You probably waited with bated breath for your toddler to take his first steps. But when he did start walking, you may have noticed something unexpected: your child proudly making his way across the room on tiptoes or the balls of his feet.
This behavior is known as toe walking. It happens frequently in toddlers, and it's usually no cause for concern. Here’s what you need to know if your newly walking child is getting around on his toes.
What is toe walking in toddlers?
Toe walking is when a child walks on his toes or the balls of his feet without his heels touching the ground. It's a common habit among babies and toddlers who have recently taken their first steps.
After age 2, most kids outgrow toe walking and start to step with a typical heel-to-toe pattern. By age 5, the vast majority of children who walked on their toes have stopped, research has found.[1]
Why is my toddler walking on tiptoes?
Toe walking in toddlers is often idiopathic, which means there’s no known cause. It’s more than likely that your little one is simply learning how to navigate his world, and toe walking will naturally progress to heel-to-toe steps in time. Toe walking can also sometimes run in families.[2]
Much more rarely, toe walking can be caused by an underlying medical condition, such as:[3]
- A short Achilles tendon. Your calf muscles and Achilles tendon work together to help lift your heels when you walk. In some toddler toe walkers, this muscle-tendon combination may simply be shorter, which prevents a child from touching his heels to the ground.
- Cerebral palsy (CP). This neurologic disorder can affect muscle control, and children with CP may have a harder time walking or running.
- Muscular dystrophy. With this genetic disease, muscles are prone to damage and weakness, which can cause a child to toe walk.
- Autism spectrum disorder (ASD). Children with ASD tend to toe walk more frequently, but there isn’t a direct link. For kids with ASD, it’s thought that toe walking may be sensory-related.
Symptoms of toe walking
The main symptom of toddler toe walking is exactly what it sounds like: walking on the toes or balls of the feet.
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Your little one will very likely outgrow the habit before his second birthday, so remember that it's generally not a sign of something more serious.
But if it continues, your pediatrician will look out for other symptoms of potential complications, such as:
- Problems with balance and coordination
- Frequent falls
- Problems wearing shoes
- Trouble participating in sports and other activities
- Complaints of heel pain
- Tight heel cords
How is toe walking diagnosed?
Your child’s doctor will talk to you about your child’s medical history and perform a physical exam to watch your toddler walk. They’ll have your tot walk like he normally does (on his toes), then ask your child to do his “best walk,” or walk as flat-footed as possible.[4]
The doctor will also perform a neurological exam to make sure your toddler’s toe walking isn’t due to a nerve-related condition. Your pediatrician or orthopedist will check your child’s:
- Arm and leg muscles for tightness
- Major muscles for strength
- Reflexes (usually done by tapping a small rubber hammer on different body points)
- Sensation or feeling in his arms and legs
- Leg lengths
- Developmental milestones
- Gait (the way your child walks) with and without shoes
Other tests, like X-rays, CT and MRI scans, and nerve and muscle tests, usually aren’t necessary. If the physical and neurological exams don’t raise any concerns, your toddler will likely be diagnosed with idiopathic toe walking, or toe walking with no known cause.
How to treat toe walking in toddlers
There’s often no need to treat toe walking in toddlers, especially if your child is under age 2. Your pediatrician may simply want to monitor your little one’s toe walking at well visits. If your tot toe walks out of habit, there’s a good chance he’ll stop on his own.
But if toe walking persists beyond age 2, your doctor may recommend treatment. Non-surgical options are always the first approach, which might include:
- Stretching exercises. Your practitioner may suggest that your child try strengthening and stretching exercises, which need to be done with a parent or at physical therapy. These exercises typically use your toddler’s own body weight to stretch the muscles out.
- Serial casting. With this treatment, which is performed over the course of several weeks, your orthopedic surgeon applies a series of short leg walking casts to stretch and lengthen your child’s calf muscles and tendons.
- Bracing. Your child’s doctor may want him to wear an ankle-foot orthosis (AFO), a plastic brace that holds his foot at a 90-degree angle. This treatment helps stretch and lengthen muscles and tendons, but takes longer than serial casting.
- OnabotulinumtoxinA (Botox) injections. Depending on what’s causing your toddler’s toe walking, doctors may sometimes recommend an injection of OnabotulinumtoxinA to temporarily relax the calf muscles.
Kids 5 and older who are still toe walking may have such tight calf muscles and tendons that the doctor may recommend surgery to lengthen the Achilles tendon. This is usually done on an outpatient basis, and your little one would wear a cast for four to six weeks after.
Can you prevent toe walking in your toddler?
Toe walking is often just a normal part of toddlerhood as kids learn to walk and balance. But if your practitioner recommends it, stretching or strengthening exercises may be helpful. You can also make sure to choose shoes for your toddler that fit well and provide good support.
When to call the doctor about toe walking in your child
If your toddler continues toe walking after age 2, if he was walking flat-footed and suddenly starts toe walking, or if you have any other concerns about his development, let your pediatrician know. You should also call your doctor if you notice any of the following:[5]
- Tight leg muscles
- Stiff Achilles tendons
- Poor muscle coordination
- Toe walking on just one side
- Foot pain
- Frequent falls
- Walking with an odd gait
- A verbal delay or poor eye contact, which may be signs of autism
- Difficulty keeping up with other kids the same age
Toe walking in toddlers is very common, and most kids outgrow the behavior by the time they turn 2. Your pediatrician or specialist can reassure you and advise on any strategies that might help in the meantime. And if your child does end up needing treatment for toe walking, doctors will work with you to find the best solution.
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