Small children tend to spend a lot of time on their toes, doing things like peering over high counters, reaching for forbidden snacks, or playing ballerina. But a child who walks solely on the balls of their feet, without their heels ever touching the ground, is toe walking.
Toe walking is fairly typical in the first few years of life. Past that stage, it becomes rarer and more noteworthy. When this behavior shows up in older kids without a clear medical cause, it’s called idiopathic toe walking.
Experts have yet to determine the exact cause of this link, but they do have a few theories. Read on to get the details on the relationship between ADHD and toe walking, when you can expect your kid to likely outgrow this behavior, and possible interventions.
A typical footstep has three phases:
- Your heel strikes the ground.
- Your whole foot is in contact with the ground.
- You push off the ground with your toes.
Toddlers just learning to walk can sometimes get stuck on phase 3, only touching the ground with the balls of their feet. While not all toddlers do this, it’s fairly common when kids first learn how to use their feet. Most children will learn to walk on their feet by 18 months.
Idiopathic toe walking
Around 2 percent of kids continue toe walking without an obvious medical reason. They may know how to walk heel-to-toe but still walk on their toes most of the time by default.
Potential causes of toe walking
Experts have come up with a few theories:
- Genetics: In one
2021 study, 44.2 percent of people with idiopathic toe walking had a family history of the condition. Experts believe that you only need to inherit the genes from one parent to develop it.
- Muscle composition: People who toe walk often have a higher proportion of slow-twitch muscle fibers in the leg. Since these fibers don’t generate force very well, children may toe walk so they don’t have to push their feet as hard when they step.
- Hyper-sensitive feet: Idiopathic toe walking may relate to increased foot sensitivity, according to 2013 research. Toe walking may be an unconscious strategy to avoid overstimulation by only having a fraction of the foot touch the ground.
- Limited ankle movement: Some people with idiopathic toe walking are born with unusually short Achilles tendons. They may have a harder time with dorsiflexion, a type of movement where you pull your toes up toward your shin, and so their feet naturally fall into an en pointe position.
Emerging evidence suggests it also shows up frequently among children with ADHD.
Of course, these studies are both fairly small, as scientific research goes. Future evidence may offer more insight to help confirm this link.
Experts have come up with a few potential reasons why kids with ADHD might toe walk.
Like toe walking, ADHD runs in families. If you have ADHD, there’s roughly a
Differences in brain structure can make it harder for people with ADHD to
Kids with ADHD may have less automatic walking movements, which could contribute to toe walking.
Sensory processing issues
People with ADHD often don’t process sensory information in the same ways as people who don’t have ADHD. Some people with ADHD have sharpened senses or an increased sensitivity to stimuli, and people with heightened tactile senses may toe walk to reduce distracting stimuli from the ground.
Most kids stop toe walking on their own without any need for intervention. A Swedish study from 2018 followed 63 neurotypical children who had a history of ITW and found that:
- 59 percent had stopped by the age of 5
- 68 percent had stopped by the age of 8
- 79 percent had stopped by the age of 10
The same study also considered a smaller group of 17 kids with neurodevelopmental conditions, including ADHD. Like their neurotypical peers, most of these kids (71 percent) stopped toe walking by the age of 10.
Wondering whether toe walking could weaken your child’s ankles or shorten their calf muscles?
To date, no randomized controlled trials have answered that question.
The 2018 Swedish study didn’t find evidence that toe walking could affect ankle development. Study authors did suggest the small portion of toe walkers who do have shortened muscles usually have those differences at birth. In those cases, toe walking more likely happens as a symptom of a pre-existing health condition, not a cause.
That said, toe walking may contribute to chronic pain, which can seriously affect quality of life.
The authors of the
Toe walking in adulthood can also lead to chronic pain, according to a
Toe walking doesn’t necessarily pose a cause for concern, particularly among younger children. If your kid has a full range of movement and no pain, then you probably don’t need to do anything.
Sometimes kids who toe walk too often can strain their muscles. You can treat mild, situational pain with over-the-counter pain relievers.
When to get medical guidance
You may want to connect with a healthcare professional if:
- your child continues toe walking past the age of 10
- your child still has pain after doing stretches for several weeks
- your child has stiff ankles — standing flat-footed on the ground may feel like a stretch in itself
Your child’s doctor might address prolonged toe walking and any related health concerns with more specialized treatment. Possible interventions, from least to most intensive, include:
- Physical therapy: Some kids may benefit from “re-learning” how to walk.
- Specialized footwear: Shoes with rigid soles may prevent kids from bending their feet.
- Serial casting: A child wears a series of temporary casts that help progressively stretch out a muscle.
- Botox injection: Injecting botulinum toxin type A (Botox) into leg muscles can temporarily make it harder for children to point their feet for toe walking.
- Operation: Surgeons may lengthen the Achilles tendon or the calf muscles to restore the ankle’s range of motion.
If you believe your child’s toe walking could relate to ADHD, you may want to pay attention to any other motor issues you notice. Kids with ADHD are more likely to have difficulty with balance and motor control, which can contribute to:
- clumsiness, including trouble grasping or holding onto objects
- stumbling while walking
- postural sway
- messier handwriting
Clumsiness alone doesn’t automatically suggest ADHD. But if a child who toe walks also has other signs of ADHD, including high distractibility and trouble sitting still, a good next step might involve getting an evaluation.
An ADHD specialist can help your child get the right diagnosis and offer more information about treatment options.
Toe walking is common during the toddler years, and it doesn’t always suggest ADHD.
That said, kids with ADHD are more likely to continue toe walking through childhood. If you notice signs of ADHD in your child, a trained specialist can offer more guidance with diagnosis and treatment.
Most kids will eventually stop toe walking on their own, with no need for treatment. In some cases, though, toe walking may relate to an underlying health condition or contribute to chronic pain, so it may be worth visiting a podiatrist.
Emily Swaim is a freelance health writer and editor who specializes in psychology. She has a BA in English from Kenyon College and an MFA in writing from California College of the Arts. In 2021, she received her Board of Editors in Life Sciences (BELS) certification. You can find more of her work on GoodTherapy, Verywell, Investopedia, Vox, and Insider. Find her on Twitter and LinkedIn.