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Why do children walk on their tiptoes?

We see many children walk on their tiptoes, and parents wonder why this occurs and if it is cause for concern.  Children walk on their tiptoes for many different reasons.  I would like to address a few of the many possible reasons we see in children who walk on their tiptoes:  

Sometimes, children are just playing with weight shifting and balance;  It can be fun to figure out limits of how high you can transition up on your toes before going too far and toppling over or catching their balance at the last possible second.  

Other times, children have tactile sensitivities; they will transition high on his/her tiptoes to avoid physical contact with the less desired surface.  For these children, grass feels may feel like razors and sand feels like glass.  

Sometimes, children struggle to understand where their body is in space; they are seeking additional information to understand his/her body in space.  By going up tiptoes, it provides the child increased feedback to the nervous system.  Also, children who are in jumpers or walkers can tighten heal cords by habitually bearing weight through the front of the foot.  

An additional reason a child could walk on tiptoes is due to a visual deficit; the child is going on tiptoes as a visual compensatory strategy. At times, due to chronic and habitual tiptoe walking, this becomes an anatomical issue, requiring orthotics or even surgery to lengthen heal cords.  

Is occupational therapy needed?

Some tiptoe walkers benefit from occupational therapy; Occupational therapy will deal with the underlying cause of the reason they choose to walk, stand or run with this posture.  

The occupational therapist would first assess the child; the parent or caregiver would be asked many targeted questions so the OT can gain a better understanding of the reasons for transitioning to tiptoes and to determine if intervention is warranted.  

If services are deemed to be beneficial; the therapist would create a customized treatment plan depending on the child and the underlying reason for walking using this pattern.  

What therapy intervention might be recommended?

If tactile sensitivities are present, various desensitization strategies would be implemented to gain increased tolerance of placing the whole foot on the ground. This would be through gradually increasing the challenges of textures using different textures, pressures and therapeutic ‘prep work’ to feel more comfortable with these textures.

Sometimes children are very active, have a high pain threshold, are a ‘bull in a china shop’, less coordinated, and may flap hands;  These may be children who are looking for extra information about their body, and tiptoe walking is one strategy to increase feedback.  They are often times our ‘movers and shakers’ who struggle to sit and focus because they are so focused on gaining more feedback to their bodies.  For these children, they will likely benefit from activities to understand their body.  Often times, this is through a variety of heavy work opportunities and activities to calm and organize the body.  Sometimes, massage, joint compressions, weighted items, or pressure vests provide improved understanding of a child’s body, and a by-product is improved foot alignment.

What should a parent be mindful of?

Many children love to go in jumper and bouncers, but beware!  These pieces of equipment don’t help with development and the encourage tiptoe walking. Johnny Jumpers and walkers promote less desired patterns, and the tiptoe position learned in the equipment can then  transition to standing and walking alignment.  Sometimes, this results in shortened heal cords, which can require therapy and sometimes orthotics and even surgery.  This reason for tiptoe walking is an easy fix…don’t place your child in these types of equipment that encourage this alignment. 

Vision is such an important piece of body awareness.  If there is a visual issue at play, at times, children will transition to tiptoes as a way to gain understanding of the his/her body.  For these children, it is often times worth seeing a developmental optometrist to gain an in-depth understanding of functional vision and any needed intervention.  Occupational therapy can also help target visual tracking/scanning the environment, using depth perception, and bringing gaze from close to distant objects in a seamless fashion.  This is essential to avoid obstacles, navigate equipment at the part, and go on the stairs.  Sometimes, these children with visual challenges are tentative and uncertain with movement opportunities. 

Occupational therapy can be a helpful tool to help children who walk on tiptoes improve alignment and address the underlying factor and play with support the child!  If services are needed; your therapist would explore the reasons behind it and develop a customized plan with ongoing therapy and home programs to assist the child and family.

For more information, or to schedule an appointment or evaluation with a specialist, contact Blossom Therapy in Chicago today!

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