe walking in some children, promoting heel contact in their gait.


  • In some cases, a physiotherapist may recommend orthotics, such as braces or splints or carbon fibre foot plates, to help correct foot position and promote a normal gait pattern.

In summary, physiotherapy is an effective treatment option for toe walking, helping to improve muscle strength, balance, coordination, and mobility. A physiotherapist can design a treatment plan that is tailored to the individual's needs, helping them to overcome the challenges of toe walking and restore normal gait patterns. If toe walking persists with physiotherapy treatment, your physiotherapist can refer you onto a paediatrician or orthopaedic surgeon for further intervention.

When should my child see a physiotherapist about toe walking?

  • Their toe walking happens every time they walk

  • Their toe walking is one sided

  • Their toe walking is getting worse

  • They cannot stand with their heels on the ground

  • They trip or fall a lot for their age

Each child is unique! Your child is unique and needs a treatment plan which is tailored to their individual needs. Speak to your physiotherapist or other health professional about your child’s toe walking if you have concerns and if you need, our team of physios are only a call or email away!

Thank you for reading this blog!

Wishing you the best,

Kirsty and the team at Physiotherapy for Children

Kirsty Buhlert-Smith

Paediatric physiotherapist

Physiotherapy for Children

0421 886 691


Toe walking in children. The Mayo Clinic:


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