Cerebral palsy and toe walking

You may notice your child walking on their toes around the house. Usually there's no reason to worry. Many healthy children toe walk for no known reason, can put their heels down when asked, and gradually come down onto their heels as they grow.¹ Sometimes, though, toe walking is one sign of a condition that affects the muscles, such as cerebral palsy.² Here's how to tell the difference, and what can help.

When to get your child checked

Talk to your podiatrist or GP if your child:

• always walks on their toes and their leg muscles feel stiff or tight
• can't stand with their heels flat on the ground¹
• toe walks on one side only¹
• trips and falls a lot, or seems uncoordinated or wobbly when walking¹
• is slow to reach milestones, such as sitting by 9 months or walking by 18 months.³

Toe walking that's getting in the way of play, walking or running is worth checking at any age.¹

What is cerebral palsy?

Cerebral palsy (CP) is a condition that affects muscles, movement, coordination and posture. It's caused by damage to the brain, or a problem with how the brain develops, during pregnancy, around birth or in early childhood.³ It's the most common physical disability in childhood.⁴ In Australia, about 1 in 700 children are born with CP, and the rate has been falling.⁵

CP lasts for life, but the brain damage itself doesn't get worse over time.³ What a child can do often changes as they grow, which is why ongoing support matters.

What causes it?

Most CP starts before or during birth.⁵ A baby is more likely to have CP if they:³

• are born early or with a low birth weight
• have a birth difference
• don't get enough oxygen during pregnancy or birth
• have severe jaundice after birth
• have a serious infection during pregnancy or infancy.

Less often, CP follows a brain injury in early childhood, such as a near-drowning or a head injury.³

Types of cerebral palsy

CP is often described by the main movement problem:²

• Spastic CP: muscles are stiff and tight. Tight calf muscles can pull the heel up, which is one reason a child with CP may walk on their toes.²
• Dyskinetic CP: muscles switch between stiff and floppy, with movements the child can't control.
• Ataxic CP: balance and coordination are affected, so movements look shaky or clumsy.

It's also described by which parts of the body are affected. Sometimes only one side of the body is affected, sometimes mainly the legs, and sometimes the whole body.²

What can help?

Children with CP usually have a team that may include a paediatrician, physiotherapist, occupational therapist and podiatrist. Treatment is tailored to each child's goals.

Orthoses and splints

Splints and orthoses are a common part of CP care.³ An ankle-foot orthosis (AFO) is a brace that holds the foot and ankle in a better position. It aims to make standing and walking more stable. Foot orthoses (shoe inserts) can help with foot alignment for some children. Serial casting, where a series of plaster casts gradually stretches a tight calf, also works well, especially combined with botulinum toxin injections.⁴

Exercise and therapy

Active, goal-focused therapy works well for children with CP. This includes strength training, practising walking and other everyday tasks, and fitness training.⁴ A physiotherapist will usually lead this, often with a home exercise program.⁴

Injections and surgery

Botulinum toxin injections (the same medicine used in "Botox") can relax tight, spastic muscles for a few months, and they work well for spasticity.⁴ Some children need surgery to lengthen tight muscles or correct the position of the foot.³ These treatments are arranged through your child's paediatrician or specialist team.

When to see a podiatrist

If your child walks on their toes and you're not sure why, a podiatrist can check their walking, muscle tightness, joint range and development, and refer them on if anything needs a closer look. If your child already has a CP diagnosis, we can work with their team on orthoses, footwear and foot care.

To have your child's walking checked, book an appointment with our podiatrists.

References

1. The Royal Children's Hospital Melbourne (2007). Idiopathic toe walking (Orthopaedic fact sheet 4). https://www.rch.org.au/uploadedFiles/Main/Content/ortho/Toe%20walking%20factsheet.pdf
2. NHS (2023). Cerebral palsy: symptoms. https://www.nhs.uk/conditions/cerebral-palsy/symptoms/
3. healthdirect Australia (2024). Cerebral palsy. https://www.healthdirect.gov.au/cerebral-palsy
4. Novak I, Morgan C, Fahey M, et al. (2020). State of the evidence traffic lights 2019: systematic review of interventions for preventing and treating children with cerebral palsy. Current Neurology and Neuroscience Reports, 20(2), 3. https://doi.org/10.1007/s11910-020-1022-z
5. Cerebral Palsy Alliance (2023). Sustained decline in rate and severity of cerebral palsy, collaborative research partnership reveals. https://cerebralpalsy.org.au/?p=2279

Reviewed by Andrew Schox, Podiatrist, BSc(Hons) PGradDipPod MPod. Last reviewed October 2026.