Overview

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.

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 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.

Causes

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.

Risk factors

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

Complications

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.

March 26, 2015
References
  1. Oetgen ME, et al. Idiopathic toe walking. Journal of the American Academy of Orthopedic Surgeons. 2012;20:292.
  2. Engstrom P, et al. The prevalence and course of idiopathic toe-walking in 5-year-old children. Pediatrics. 2012;130:279.
  3. Williams CM, et al. The toe walking tool: A novel method for assessing idiopathic toe walking children. Gait & Posture. 2010;32:508.
  4. 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.
  5. 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.
  6. Autism fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/autism/detail_autism.htm. Accessed March 2, 2015.
  7. 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.