From the Guidelines
Toe walking in children is often caused by underlying conditions such as cerebral palsy, muscular dystrophy, autism spectrum disorder, or tight Achilles tendons, and parents should consult a pediatrician for evaluation if the behavior persists beyond age 2-3. The causes of toe walking can be varied and may include:
- Idiopathic (without known cause) cases, which are the most common and often resolve spontaneously
- Neurological conditions such as cerebral palsy or muscular dystrophy
- Autism spectrum disorder, which has been linked to atypical body movements and motor development, including toe walking 1
- Tight Achilles tendons, which can be treated with physical therapy exercises to stretch the calf muscles and Achilles tendons
- Other conditions such as scoliosis, clubfoot, or patellar dislocation, which may require surgical intervention 1 It is essential to evaluate the child to determine the underlying cause of toe walking, as treatment depends on the cause and severity of the condition. Regular follow-up with healthcare providers is crucial to monitor progress and adjust treatment as needed. Parents can also help by gently reminding their child to walk flat-footed and making it into a game, such as pretending to squish bugs with their heels.
From the Research
Causes of Toe Walking
The causes of toe walking in children can be attributed to various factors, including:
- Underlying anatomic or neuromuscular conditions, such as cerebral palsy, congenital contracture of the Achilles tendon, or paralytic muscular disorders like Duchenne Muscular Dystrophy 2
- Developmental disorders, including autism or other myopathic or neuropathic disorders 2
- Idiopathic toe walking, which is a diagnosis of exclusion when a child presents with bilateral toe-to-toe gait and no underlying medical condition is found 3, 2, 4
- Tethered spinal cord, which can be caused by conditions such as ganglioneuroma 5
Prevalence of Toe Walking
The prevalence of toe walking in children varies, with:
- 2% of normally developing children exhibiting toe walking at age 5.5 years 3
- 41% of children with a neuropsychiatric diagnosis or developmental delays exhibiting toe walking 3
Diagnosis and Treatment
Diagnosis and treatment of toe walking depend on the underlying cause and severity of the condition, with:
- A thorough evaluation, including medical history and physical examination, necessary to rule out underlying causes 5, 3, 2, 4
- Treatment options including observation, conservative methods (such as casting, bracing, and physical therapy), and surgical methods (such as lengthening of the gastrocnemius-soleus complex and/or Achilles tendon) 3, 2, 4, 6