Why Does My Child Walk on His Toes?

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Does your child toe walk? Are you worried about it? There are many theories as to the cause of toe walking and the treatment for it, but does it even need treatment? Is toe walking that abnormal?

By Karen Beardsley

 

Recent research says no, not always. Before we all decide to buy special orthopedic shoes for our toe walking children, let’s look at the subject a little more closely.

Toe walking is when a child walks by touching the ball of the foot first, rather than the heel first pattern of normal walking. Some children will then lower the heel to the ground, resulting in a short, shuffling gait pattern, while others keep the heel elevated and walk “tip toe”.

The cause of toe walking is unknown and could be related to many things, such as the condition of muscles, bones,  tendons, a child’s sense of balance, vision, or other factors. The research regarding the cause of toe walking is mixed and inconclusive.

Children frequently toe walk when they are toddlers and are first learning the skill. Many parents may become alarmed that something is wrong when they see their children toe walking. A Swedish study conducted by the Karolinska Institutet, Stockholm, and published in the July 2012 edition of Pediatrics, focused on 1400 children. The children were followed during 5 ½ year check-ups.

The results of the study found that almost 5% of the children had toe walked at some time, most often right after learning to walk independently. By age 5½, however, less than half of these children were still toe walking about 25% of the time.

The study did conclude that children with developmental and neuropsychiatric disorders, which included 17 children, were at higher risk of developing toe walking, but that toe walking also occurred in normally developing  children.

Children who toe walk but are otherwise developing normally are identified as idiopathic toe walkers. Medical professionals usually advise parents that, if other medical conditions are not present, toe walking is not something to be concerned about before the age of 6.

Most children will “grow out of it”. If a child who is otherwise developing normally continues to toe walk after age 6, that child may require treatment for pain, stiffness, and tightening of the Achilles tendon, also called the heel cord.

Stretching programs can help this tightening or other interventions might be serial casting, special shoes or even bracing. If a child toe walks for a long time and shortening of the Achilles tendon happens, then surgery to lengthen it may be required. Only a very small number of normally developing children ever require surgery for this condition.

Children who do have neuropsychiatric disorders such as autism, or developmental disorders such as cerebral palsy, are at an increased risk for toe walking. It may be related to a variety of physical, sensory, or perceptual conditions. Abnormal muscle tone can cause a child’s muscles to be very tight  or spasm, causing the Achilles tendon to shorten, or the structures in the foot  may cause a child to compensate by toe walking.  Other children may have sensitive feet and try to avoid touching the sole of the foot to the ground. For some children their sense of balance may feel compromised, while others may seek the “sensory” or vestibular input  provided by the feeling of being up on the toes. If a child has difficulty processing where they are in relation to their surroundings, then toe walking may help them adapt to this difficulty too.

Since the causes may be varied, the treatments for toe walking are also varied and dependent on the type of condition the child has. Parent’s best course of action in this case is to consult with their child’s doctors, physical therapists, and occupational therapists.

So if your toddler is walking on his or her toes, do not be alarmed. This does not mean that your child has autism. Demonstrate normal walking patterns to your child through your own walking and your child will most likely stop toe walking at some point. If you see other symptoms along with the toe walking and suspect that your child has a medical condition, certainly consult your child’s physician. In addition, if your child is over the age of 6 and is still toe walking, talk to your child’s doctor about it in case treatment is needed.

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