Toe Walking

Toe walking is a condition in which a person (usually a young child) walks on his or her toes without putting significant weight on any other part of the foot. It’s commonly seen in babies and toddlers as they first begin to walk and usually disappears around the age of two or three. If a child continues to toe walk several years into his or her development, it could be a sign of a more serious problem that requires medical intervention.  

Causes

There are several causes of toe walking, though not all cases have a definite reason for developing. 

• Idiopathic: Most cases of toe walking are idiopathic, meaning a sporadic condition for which the cause is unknown. Depending on the child, toe walking may be habitual, or it could be hereditary. 

• A Short Achilles Tendon: The Achilles tendon connects the leg muscles to the back of the heel bone. If the tendon is too short, it can be difficult for a person to touch his or her heel to the ground. A short Achilles tendon could be hereditary, it could be caused by under use, or it could be the result of abnormal foot structure. 

• Muscular Issues: Some cases of toe walking are due to muscular problems, such as paralytic muscle diseases (Duchenne muscular dystrophy, for example) and muscle spasticity, especially associated with cerebral palsy. 

• Bone Issues: Some cases of toe walking are caused by a bone block that prevents dorsiflexion (forward and backward bending of the foot), arthritis or trauma. 

• Dysfunctional Vestibular System: A common condition of autism, a dysfunctional vestibular system (which provides the brain with feedback concerning the body’s motion and position) could cause toe walking. Additionally, a visual-vestibular problem may be to blame, with prism lenses immediately correcting the problem

Treatment

Because most cases of toe walking will eventually resolve on their own, many doctors prefer the “watch and wait” method in which a parent observes a child for a specific amount of time to see if perhaps the child will outgrow the condition. In the case of toe walking that impairs a child’s range of motion or toe walking that continues past the age of three, there are several options:

• Wearing a brace or splint, such as an ankle-foot orthosis (AFO), that restricts the child from walking on his or her toes and helps stretch the Achilles tendon

• Botox therapy that paralyzes the calf muscles and “forces” the feet and legs to use the Achilles tendon

• Serial casting in which the Achilles tendon is stretched, with the cast changed on a frequent basis to allow for progressive stretching

• Exercises to help lengthen and strengthen the Achilles tendon 

• Surgical lengthening of the Achilles tendon, which is generally considered a last option

When A Parent Should Worry

Most cases of toe walking are no cause for concern, as children who have the condition typically grow out of it within the first two to three years of walking. As long as the child is growing and developing normally, there’s usually no reason to be worried.

However, in rare cases, toe walking can be a sign of serious neuro-muscular conditions or an early indicator of autism, a neuro-developmental disorder characterized by impaired social interaction, abnormal communication and restricted or repetitive behavior. Some signs that a child’s toe walking could be a more serious issue include:

• Muscle stiffness in the legs
• Extremely tight Achilles tendons
• Lack of muscle coordination
• Toe walking past the age of three
• A period of normal walking followed by toe walking
• Communication problems
• Other physical abnormalities 

If you observe any of the above symptoms in your toddler, you should contact a podiatrist or foot and ankle specialist. After an initial examination of your child’s legs, feet and gait, he or she then may refer you and your child to a pediatric neurologist, a neuropsychiatric specialist (a doctor who specializes in disorders of the nervous system), or a physical therapist.