Overview

Walking on the toes or the balls of the feet, also known as toe walking, is fairly common in children who are just beginning to walk. Most children outgrow it.

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 is unlikely to be a cause for concern.

Toe walking sometimes can result from certain conditions, including cerebral palsy, muscular dystrophy and autism spectrum disorder.

Symptoms

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 age 2, talk to your doctor about it. Make an appointment sooner if your child also has tight leg muscles, stiffness in the Achilles tendon or a lack of muscle coordination.

Causes

Typically, toe walking is 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 a disorder of movement, muscle tone or posture caused by injury or abnormal development in the parts of the immature brain that control muscle function.
  • Muscular dystrophy. Toe walking sometimes occurs in this genetic disease in which muscle fibers are unusually prone to damage and weaken over time. This diagnosis might be more likely if your child initially walked normally before starting to toe walk.
  • Autism. Toe walking has been linked to autism spectrum disorders, which affect a child's ability to communicate and interact with others.

Risk factors

Toe walking out of habit, also known as idiopathic toe walking, sometimes runs in families.

Complications

Persistent toe walking can increase a child's risk of falling. It can also result in a social stigma.

April 26, 2018
References
  1. Haynes KB, et al. Toe walking: A neurological perspective after referral from pediatric orthopaedic surgeons. Journal of Pediatric Orthpaedics. In press. Accessed Jan. 22, 2018.
  2. Van Kuijk AAA, et al. Treatment of idiopathic toe walking: A systematic review of the literature. Journal of Rehabilitative Medicine. 2014;46:945.
  3. Szopa A, et al. Effect of a nonsurgical treatment program on the gait pattern of idiopathic toe walking: A case report. Therapeutics and Clinical Risk Management. 2016;12:139.
  4. Sätilä H, et al. Does botulinum toxin A treatment enhance the walking pattern in idiopathic toe-walking? Neuropediatrics. 2016;47:162.
  5. Williams CM, et al. Do external stimuli impact the gait of children with idiopathic toe walking? A study protocol for a within-subject randomised control trial. BMJ Open. http://bmjopen.bmj.com/content/3/3/e002389. Jan. 22, 2018.