Toe walking is when a person walks on the balls of their feet or on their toes, keeping their heel off the ground. In children under 2, it’s a common way to walk when just learning. After that age, most people adopt the heel-to-toe walking pattern.
However, toe walking can continue past age 2, leading to issues, including tight calf muscles. Toe walking past a certain age may also indicate an underlying health condition.
This article discusses everything to know about toe walking and its treatment options.
Milan Markovic / Getty Images
What Causes Toe Walking?
Many toe walking cases are considered idiopathic, meaning there is no clear cause. However, other various anatomic or neuromuscular conditions can drive the walking pattern. They include:
Cerebral Palsy
Cerebral palsy is a group of neurological disorders that affect a person’s movement, muscle coordination, and posture. It is typically caused by brain damage in the womb, during birth, or shortly after birth. Symptoms appear in infancy or by the time a child reaches preschool.
Along with toe walking, a child with cerebral palsy may:
- Have issues with muscle coordination
- Experience stiff or tight muscles and exaggerated reflexes
- Have weakness in one or more of their arms or legs
- Have a crouched or scissored gait
- Experience variations in muscle tone from stiff to floppy
- Have tremors or random, involuntary movements occurring often
- Experience developmental delays in motor skills
- Have difficulties with specific movements, such as writing or buttoning a shirt
Muscular Dystrophy (MD)
Muscular dystrophy (MD) is a group of genetic diseases characterized by the progressive degeneration of skeletal muscles and weakness. There are over 30 types of MD, all of which get worse over time. The types of MD most associated with toe walking are Becker, Distal, and Emery-Dreifuss MD.
Other general symptoms that develop in muscular dystrophy include:
- Progressive muscle weakness and wasting
- Difficulty walking, climbing stairs, or rising from a lying or sitting position
- Repeatedly falling
- A curvature in the spine
- Abnormal enlargement of the spine
- Trouble breathing or swallowing
- Limbs becoming fixed in an inward position
- Enlargement of the heart
Spinal Cord Abnormality
Spinal cord abnormalities can develop because of issues either inside or outside of the spinal cord. Damage to the spinal cord caused by an injury, for example, can cause spinal cord compression. This compression hinders the communication pathways between the brain and the rest of the body, which may lead to movement issues, such as toe walking.
Autism
According to the Autism Research Institute, toe walking can develop in children with autism because of a dysfunctional vestibular system, which is a common issue in people with autism. The system provides feedback to the brain that assists with body motion and position, and if there is an issue with this communication, toe walking can occur. That said, toe walking alone is not a sign of autism.
How Common Is Toe Walking?
In the general population, toe walking occurs at a rate of 2% in children 5 to 5.5 years old. Those rates rise to roughly 41% in children with underlying conditions in the same age group.
Other Symptoms From Toe Walking
Along with toe walking, a child may display additional symptoms that could indicate issues with movement and balance. Those symptoms can include:
- Poor balance and coordination
- Tight muscles in the calves and ankles
- Increased falls
- A reduced level of self-esteem due to walking differently than their peers
Why Do Kids Walk on Their Toes?
Aside from the causes mentioned above, a child could walk on their toes simply due to preference or for no reason at all.
There is no way to determine what the cause of toe walking is until the proper tests are done.
Toe Walking in Adults
Toe walking is most closely associated with children, but it can also occur in adults. If an adult didn’t walk on their toes as a child but developed toe walking when nearing adulthood, it could be due to underlying causes, such as injuries or peripheral neuropathy, which is a loss of sensation in the feet.
Consequences of Toe Walking in Adulthood
When adults continue to walk on their toes, it can lead to calf and leg muscles tightening, eventually making it difficult to walk on a flat foot. This can cause cramping and pain and difficulty wearing shoes comfortably.
How Is Toe Walking Diagnosed?
A physical exam is the first step and the most efficient way to diagnose toe walking. However, to get to the root cause, more diagnostics will need to be done.
Tests that may be done include:
- An electromyography (EMG), which looks at the condition of the muscles and nerves and how they operate
- A gait analysis to check for movements during walking
- A neurological test to see if there are any issues with the brain or spinal cord or if developmental delays are present
Diagnosing Idiopathic Toe Walking
In some cases, if the physical exam and medical history assessment do not offer clues to an underlying medical condition causing the toe walking, imaging and nerve function tests will not be conducted. Many medical providers will assume that it is idiopathic and will not want to subject a child to rigorous testing.
Will My Child Always Walk on Their Toes?
In many cases, a child will grow out of toe walking as they age and learn to navigate the world around them.
Because toe walking can be idiopathic, healthcare providers may take a wait-and-see approach unless the child is already over age 5 and still toe walking.
In other cases, treatment will be done to correct the toe walking pattern to avoid further complications.
Potential Complications from Walking on Your Toes
Continuous toe walking can result in tightness in the calf muscles and the Achilles tendon. In some cases, the tightness can be so severe that a child or adult will not be able to walk flat-footed at all.
How to Stop Toe Walking
Various treatment options are available to help stop toe walking before it becomes a significant problem. They include:
Nonsurgical Treatment
Nonsurgical treatments are highly beneficial for some children who walk on their toes. Specialized leg casts, braces, or a series of leg casts can be used to train a person to walk on a flat foot.
Special braces help to stretch the foot into a flat position and are typically worn during the day. If worn at night, the braces stretch the muscles while a child sleeps to improve toe walking.
Botox (onabotulinumtoxinA) injections have also been used to improve toe walking. They work by weakening overactive leg muscles that could be driving toe walking.
Physical Therapy
Physical therapy can be used to help stretch and expand tight muscles in the legs or feet. These exercises are most effective when also done at home.
Surgical Treatment
In more severe cases or those that do not respond to nonsurgical treatment, surgery may be necessary. Achilles tendon or gastrocnemius lengthening, which lengthens the Achilles tendon or gastrocnemius muscle (the main muscle in the leg), can be done to help improve flexibility and help a child walk on flat feet.
Summary
Toe walking is found mainly in children under the age of two. In some cases, it doesn’t cause any issues and is just part of the natural learning-to-walk process for infants. In others, an underlying health disorder or idiopathic toe walking may be to blame.
While the consequences of toe walking are not life-threatening in nature, they can be severe and lead to a person not being able to walk flat on their feet due to significant tightness in the foot and calf muscles.
Treatment is available for toe walking and often includes addressing any underlying health disorders, wearing leg braces, using Botox, and getting physical therapy. Surgery to lengthen the tightened muscles is a last resort. A healthcare provider will work with you and your child to determine what the cause is and what treatments may be necessary to improve the toe walking pattern.
:max_bytes(150000):strip_icc()/VerywellBioPicAngelicaBottaro-203f7e803ab444b2b5c13b4252d11159.JPG)
