Walking on Tiptoes: Adults, Teenager, Children – Cause & Tips

“My son walks on tiptoes, is it normal?” This is a question frequently asked to physiotherapists. Boys between the ages of 1 and 3 are most commonly affected by this type of gait.

However, sometimes walking on tiptoes can persist or even occur later in childhood, adolescence, or even adulthood.

Why does my child walk like this? What should be done if we notice that our child walks this way?

What interventions should be implemented? Is physiotherapy useful? Does the gait become more normal over time without any intervention? And what about teenagers or young adults?

I will answer these questions based on:

• My experience as a physical therapist
• My research and reading of medical studies published in international literature on the subject.”

Enjoy your reading 🙂!

At what age is toe-walking most common?

The ages when parents are most concerned

Search queries made by internet users show that parents notice and become most concerned between the ages of 1 and 3.

Here are several search queries that mention an age associated with toe-walking, which are searched dozens of times per month on Google.

They indicate that parents are primarily seeking information when their child is young:

• walking on tiptoes age 7
• my son walks on tiptoes
• 18 month old walks on tippy toes sometimes
• 15 month old walking on tiptoes
• walking on tiptoes age 5
• 20 month old walks on tippy toes

Although less frequent, some teenagers and adults can also walk on tiptoes, as illustrated by other user queries:

• walking on tiptoes adults
• walking on tiptoes teenager
• walking on tiptoes adults adhd
• walking on tiptoes age 9

You will notice that the queries only mention sons: toe-walking primarily occurs in males.

You will also notice something else: although you may not know anyone around you in the same situation, many babies, children, teenagers, and adults walk on tiptoes.

Several thousands people enter these phrases into a search engine each month.

This should already reassure you: your child is far from being the only one in this situation, whether they are 1, 2, 3 years old, or even a teenager or adult.

The ages when toe-walking is most commonly observed

A Swedish study 🇸🇪 (Engström 2012) examined over 1,400 randomly selected 5.5-year-old children. Among them:

• 2% still walked on tiptoes at 5.5 years old.
• 3% had previously walked on tiptoes but had stopped.

This means that in every kindergarten with approximately 150 children, there should be 5 to 8 children still walking on tiptoes.

The Swedish research team re-examined the same children at the ages of 8 and 10 (Engström 2018). Again, spontaneously, the toe-walking pattern had disappeared:

• In 1/4 of the children at 8 years old.
• In 79% of the children at 10 years old.

These children may walk on tiptoes 100% of the time or less.

A Dutch study 🇳🇱 even found that 12% of children and young adults have this condition. However, this study was conducted on only 362 people (Engelbert 2011).

I believe that the figure from the Swedish study is closer to reality. This study shows, however, that this condition also exists in adolescents and young adults.

Children under the age of 5 are most affected by toe-walking without any associated pathology. This affects approximately 5% of children.

Causes of tip toe walking: Why does my child walk on tiptoes?

Walking on tiptoes is not the most common walking pattern. Therefore, it is normal to wonder why your child walks like that.

If your child:

• Does not have any motor or cognitive developmental issues
• Is regularly monitored by a doctor or pediatrician

Then, it is likely that there is no known cause for this way of walking. It is referred to as idiopathic cause.

Much more rarely, it may be linked to an underlying condition that has already been diagnosed in your child.

Let’s take a closer look at these two cases.

Idiopathic cause (unknown cause) of toe walking

It is common to observe children walking on tiptoes without being able to establish a precise cause.

It can be frustrating not to know “why.” You will always find professionals or parents who propose explanatory hypotheses such as:

• It’s a game; they want to appear taller.
• It’s because they learned to walk incorrectly. For example, they used a walker.
• It’s a genetic predisposition.
• It’s due to an increase in the proportion of type I muscle fibers.
• It’s caused by congenital ankle stiffness.
• It’s because we did not respect their psychomotor developmental patterns. For example, we sat them down before they could sit on their own.

Certain explanatory hypotheses for toe-walking seem more plausible than others. However, none of them have reached a consensus in the international medical literature.

For example, a Swedish study followed over 1,000 5-year-old children, some of whom walked on tiptoes without any specific pathology (Engström 2012).

The cause of toe-walking in children lacks a consensus.

Toe walking associated with another pathology

Much more rarely, there can be a cause for toe-walking, but it is typically accompanied by other symptoms.

Here are the main pathologies where toe-walking is more common than in the general population:

• Neurological: cerebral palsy, spinal cord injury, muscle dystonia, etc.
• Musculoskeletal: congenital contracture of the Achilles tendon, foot deformities, leg length discrepancy (in this case, only one side is affected), etc.
• Developmental disorders: autism spectrum disorder, learning disabilities, etc.

These pathologies are rare. It is much more likely that the cause of this walking pattern in yourself or your child is not associated with any of these issues.

Nevertheless, let’s now explore how to determine if it is not a more serious problem.

How can I be sure it’s not a more serious cause?

The best thing you can do is to discuss it with the doctor who has been following your child since birth (or for the longest period).

Whether it’s a general practitioner or a pediatrician, it doesn’t matter. You can also seek the opinion of your physiotherapist if you have one.

These professionals are trained to differentiate idiopathic toe-walking from toe-walking caused by other conditions.

They will ask you questions, examine your child, and should be able to reassure you.

Here are the questions that healthcare professionals ask to differentiate idiopathic toe-walking from toe-walking related to other conditions (Source: Morozova 2017):

You can also ask yourself these questions:

1. Does your child have any motor or cognitive developmental issues?
2. Has your child been regularly monitored by a doctor or pediatrician?
3. Are there any other symptoms or signs of an underlying condition?
4. Is there a family history of similar walking patterns or related conditions?
5. Has your child had any previous injuries or surgeries that could affect their walking pattern?
6. Has your child experienced any delays or abnormalities in their overall development?

Some people may fear that their doctor or physiotherapist may have missed something, leading them to seek additional opinions, especially from more “specialized” people.

While I understand this attitude, I do not encourage it, at least beyond seeking a second opinion. Why? Because it increases the statistical risk of the professional becoming concerned and wanting to conduct potentially anxiety-inducing tests or urging you to implement potentially invasive treatments like botox injections.

There are also “mandatory” appointments with your doctor, especially around 9 months and 18 months of age, to detect any underlying conditions.

Consult the healthcare professionals who know your child best to get their opinion on toe walking. Share your concerns with them. Avoid seeking multiple opinions.

What should I do if a baby/child walks on tiptoes?

As you have observed, toe-walking is something relatively common. Your child has likely seen multiple doctors who have not identified any specific diseases, particularly neurological ones.

They are likely developing normally in terms of motor and cognitive skills.

In this case, the main thing you need to do is try to reassure yourself: toe-walking is not something serious. It tends to fade away over months and years in children, typically by the early school years:

• It spontaneously disappears in 59% of children before 5 and a half years old.
• And in 79% of children before 10 years old (Freiman 2022).

There are no known serious consequences in adulthood (Freiman 2022).

Let’s examine this in more detail.

Tip toe walking treatment

If your child is under 6 years old and you have already discussed this issue with a healthcare professional, it is likely not necessary to implement a specific treatment.

It is highly probable that their gait will naturally evolve towards normality without any specific intervention.

The best thing you can do is let your child live their life as a child, especially running, jumping, and engaging in exercise. These activities encourage movement.

However, in cases where toe-walking persists for several years and both parents and the child are interested in trying interventions to modify the gait because it is physically or socially restrictive for the child, some treatments are still suggested in academic publications.

These treatments include:

• Lower limb orthoses or braces, customized or non-customized, articulated or non-articulated.
• Sequential casting (application of multiple plaster casts).
• Botulinum toxin injections followed by casting.
• Exercises.
• Proper footwear.

What studies say?

The main synthesis of studies on this subject concludes:

The certainty of evidence from a study comparing sequential casting alone versus sequential casting with botulinum toxin injections in children was too low to draw any conclusions. Three other studies reported results related to botulinum toxin injections, footwear, exercises, and various types of orthoses, but the data were too limited to evaluate their effects.

Cochrane 2019

In other words, clinical studies do not provide enough evidence to determine which tip toel walking treatment is more effective than another or even if any treatment is more effective than natural progression without intervention.

How can you still choose a treatment?

In cases where treatment is considered, it is important to consider factors such as:

• Burden and discomfort.
• Financial cost.
• Potential side effects.
• Accessibility.

An older publication titled “Idiopathic Toe Walking: To Treat or not to Treat, that is the Question” noted that the academic community either:

• claimed that no treatment was necessary except in very rare cases,
• or suggested starting with stretching the calf muscles and performing ankle dorsiflexion exercises, followed by sequential casting in ankle flexion if resolution did not occur, and considering surgery as a last resort.

Based on their clinical experience or a synthesis of academic literature, the authors concluded:

“We believe that idiopathic toe walking should be considered a cosmetic deformity and treated only if it bothers the family. Nonsurgical treatment can be used in families unwilling to accept surgical intervention, although its effectiveness is uncertain. Surgical treatment is a reasonable option for families who desire a rapid resolution of idiopathic toe walking.”

However, it is worth noting that the lead author of that study was a surgeon, which might lead to an overestimation of the value of surgery (just as I might overestimate the value of physical therapy).

A more recent study (Williams 2020) lists a broader range of treatments, although their effectiveness has not been rigorously evaluated:

These include motor control strategies, biofeedback, verbal reminders, wearing orthotic inserts, etc.

Choosing not to implement treatment of tiptoe walking is a reasonable approach.

If the discomfort is significant, it is possible to try different interventions, recognizing that it is uncertain whether one approach is truly more effective than another or than natural progression.

Physical therapy for toe walking?

Physical therapists are among the healthcare professionals who are knowledgeable about tiptoes walking. We offer some of the treatments suggested in the literature for toe-walking, such as:

• reassurance,
• stretching,
• exercises,
• feedback techniques, etc.

In the United States 🇺🇲 and Canada 🇨🇦, coverage for the rehabilitation of toe walking can vary depending on public and private insurance.

In France 🇫🇷, if you have a doctor’s prescription, your physiotherapy sessions will be covered by the French health insurance and complementary health insurance companies.

Walking on tiptoes in adults: What does it mean?

Remember: thousands of people search for information about toe walking in adults every month. If you are affected, you are far from being alone.

It is tempting to attribute meaning to this and explain the phenomenon through biomechanical, psychological, or personality-related reasons. However, to date, no explanatory hypothesis has reached a consensus.

The causes of toe walking in adults are the same as in children: often idiopathic (without a known cause) and very rarely associated with pathologies.

What should be done for adults or teenager who walk on tiptoes?

As there are fewer adults and teenagers who walk on their toes compared to children, there are fewer published studies on the subject.

The first thing to consider is how long this condition has been present:

• Is it a matter of days or weeks? In that case, it may be reasonable to wait and see if the situation resolves on its own.
• Is it a matter of months or years? If the physical or social discomfort is significant, seeking professional advice to find solutions is recommended. You can consult a doctor initially. Physical therapists can be consulted for this condition, but direct access to physical therapy is not possible if you want insurance coverage. You would first need a prescription for physical therapy sessions.

There is no specific treatment for adults. The treatments described for children can be tried in adults, including stretching, exercises, orthotic devices, etc.

The treatments for toe walking in adults are the same as those for children.

2 clinical cases from my experience as a physical therapist

As a home physiotherapist, I’m sometimes asked to help families with this problem. Here are 2 stories of people I’ve taken care of, fairly representative of the situations of people I’ve met with this problem.

Case 1: walking on tiptoes age 2

J is a 2-year-old girl. Her mother is concerned about her gait: she walks on her toes with knees turned inward. She started walking at around 10 months.

She has no associated medical conditions and is developing well in all aspects. She walks on her toes approximately 80% of the time and does not have ankle stiffness at rest or with movement.

Her mother asks if this is normal, if it can resolve on its own, and what she should do to help it improve.

I reassure her about the natural progression of this condition: in the vast majority of cases, the gait becomes normal over time without any specific intervention. I explain that the best approach is to let J play, run, and jump like other children her age, without trying to correct her gait specifically. I suggest reassessing the situation in a year.

One year later, J’s gait is still somewhat atypical compared to most children her age, but it is much less noticeable. Two years later, J still has a slight inward knee alignment, but she no longer walks on her toes.

Case 2: teenager who walks on tiptoes

I am contacted by A’s mother. A is a 15-year-old teenager who has been walking on his toes for the past year and a half without any specific triggering factor.

He has no associated medical conditions.

Regardless of his choice of footwear, he walks on his toes approximately 90% of the time.

He has stopped participating in sports because of this issue and feels socially uncomfortable at school due to his distinctive gait. He is going out less frequently, and his family is very concerned.

He has been receiving physical therapy twice a week (mobilization, stretching) and doing exercises independently for a year, with no significant improvement. He has also tried custom-made insoles from a podiatrist, but they didn’t yield any results.

At rest, his foot is in equinus (toes pointed forward). The equinus position is partially reducible, and there is no pain.

After a comprehensive evaluation, I present to A and his mother the possibility of using an orthosis to limit the equinus position of the foot, potentially even during nighttime.

I provide them with contact information for several orthotists in the area who specialize in lower limb orthoses.

I did not receive any further updates from them.