Walking on tiptoes in children

Toe Walking in Children: Causes, Symptoms, and Treatment Options

Toe walking is a common behavior observed in young children, especially in the early years of life. While it can be a normal stage of development, in some cases, it may indicate underlying medical or developmental issues that require attention.^[1] In this article, we will explore the causes of toe walking, symptoms to monitor, and available treatment options.

What is Toe Walking?

Toe walking is a form of walking where the child supports their body weight on their toes without touching the ground with the whole foot. This behavior is common in the early years of walking, but if it persists beyond the age of 2-3, it may indicate a problem that needs attention.^[1][2]

Causes of Toe Walking in Children

In the majority of cases, this behavior is idiopathic, meaning it has no known cause. However, there are situations where toe walking is caused by an underlying medical condition. An example is the shortening of the Achilles tendon, which connects the muscles of the lower leg to the back of the heel bone. If these tendons are too short, they can limit ankle flexion, preventing the heel from touching the ground.^[1][2][3] Other conditions that can lead to toe walking include:

• cerebral palsy;
• muscular dystrophy;
• spinal cord abnormalities;
• certain neurological disorders.^[1][2][3]

It should also be noted that there is a higher incidence of toe walking in children with autism spectrum disorders. Explanations for this increased rate are still uncertain, as there is no direct link between autism and toe walking. Researchers suggest that muscle tension in the heel or sensory processing difficulties, common in children with autism, could be contributing factors.^[1][2][3]

Symptoms Associated with Toe Walking in Children

The most obvious sign of toe walking is that your child supports their weight only on the toes and the front of the foot. Although many young children can walk normally when asked, if this habit persists, other issues may arise: difficulties in maintaining balance and coordinating movements, frequent falls, discomfort with footwear, limitations during physical activities, and even pain. Additionally, you may notice that they have trouble walking on their heels and that the heel tendons are tense.^[3]

When to Consult a Specialist?

If you notice that your child continues to walk on their toes after the age of 2-3, if they used to walk with the entire foot touching the ground but have started toe walking, or if other concerning symptoms appear, it is advisable to schedule a consultation with a pediatrician or pediatric orthopedist. The doctor will perform a complete physical exam and may recommend further tests to establish the correct diagnosis.^[1][2][3]

Treatment Options for Correcting Toe Walking in Children

The treatment for toe walking in children depends on the child’s age and their ability to walk with flat feet on the ground and may be either non-surgical or surgical. Physical therapy can also be beneficial.

Non-Surgical Treatment for Toe Walking in Children

For children aged 2 to 5 who can walk with their feet flat on the ground, initial treatment is usually non-surgical and may include:

• monitoring - the doctor may simply recommend monitoring the child through regular visits; if toe walking is a temporary habit, the child may naturally return to normal walking without additional interventions;
• serial casting - a series of short-term casts can be used to gradually stretch the calf muscles and Achilles tendon, reducing the tendency to walk on toes; this process usually lasts a few weeks;
• ankle-foot orthoses - these can help stretch and lengthen the calf muscles and tendons, keeping the foot at a 90° angle to maintain the correct position; these orthoses usually need to be worn for several months;
• botulinum toxin injections - for children with increased muscle tone due to neurological conditions, botulinum toxin injections can relax the calf muscles; this treatment is often combined with casting or orthoses.^[1][3]

Surgical Treatment for Toe Walking in Children

Toe walking in older children, over 5 years, may require surgical treatment, especially if there is significant muscle or Achilles tendon contracture. In such cases, the doctor may recommend surgery to lengthen the tendon. This aims to improve foot and ankle mobility, allowing the child to walk correctly. After surgery, the doctor will apply short casts to the child’s feet, which are worn for 4-6 weeks to support recovery.^[1][3]

Physical Therapy

Pediatric physical therapy is essential both after surgical interventions and in non-surgical treatment of toe walking. It helps the child learn to walk correctly, fully supporting their weight on the soles. In the case of surgical treatment, the recovery process usually begins after cast removal.^[1]

Toe walking in children is common in the early years of life, but if it persists, it is important for parents to stay vigilant and seek the advice of a specialist. Regardless of the cause, early identification and appropriate treatment can help the child develop a correct posture and healthy gait.

References:

1. „Toe Walking”, OrthoInfo, American Academy of Orthopaedic Surgery, 2022. Accessed Nov 8, 2024.
2. „Toe Walking in Children”, Mayo Clinic, 2022. Accessed Nov 8, 2024.
3. „Toe Walking: Symptoms, Causes & Treatment”, Cleveland Clinic, Oct 24, 2018. Accessed Nov 8, 2024.