Toe walking in children

Definition

Walking on the toes or the ball of the foot — also known as toe walking — is fairly common in children who are just beginning to walk. Most children outgrow toe walking by age 2. Kids who continue toe walking beyond the toddler years often do so out of habit. This is known as idiopathic toe walking. As long as your child is growing and developing normally, toe walking on its own in early childhood isn't likely cause for concern.

It's important to keep an eye on other signs and symptoms, however. For example, toe walking accompanied by lack of muscle coordination could indicate cerebral palsy. Toe walking may also be a sign of autism or other developmental disorders.

Symptoms

Toe walking is walking on the toes or the ball of the foot.

When to see a doctor
Mention the toe walking to your child's doctor at your child's next checkup. Make an appointment sooner if your child is older than age 2 or the toe walking is accompanied by other signs and symptoms, such as:

• Lack of muscle coordination
• Stiff muscles
• Difficulty with precise motions, such as writing or buttoning a shirt

Causes

Typically, toe walking is simply a habit that develops when a child learns to walk. In a few cases, toe walking is caused by an underlying condition, such as:

• A short Achilles tendon — the tendon in the lower leg that links the leg muscles to the back of the heel bone
• Cerebral palsy
• Autism
• Other muscular, neurological or developmental disorders

Risk factors

Idiopathic toe walking — toe walking out of habit — may run in the family.

Complications

Persistent toe walking may increase a child's risk of falling.

Tests and diagnosis

Toe walking can be observed during a physical exam. In some cases, the doctor may do an in-depth gait analysis or an exam known as electromyography (EMG). During EMG, a thin needle with an electrode is inserted into a muscle in the leg. The electrode records the electrical activity in the affected nerve and muscle, and the electrical activity is displayed on a printout or monitor and broadcast over a speaker.

If the doctor suspects an underlying condition such as cerebral palsy or autism, he or she may recommend a neurological exam or testing for developmental delays.

Treatments and drugs

If your child is toe walking out of habit, treatment isn't needed. The doctor may simply monitor your child's gait while you wait for him or her to outgrow the habit. If habitual toe walking continues beyond age 2, the doctor may recommend an orthotic device to encourage your child to bend his or her foot at the ankle.

If a physical problem is contributing to the toe walking, treatment options may include:

• Physical therapy. Gentle stretching of the leg and foot muscles may improve your child's gait.
• Leg braces. Sometimes leg braces or splints help encourage a normal gait.
• A series of below-the-knee casts. If physical therapy or leg braces aren't helpful, serial casting may be recommended. At first, the foot is cast in a neutral position. Over the next six to eight weeks, a number of new casts are used to progressively improve the ability to bring the toes toward the shin.
• Surgery. If conservative treatments fail, the doctor may recommend surgery to lengthen the Achilles tendon or other muscles at the back of the lower leg.

If the toe walking is associated with an underlying condition such as cerebral palsy or autism, treatment is aimed at the underlying condition.