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Toe Walking


Toe walking is a special kind of walking pattern in which the toes and balls of the feet touch the ground, but the heels do not. It is usually common in toddlers who are just beginning to walk. Toe walking is not a matter of concern if your child is below two years of age, as they are still learning a stable walking pattern. If your child is above two years of age and still follows the pattern of toe walking, it may be due to habit formation, muscular dystrophy, or certain neurological issues. It can be corrected with proper guidance and supportive measures. 


The exact cause of toe walking has not been determined yet. In young toddlers, it occurs when they begin to walk. Most children take some time to learn how to balance themselves on their feet. For this reason, toe walking may be observed in the first 2 or 3 years of life. It resolves with time as the child settles their weight on their whole feet. If they continue to follow toe walking beyond this age limit, it could be a cause of concern.

If your child is developing normally and there are no apparent symptoms except for this issue, it is referred to as idiopathic toe walking. Some children may have a short Achilles tendon from birth which can be a potential cause of toe walking. Other possible causes include cerebral palsy, Duchene muscular dystrophy, and bone block due to trauma and arthritis. Autism has also been linked with this particular walking pattern. Not all children, but many children with autism spectrum, have been found to have walking or gait abnormalities. 

Risk Factors And Epidemiology

Toe walking commonly occurs in children below five years of age. It rarely continues to adulthood unless it is not treated at an earlier stage. Toddlers who develop a strong habit of toe walking are likely to continue this pattern after 2 or 3 years of age. Idiopathic toe walking has also been noticed to have a genetic tendency. If there is a positive family history of toe walking, it is likely that your child may also develop this pattern. Children diagnosed with cerebral palsy, muscular dystrophy, or autism at an early stage may also be at risk.

According to research, almost 5% of healthy children have the pattern of toe walking for no apparent reason (idiopathic). The link between autism with toe walking is still under research. So far, it has been stated that 68% of children on the autism spectrum have an abnormal walking pattern. 

Signs And Symptoms

The most noticeable sign of toe walking in children is walking on the toes and balls of feet, unlike the normal walking pattern in which you land on your first. These children try to balance their entire weight on the front portion of their feet, due to which they can have an unstable gait. They may also fall frequently during walking. These children may also be more prone to injury due to unstable walking patterns. If a child has an underlying medical issue such as cerebral palsy or autism, they will also have other signs and symptoms relative to that condition. 


Your doctor will require a brief history of your child’s walking pattern and perform a physical examination. If your child already has a known medical condition, make sure to mention it. In physical examination, the child will be asked to walk, and the doctor will assess the gait pattern, stability, and coordination. If cerebral palsy or another neurological issue is suspected, your doctor may perform electromyography (EMG) to rule out the risk. In this test, an electrode is inserted into a leg muscle, and that region's electrical activity is observed. Some other tests may also be performed if the signs of the short Achilles tendon, trauma, or autism are present. 

Differential Diagnosis

There are many causes of abnormal walking patterns among children. These include developmental coordination disorder, cerebral palsy, juvenile idiopathic arthritis, global developmental delay, autism, Charcot Marie tooth disease, leg length difference, and calcaneal apophysitis. Toe walking should be differentiated from other gait abnormalities based on history and diagnostic tests. 


Treatment of toe walking depends on the cause and severity of the condition. If your child is below 2 or 3 years old, it is likely just a habit and will get better with time. In the case of children from 3 to 5 years, different treatment measures can be used. Leg stretches, and guided walking can help in mild cases. Your doctor may recommend leg braces or walking casts that stretch the muscles and promote normal walking patterns. Botulinum A toxin (Botox injection) can also be used to loosen the calf muscles, making it easier to stretch them. If your child is older than five years and no other treatment option has helped so far, your doctor may recommend surgery. During surgery, the calf muscles and Achilles tendon are loosened and lengthened to facilitate regular walking patterns.


Most children outgrow the habit of toe walking as they age. Early diagnosis and treatment can help in stubborn cases. It may take a few weeks or months to develop a normal walking pattern, depending on the severity of the condition. 


It isn’t easy to prevent toe walking as it may develop due to a genetic factor. However, you can avoid it to a certain extent by guiding your child as they begin to walk. Supportive footwear can also help in maintaining balance. If the problem persists for a few years, you should consult a doctor at an early stage.