What can cause children to toe walk?

Toe walking is a common gait pattern observed in younger children where they predominantly walk on their toes instead of using their entire foot. While toe walking can be quite normal in toddlers as they explore various ways of moving and just want to be taller when all those around them are taller, persistent toe walking can be a cause for concern. Several neurological causes can underpin toe walking, so they do need to be investigated further. There may be physiological and psychological reasons for this, many of the cases are what is called idiopathic toe walking as there is no identifiable cause for it.

The most common physiological cause is tight Achilles tendons or calf muscles. When the Achilles tendons, which connect the calf muscles to the heel bone, are shorter than normal, they restrict the child's ability to dorsiflex their foot, making it difficult to put their heels down. There may be muscle imbalances in the calf and shin muscles can lead to walking on the toes. Weakness in the shin muscles and overactivity in the calf muscles can result in a gait pattern where the child elevates their heels while walking. Several certain neurological conditions, such as cerebral palsy, can affect a child's ability to walk normally. Walking on the toes may be a symptom of these conditions due to muscle spasticity or imbalance in muscle tone. It is for this reason that all cases of toe walking need to be investigated in case there is an underlying neurological problem. The psychological causes include habitual toe walking where some children begin toe walking out of habit, maybe because they want to feel taller. It may start as a phase, but if left unaddressed, it can become ingrained in their walking pattern. Children with autism spectrum disorders may exhibit the problem as a sensory-seeking behavior. The condition can provide sensory stimulation to these children, helping them cope with sensory challenges.

In many cases, toe walking may have no identifiable physiological or psychological cause, leading to a diagnosis of idiopathic toe walking. This means that despite thorough evaluation, the reason behind the problem remains unclear. Idiopathic toe walking often resolves spontaneously as the child grows. Other factors can contribute to toe walking family history. There may be a genetic component to the condition. Children with a family history of toe walking may be more predisposed to develop this gait pattern. Premature infants may have underdeveloped muscle tone, which can contribute to walking this way as they learn to walk.

Toe walking in children can be attributed to a variety of causes, both physiological and psychological. Identifying the underlying cause is crucial to determine the most appropriate intervention. Early intervention, such as physical therapy involving stretching and other exercises as well as things like rigid foot plates in the shoe can be tried. Sometime walking braces are used. In the most severe cases of tight Achilles tendons, then surgery might be indicated. Of most importance is the identification of the cause and interventions if a specific cause is identified.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.