Toe walking is a walking pattern where a person walks on the balls of their feet instead of with their heels touching the ground.
While this is a common walking pattern in children younger than 2 years old, most people eventually adopt a heel-to-toe walking pattern.
If your toddler is otherwise hitting developmental milestones, toe walking is not a cause for concern, according to the Mayo Clinic.
In many instances, the reason your child might continue to toe walk beyond age 2 isn’t known. However, it can occasionally cause tight calf muscles that make a heel-to-toe walking pattern harder to learn as your child gets older.
Often, doctors can’t identify a reason why a child may toe walk. They call this “idiopathic” toe walking.
These children are typically able to walk in a usual heel-to-toe walk, but prefer to walk on their toes. However, doctors have identified some conditions where a child may commonly toe walk.
This condition affects muscle tone, coordination, and posture. Those with cerebral palsy may exhibit unsteady walking, including toe walking. Their muscles also may be very stiff.
Muscular dystrophy is a genetic condition that causes muscle weakness and wasting. One of the potential side effects is toe walking. If a child had walked in a heel-to-toe pattern before and starts toe walking, muscular dystrophy could be a potential cause.
Spinal cord abnormality
Spinal cord abnormalities, such as a tethered spinal cord — in which the spinal cord attaches to the spinal column — or a spinal mass, can cause toe walking.
Doctors have observed a higher incidence of toe walking in those with autism spectrum disorders. This is a group of conditions that affect a person’s communication, social skills, and behaviors.
However, doctors haven’t pinpointed exactly why those with autism may be more likely to toe walk.
Toe walking by itself is not a sign of autism.
Some of the proposed causes of toe walking in people with autism include sensory concerns, where a child may not like the way their heels feel when they hit the ground. Another possible cause is vision- and vestibular (balance)-related concerns.
While doctors usually associate toe walking with children, it’s possible the condition can affect adults. Sometimes, an adult may have always toe walked and corrective measures were ineffective.
Other times, you might start toe walking in adulthood. This could be idiopathic or due to various conditions that can affect the feet. Examples include:
If you have started toe walking, but didn’t as a child, talk to your doctor about potential underlying causes.
If you or your child continues toe walking, you’ll want to see your doctor who will evaluate for potential causes. This usually begins with taking a medical history. Examples of questions a doctor may ask include:
- whether a child was born full term (37 weeks or more) or if the mother had pregnancy complications
- whether a child reached developmental milestones, such as sitting and walking
- if they toe walk on both feet or one
- if there is a family history of toe walking
- if they can walk heel to toe when asked
- if they have other leg- or foot-related symptoms, such as pain or weakness in the legs
Your doctor will also perform a physical examination. This will usually include asking to see you or your child walk. They will also examine the feet and legs for development and range of motion.
Other exams may include those for neurological function and muscle strength. If there’s nothing in your child’s medical history to indicate a cause of toe walking, your doctor won’t usually recommend imaging or nerve function tests. That’s because for a lot of people, toe walking is idiopathic and doesn’t have a known cause.
Toe walking may be a concern because if it continues past age 5, a person may have problems walking with their heels down later in life, though most with idiopathic toe-walking do not.
If you toe walk most of the time, you may have problems wearing shoes comfortably or engaging in recreational activities involving wearing special shoes, such as roller skates. You may also fall more easily.
Non-surgical treatment is usually recommended for children between ages 2 and 5, especially if they can walk flat-footed when prompted. Sometimes simply reminding a child to walk flat-footed can help. As they get older, children with idiopathic toe walking almost always progress to flat-footed walking.
Other treatments include:
- Wearing special leg casts that can help to stretch muscles and tendons in the calves if it is identified that they are tight. Your child will usually get new casts several times as flexibility increases.
- A special brace known as an ankle-foot orthosis (AFO) can help to stretch the muscles and tendons in the ankles. This type of brace is usually worn for a longer period of time than leg cast.
- Botox injections in the legs can help to weaken overactive and tight leg muscles if these are causing the toe walking. These injections can help your child’s muscles stretch more easily if they can benefit from casts or bracing.
Your doctor may recommend a combination of treatments for the best results.
If a person continues toe-walking after age 5, and is unable to walk flat-footed when asked, their muscles and tendons may be too tight for bracing or casting to stretch them. As a result, your doctor may recommend surgery to lengthen a portion of the Achilles tendon.
This is typically an outpatient procedure, not requiring you to stay overnight at a hospital.
Following surgery, you will usually wear walking casts for four to six weeks. You may then have physical therapy to further develop a flat-footed walking pattern.
Most children who have no underlying medical condition causing their toe walking will eventually walk in a heel-to-toe fashion. When a cause is identified, toe walking treatments can allow them to walk in a flat-footed fashion.
However, some children with idiopathic toe walking may go back to toe walking, even after treatment, until most of them eventually walk flat-footed.