Do you ever notice that your child walks on his or her tiptoes? While toe walking may occur while children are initially learning to walk, they should develop a mature heel-to-toe walking pattern by age two. If your child is still toe walking around this age or beyond, it may be due to underlying difficulties with sensory processing:
- Retained Babinski Reflex: This reflex occurs when the outer edge on the sole of the foot is stroked. The big toe extends upward while the other toes fan outward. This reflex emerges just after birth and integrates between nine months and two years of age. If retained, this reflex may influence tactile and vestibular processing, and can lead to toe walking.
- Tactile Sensitivity: Children who are over-responsive within their tactile systems may experience tactile defensiveness. This can result in walking on their toes as a way to avoid touching the floor.
- Vestibular Processing: Children with difficulty discriminating vestibular input may feel more stable walking on their toes. They may experience an improved sense of where their body is in space from walking on their toes. This is also true for children with low muscle tone, as the added stabilization from toe walking can help them feel more posturally secure while moving through space.
- Seeking Proprioceptive Input: Children may toe walk to seek out additional proprioceptive input through prolonged activation of muscle and joint receptors. This can have a calming effect on the body, as well as help improve body awareness.
Toe walking should be addressed, as it may lead to muscle tightness, compensatory joint pain, and the avoidance of shoes, socks, or uncomfortable surfaces (i.e. grass, sand, etc.). In occupational therapy, toe walking may be addressed through reflex integration and increasing tactile input to the sole of the foot. Further, toe walking can also be addressed by helping children modulate and discriminate vestibular and proprioceptive input. As children process and receive accurate information from their environment, they will be able to better understand where their body is in space and feel more secure as they move through space. Activity ideas may include:
- Animal walks: crab walk, penguin walk, frog jumps
- Picking up objects with toes (i.e. bean bags)
- Balancing objects on top of foot (i.e. socks, bean bags)
- Walk heel-to-toe up an inclined surface or on a balance beam
- Sit on scooter board and propel self forward using heels
- Hold a wall sit
- Stand on a balance board
- Warm up by marching or stomping feet, then walk across different surfaces (i.e. grass, gravel, sand), paint a picture, or ice skate with shaving cream while barefoot