Toe Walking: Should you be concerned?

Walking is such an important milestone in young children that anything that is “not typical” about it, causes parents a lot of anxiety. Add to that friends and relatives who casually mention that toe walking is “usually” a sign of Autism or a neurological problem, it can become a source of huge concern.

WHAT IS TOE WALKING?

Toe walking refers to a walking pattern in which a child walks on the balls of their feet and there is no contact between the heels and the ground. Most children begin walking at 12 to 15 months of age. When children start to learn walking, they try different foot positions, and walking on their toes may be part of this. By around 24 months, they should walk with their feet flat on the ground. By 3 years of age, children should walk with a heel-toe pattern.

IS IT JUST A DEVELOPMENTAL VARIATION?

Generally, until age 2, toe walking isn’t something to be concerned about. Often, children who toe walk after that do so out of habit. More than half of young children who toe walk will stop doing so on their own by about age 5. Most children toe walk occasionally when they’re cruising around a room (by holding on to furniture), especially if they’re on a bare floor. Some kids keep toe walking, off and on, just for fun. Toe walking out of habit, also known as idiopathic toe walking, sometimes runs in families. The cause of idiopathic toe walking is unknown.

Parents of more than 1,400 children participated in a study conducted in Blekinge County in southeast Sweden. The results, published in Pediatrics in 2012, showed more than half of young children who toe walk stopped doing so on their own by about age 5, and most toe walkers did not have any developmental or neuropsychiatric problems.

SOME SPECIFIC CAUSES

Rarely, toe walking can be the result of a short Achilles tendon (the tendon that links the lower leg muscles to the back of the heel bone), cerebral palsy, muscular dystrophy, or another generalized disease of nerve and muscle. Children with autism also may walk on their toes or the balls of their feet. But as long as your child is growing and developing normally, toe walking on its own is unlikely to be a cause for concern.

WHEN SHOULD YOU BE CONCERNED?

Consult your doctor if your child is toe walking AND…

• Walks on her toes most of the time
• Has stiff muscles
• Is uncoordinated
• Walks awkwardly and stumbles all the time
• Has fine motor skills that don’t seem to be developing normally (for example, she can’t button her shirt)
• Seems as though she can’t bear her weight on a flat foot
• Loses motor skills she already had
• Has any other medical problems
• Has a family history of muscular dystrophy or autism
• Was born prematurely
• Has previously walked flat-footed and only recently began to toe walk
• Avoids eye contact or exhibits repetitive behaviors such as rocking or spinning

COMPLICATIONS OF TOE WALKING

Kids who spend a lot of time on their toes can develop stiffness, tightening, and pain in their Achilles tendon, which can be treated with physical therapy and stretching exercises. Rarely surgery may be required (usually after age 6) if the toe walking is the result of (or results in) tendon stiffness.

So, parents: every time a preschool teacher comes to you and says, “I think you need to get your kid checked out by his doctor, he is really up there on his toes,” don’t get too worried as long as your child is developing normally and has no other medical problems. But talking to your pediatrician will surely go a long way to reassure you that your little one is “toeing the line” with his development!