Toe walking is a pattern of walking in which the balls and toes of the feet make contact with the ground, but the heels do not. Children under the age of 2 who are learning to walk often walk on their toes intermittently, but typically grow out of it as they get older. If a child continues to walk on his or her toes after the age of 2, it may cause complications, or may be a sign of a medical condition.

Toe Walking

What causes toe walking?

In most cases, persistent toe walking is an idiopathic condition (the cause is unknown). For some children, toe walking is caused by a medical condition, which may include:

  • A problem in the brain, such as cerebral palsy
  • A muscle or nerve disorder, such as Duchenne muscular dystrophy
  • Autism spectrum disorder

What are the symptoms of toe walking?

The main and most noticeable symptom of toe walking is walking on the balls and toes of the feet, rather than in a normal pattern (stepping heel first). These children may also have decreased balance and coordination, or may fall frequently.

How is toe walking diagnosed?

The doctor will talk to the parents about the child’s medical history and will conduct a physical examination. As part of the physical exam, the doctor will observe how the child walks, and look for any problems with the child’s feet or legs.

In some cases, doctors perform simple neurological tests to see if the child has a problem with his or her nervous system. These tests may include checking the child’s reflexes, measuring the ability to feel sensations on his or her arms or legs, and testing muscle strength.

How is toe walking treated?

Treatment depends on the child’s age, how severe the toe walking problem is, and the underlying cause of the toe walking. The doctor may recommend nonsurgical treatments, including:

  • Observation to see if the condition improves on its own
  • Walking casts. These are worn for several weeks to stretch the calf muscles and tendons.
  • Ankle-foot orthotics (leg braces). A plastic leg brace keeps the foot at a 90-degree angle to stretch the muscles and tendons.
  • Botulinum A toxin (Botox®) injection to weaken the calf muscle and make it easier to stretch

If the child is older than 5, the doctor may recommend surgery to loosen and lengthen the calf muscles and Achilles tendons, which attach the calf and heel.

What complications are associated with toe walking?

Persistent toe walking may cause the calf muscles and Achilles tendons to tighten, which can make it difficult or even impossible for a child to walk flat-footed. In addition, children may have less range of motion in the feet and ankles, or may have difficulty wearing shoes or footwear for certain sports, like ice skating.

Can toe walking be prevented?

As your child grows, you can help reduce the likelihood of toe walking by stretching the Achilles tendon and selecting footwear that fits and has good support.

What is the prognosis (outlook) for children who walk on their toes?

The outlook depends on the cause of the toe walking. In idiopathic toe walking, most children recover fully with treatment and learn to walk flat-footed. However, some children will continue to walk on their toes even after treatment or surgery.

What questions should I ask my doctor about toe walking?

If your child continues to walk on his or her toes after the age of 2, you should ask your doctor:

  • Will my child need casts or leg braces?
  • What tests are necessary to rule out other medical conditions, like cerebral palsy?
  • Should I watch for signs of another condition, like autism?
  • If this condition persists, what will the effect be on the rest of my child’s life?