Toe walking is a common issue seen in children with cerebral palsy, especially those with spasticity affecting the lower legs. While many toddlers briefly go through a phase of walking on their toes, persistent toe walking — particularly in children with cerebral palsy — often indicates an underlying muscular or neurological cause.

If your child is frequently walking on their toes, it’s important to understand why it’s happening and what treatment options are available. At Children’s Cerebral Palsy, Dr. David Siambanes offers expert orthopedic care to help address the causes of toe walking and guide families toward the most effective solutions.

What is Toe Walking?

Toe walking refers to a walking pattern where the heel does not touch the ground. Instead, the child walks on the balls of their feet or their toes. In cerebral palsy, this walking pattern is typically due to muscle tightness or imbalances that limit flexibility in the lower leg and foot.

Persistent toe walking can cause pain, instability, and long-term changes in foot and joint structure if left untreated. It can also affect balance, coordination, and energy levels during walking, making daily activities more difficult for your child.

Why Does Toe Walking Happen in Children with Cerebral Palsy?

Toe walking in cerebral palsy is most commonly caused by spasticity, which is the involuntary tightening or stiffness of muscles. Children with spastic cerebral palsy often have increased tone in the calf muscles (gastrocnemius and soleus), which prevents the heel from touching the ground during walking.

Other contributing factors include:

• Shortened Achilles tendon or calf muscles
• Poor muscle coordination
• Weakness in opposing muscle groups
• Balance or sensory challenges
• Delayed motor development

Over time, untreated toe walking can lead to joint contractures (permanent tightening of the muscles and tendons), abnormal gait patterns, and even pain in the feet, knees, or hips.

When to Seek Help for Toe Walking

If your child consistently walks on their toes, especially past the toddler years, it’s worth getting an evaluation, particularly if they have cerebral palsy or other neuromuscular conditions. Early intervention can help prevent complications and support better long-term outcomes.

Signs it may be time to seek help include:

• Toe walking that persists beyond age 2 or 3
• Your child avoids putting their heels down entirely
• Toe walking is accompanied by pain, falls, or poor balance
• Tightness in the calves or reduced range of motion in the ankle
• Toe walking that worsens over time

Treatments for Toe Walking in Cerebral Palsy

The goal of treatment is to address the root cause of toe walking — usually muscle tightness or imbalance — and help your child develop a more natural, functional walking pattern. Dr. Siambanes, a fellowship-trained pediatric orthopedic surgeon, takes a personalized approach to care based on your child’s specific needs and mobility goals.

1. Physical Therapy

Targeted stretching and strengthening exercises can help lengthen tight calf muscles and improve ankle flexibility. Physical therapists may also work on balance, posture, and walking mechanics.

2. Orthotic Devices and Bracing

Ankle-foot orthoses (AFOs) are commonly used to support proper foot alignment and prevent toe walking. Rigid or hinged AFOs can hold the foot in a more neutral position and reduce the strain on tight muscles.

3. Botox Injections

Botulinum toxin (Botox) can be injected into overly tight muscles to temporarily reduce spasticity and allow for improved range of motion. This is often paired with physical therapy or bracing to maximize results.

4. Serial Casting

In some cases, a series of casts may be applied over several weeks to gradually stretch and lengthen tight calf muscles. This non-surgical approach is especially useful when the goal is to improve flexibility without permanent intervention.

5. Surgical Intervention

If conservative treatments are not successful, surgery may be necessary. Dr. Siambanes specializes in procedures such as tendon lengthening, which can release tight calf muscles or adjust foot alignment. Surgical correction is often recommended when toe walking causes pain, impairs function, or leads to contractures.

Advanced Care with Dr. Siambanes

As the director of the Motion Analysis Center at St. Joseph’s Children’s Hospital, Dr. Siambanes uses 3D gait analysis to precisely assess walking patterns and identify the physical barriers contributing to toe walking. This advanced tool allows him to develop highly targeted treatment plans and ensure your child is receiving the most effective care.

Dr. Siambanes has performed countless procedures to help children walk more comfortably and confidently. His experience in managing cerebral palsy-related deformities, combined with his compassionate approach to care, makes him a trusted partner for families navigating complex mobility challenges.

Improving Mobility, One Step at a Time

Toe walking may seem like a small issue, but it can have a big impact on a child’s comfort, confidence, and ability to participate in daily life. With early intervention and expert care, most children with cerebral palsy can make significant improvements in their gait and overall mobility.

If your child is toe walking, don’t wait to seek support. Click here to contact Children’s Cerebral Palsy to schedule an evaluation with Dr. Siambanes and take the first step toward better movement, improved function, and greater independence.