Toe Walking & Out/In-Toeing

As humans, we spend a lot of time on our feet. You may have noticed the way your child walks while taking a stroll in your neighborhood or during a hike. Due to tight and/or weak muscles, children can develop an atypical walking pattern such as, but not limited to, toe walking, out-toeing (e.g. penguin walk) or in-toeing (e.g. pigeon toes). 

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Toe walking

Toe walking, also known as equinus posturing, is a walking pattern of an individual that walks with their heels up. There are instances where the cause of toe walking can be unknown. Although toe walking is more prevalent in autistic children and children with Cerebral Palsy, it is also common in typically developing children. It is often due to a muscle imbalance and poor alignment.  

If left untreated, the child may experience developmental delays, poor balance, coordination, and damage to the bone structures in their feet. Physiotherapy is typically the first method of intervention. 

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What are signs to look for? 

• Walking on their toes 70% of the day with or without shoes
• Tight calf and back muscles 
• Weak core muscles 
• Sensory difficulties, such as sensitivity to the touch on the heels 
• Poor balance with heels down
• Unable to stand up straight (bends at waist) with heels down
• Out-toeing when trying to walk heels down

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Out/In-toeing

Penguin feet (e.g. out-toeing) or Pigeon toes (e.g. in-toeing) are common walking patterns that can have major negative impacts on the child as they grow up. Often, out- and in-toeing stem from the hips due to a muscle imbalance (i.e. weak and/or tight muscles) that encourage the feet to turn in or out. 

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What are signs to look for? 

• Walking with their toes turned out or in 
• Tight hip and back muscles
• May experience feet, knee, hip and/or back pain 
• Weak core muscles
• Sensory difficulties 
• Difficulty performing age-appropriate activities 

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