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There are cases when delayed walking or walking on tiptoes mean that something is wrong with a child's feet, but most of the time it's normal and will go away by the age of two, unless caused by some underlying medical condition.

Children are curious, especially around the time that they first start walking and it's normal for them to spring onto their toes to grab something from the above. According to experts, it's perfectly healthy to walk on tiptoes for couple of months, but not longer. If a child walks on her toes longer than six months and the frequency is not decreasing, it probably means something is going on with her feet. [1

Toe walking occurs in up to 24 percent of toddlers, and represents a common concern in pediatric circles. [2]

Walking on tiptoes out of habit

Most of the time, when a child walks on tiptoes nothing is wrong with his feet, or he's spent too much time inside a baby walker. It's easy to notice when walking on tiptoes is benign — a child will walk on tiptoes periodically, not all the time. If toe walking is caused by some neurological disorder or foot deviation, toe walking will occur most — if not all the time.

Idiopathic toe walking

Even though there are people who walk on their toes or balls of the feet, most people walk heal-first. According to science, those who walk toe-first move slower and work 10 percent harder than people walking in a conventional heal-first manner. [3]

In children under two years of age, walking on tiptoes is considered somewhat normal and a part of developing a walking gait.

Regarding children who are older that two years and still walk on their toes without any medical reason or a known cause, it is said that this kind of walking is idiopathic (ITW) [4].

To call this type of walking idiopathic, doctors must exclude all the neurological and orthopedic reasons, meaning that a child has to be perfectly healthy and have no difficulties walking „normally“— i.e. he knows how to, but for some reason prefers walking on tiptoes. [5]

Some disorders that may cause walking on tiptoes

  • Short Achilles tendon If your little one is walking on tiptoes all the time, you might consider discussing it with your doctor, and they might send your child to an orthopedist for further examination. The treatment is usually a lot of stretching and intense physical therapy, but the good news is that the prognosis is mostly good [6]. Achilles tendon serves to attach the calf muscle to the heel. If short, it will cause tightness in the calf, and the heel is unable to touch the ground when the child is walking.
  • Cerebral palsy — Children with cerebral palsy have difficulties with muscle control, in severe cases can't walk at all. Cerebral palsy is mostly caused by prematurity, anoxia, or in-utero brain injury. Children with idiopathic toe walking have a more changeable gait than those with cerebral palsy. [7]
  • Hip dysplasia — It can range from mild dysplasia to severe dysplasia with hip dislocation. Together with limping and discrepancies in leg length, one of the common symptoms is toe walking.
  • Muscular Dystrophy — If tip-toe walking is related to muscular dystrophy, it is usually seen in the later phase of the disease, but it can occur in the early stage as well, when there's no any other sign of the disease. By walking on her toes, the child makes adjustments to the contracture of the heel cords, which makes walking easier. [8]
  • Autism Spectrum Disorder (ASD) — Walking on tips of the toes can be an early sign of autism, according to experts. A study published in the journal Brain & Development claims that almost 20 percent of children with autism spectrum disorder walk on their toes, which is presumably because of some sensory problems or because they’re prone to repetitive behaviors. In a study done on 799 children with developmental delays, 224 of them were toe-walkers. In children with autism, the prevalence of toe-walking was 63 percent. [9]

When to get worried?

Take your child to a doctor if he is older than two years and walks on his toes most of the time (about 90 percent of his wake hours), stumbles a lot, walks awkwardly with uncoordinated moves, seems slow in developing fine motor skills (such as buttoning the shirt), and especially if he starts losing skills that he's already mastered.

Possible solutions for walking on tiptoes

  • Prevention— It is said that babies who were put too early in a baby walker tend to walk on their tiptoes once they start walking on their own. Avoid using infant walkers, not only for the risk of your baby walking on her toes, but because they've lead to thousands of injuries over the years.
  • Stretching — When it comes to ITW, it is important to do regular heel cord stretches and dorsiflexion strengthening exercises, according to Lovell and Winter's Pediatric Orthopaedics. Also, if the condition persists, parents are advised to provide serial cord dorsiflexion casts. [10]
  • Bracing — Wearing a specialized brace during the day, in some cases even during the night stretches the Achilles tendon and prevents the child from walking on her toes.
  • Botulinum injections — According to studies, it's possible to treat toe walking with Botox injections to the calf muscle, followed by a regular exercise program. A single injection of Botox completely ceased walking on tiptoes in three out of 11 children. [11]
  • Surgery — If all the less invasive methods to correct walking on tiptoes even after two years of trying fail, surgical lengthening of the tendon is a possibility. It is done under full anesthesia, but the child is released in a day or two with a cast that has to be worn for at least six week, and the braces that should be worn for a few months post-surgery.

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