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. Kids who continue toe walking beyond the toddler years often do so out of habit. As long as your child is growing and developing normally, toe walking on its own is unlikely to be a cause for concern.
Toe walking is sometimes the result of cerebral palsy, muscular dystrophy or another generalized disease of nerve and muscle. Children with autism also may walk on their toes or the balls of their feet, but many do not.
Toe walking is walking on the toes or the ball of the foot.
When to see a doctor
If your child is still toe walking after the age of 2 years, talk to your doctor about it. Make an appointment sooner if the toe walking is accompanied by tight leg muscles, stiffness in the ankle's Achilles tendon or a lack of muscle coordination.
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. This tendon links the lower leg muscles to the back of the heel bone. If it's too short, it can prevent the heel from touching the ground.
- Cerebral palsy. Toe walking can be caused by cerebral palsy — a disorder of movement, muscle tone or posture that is caused by injury or abnormal development in the parts of the immature brain that control muscle function.
- Muscular dystrophy. Toe walking sometimes occurs in muscular dystrophy, a genetic disease in which muscle fibers are unusually susceptible to damage and weaken over time. This diagnosis may be more likely if your child initially walked normally before starting to toe walk.
- Autism. Toe walking has also been linked to autism, a complex spectrum of disorders that affect a child's ability to communicate and interact with others.
Toe walking out of habit, also known as idiopathic toe walking, sometimes runs in families.
Persistent toe walking may increase a child's risk of falling. It also can result in a social stigma if the child is perceived as "different" by peers.
You'll probably first bring your concerns to the attention of your family doctor or pediatrician. He or she may refer you to a doctor specializing in nerve function (neurologist) or orthopedic surgery.
What you can do
Before your appointment, you may want to write a list of questions for the doctor, including:
- What could be causing toe walking in my child?
- Are any tests needed? If so, what are they?
- What treatments are recommended for this problem?
What to expect from your doctor
Your doctor may ask some of the following questions:
- Does your child have any other medical problems?
- Do you have a family history of muscular dystrophy or autism?
- Was your child born prematurely?
- Did your child previously walk flat-footed and only recently begin to toe walk?
- Can your child walk on his or her heels if you ask?
- Does your child avoid eye contact or exhibit repetitive behaviors such as rocking or spinning?
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 an EMG, a thin needle with an electrode is inserted into a muscle in the leg. The electrode measures the electrical activity in the affected nerve or muscle.
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.
If your child is toe walking out of habit, treatment isn't needed. He or she is likely to outgrow the habit. Your doctor may simply monitor your child's gait during regular office visits. If a physical problem is contributing to toe walking, treatment options may include:
- Physical therapy. Gentle stretching of the leg and foot muscles may improve your child's gait.
- Leg braces or splints. Sometimes leg braces or splints help promote a normal gait.
- Serial casting. If physical therapy or leg braces aren't helpful, your doctor may suggest trying a series of below-the-knee casts 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 muscles or tendons at the back of the lower leg.
If the toe walking is associated with cerebral palsy, autism or other problems, treatment focuses on the underlying condition.
March 26, 2015
- Oetgen ME, et al. Idiopathic toe walking. Journal of the American Academy of Orthopedic Surgeons. 2012;20:292.
- Engstrom P, et al. The prevalence and course of idiopathic toe-walking in 5-year-old children. Pediatrics. 2012;130:279.
- Williams CM, et al. The toe walking tool: A novel method for assessing idiopathic toe walking children. Gait & Posture. 2010;32:508.
- Cerebral palsy: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm. Accessed March 2, 2015.
- Muscular dystrophy: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/md/detail_md.htm. Accessed March 2, 2015.
- Autism fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/autism/detail_autism.htm. Accessed March 2, 2015.
- Neurological diagnostic tests and procedures. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/misc/diagnostic_tests.htm. Accessed March 2, 2015.