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Is Toe Walking Normal in Children with Cerebral Palsy?

how to fix cerebral palsy toe walking

While toe walking is completely normal as children learn to walk, it should phase out by age 2. If children with cerebral palsy continue to walk on their toes past 2 years old, it’s most likely because spasticity in the calves is pulling the heels up. If a child continues toe walking beyond age 2, spasticity may continue increasing and toe walking may become a habit that’s very difficult to break.

This article will further explain what causes toe walking in children with cerebral palsy, its risks, and how to treat it.

What Causes Toe Walking in Children with Cerebral Palsy?

Toe walking in individuals with cerebral palsy is primarily attributed to spasticity, which describes involuntary muscle contractions that can pull the limbs in abnormal positions and cause stiff movements.

Over 75% of individuals with cerebral palsy experience spasticity, which explains why abnormal gait patterns like toe walking are so prevalent among this population.

Toe walking occurs most commonly in individuals with a type of cerebral palsy called spastic diplegia. Spastic diplegia is characterized by motor impairments primarily in both legs.

If spasticity isn’t properly managed, the muscles will only become tighter, and toe walking will be more challenging to reverse. Early intervention will help minimize chronic pain and correct form before the abnormal gait pattern becomes a habit.

In the following section, we’ll discuss complications that can result from toe walking.

Risks Associated with Toe Walking and Cerebral Palsy

Toe walking in children with cerebral palsy can range from mild to severe. While the brain damage that causes cerebral palsy will not worsen over time, symptoms like spasticity can.

The progression of spasticity in the calves can cause toe walking to become more severe and put children at risk for many other complications, including:

  • increased risk of falling due to poor balance and stability
  • chronic pain due to muscle tightness and excess pressure on the ankles
  • poor posture due to altering center of gravity
  • non-ambulation (inability to walk)

Early intervention is crucial to ensuring that spasticity does not harm your child’s growth and development. In the following section, we’ll discuss effective ways to correct toe walking.

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How to Fix Toe Walking in Children with Cerebral Palsy

physical therapy and bracing for treating toe walking

In order to correct toe walking in children with cerebral palsy, you have to treat the underlying problem: spasticity.

Below, we’ll discuss some of the most widely-utilized interventions to treat spasticity.

Physical Therapy

Physical therapy is one of the first treatments your child’s doctor will recommend.

A physical therapist will assess the severity of your child’s spasticity and toe walking and create a personalized exercise regimen that focuses on lengthening tight muscles, strengthening underused muscles, and practicing correct form.

Many physical therapists use fun games and activities in addition to exercises to address toe walking and encourage carryover of skills learned in therapy to a child’s daily life. Some activities they may use to address spasticity in the calves include practicing various animal walks (such as the bear crawl) and trying to stay balanced on a wiggly surface.


Orthotic devices like leg braces and casts will help ensure proper form by aligning the joints in the foot.

Function follows form. Children who learn to walk incorrectly are only further ingraining that bad habit into their brains.

A leg brace or cast will keep the heel down and stretch the muscles in the calf so that your child can learn to walk correctly. If the spasticity is relatively mild and addressed early on, a child may be able to wean off of using the orthotic over time.


Botox is injected into overactive, spastic muscles to reduce tone.

It’s a temporary treatment that lasts several months and can help people with cerebral palsy practice walking without spasticity. Practicing walking with an improved gait pattern can help children develop new and proper walking habits, and can help keep spasticity in check even after the Botox wears off.

However, Botox is only approved for children 2+, so if your child is toe walking before that, other treatments must be used.


Baclofen is a drug that can be taken orally, injected, or pumped into the body to relax spastic muscles.

However, the most popular and effective way is to get it pumped through intrathecal baclofen therapy, which involves surgically implanting a pump under the skin of the abdomen. It directly infuses baclofen into the spinal canal, so it can be delivered in smaller, safer doses.

Because the pump must be refilled regularly, it may not be ideal for children.


Surgeries are often considered a last resort and are typically only recommended if all other treatments prove ineffective.

Selective dorsal rhizotomy is a surgery that involves cutting specific sensory nerves to permanently reduce spasticity in a muscle. When that nerve is cut off, it can’t grow back, so the muscle can no longer get spastic.

Manual muscle and tendon lengthening surgeries are also commonly performed to combat spasticity in patients with cerebral palsy.

Understanding Toe Walking in Cerebral Palsy Patients: Key Points

how to fix toe walking in children with cerebral palsy

Minimizing spasticity is only the first step to correcting toe walking in children with cerebral palsy.

Next, your child has to learn how to stand and walk correctly. It might feel weird or uncomfortable, but the more your child practices walking correctly, the easier it will get.

Neuroplasticity is the brain’s ability to rewire itself and recover functions affected by brain damage. The best way to activate neuroplasticity is through lots of repetition. Children’s brains have higher levels of neuroplasticity and can learn to adapt better than adults, so encourage your child to walk as much as possible after spasticity is treated. The earlier you catch and treat toe walking, the easier it will be to correct.

Hopefully, this article helped you understand why individuals with cerebral palsy experience toe walking and how to correct it. Good luck!

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