What Parents Should Know About Toe Walking

Time seems to fly once you bring a baby home and start measuring months in milestones. Before you know it, they’re sitting up, flipping over and crawling around. At 12 months, most children can pull themselves up and take a few steps with help from you (or the furniture). By 18 months, they’ll likely walk from place to place on their own.

You might notice young children standing on the balls of their feet—or tippy toes—as they learn to walk. After age 2, they usually use a heel-to-toe pattern instead. But what if your child continues toe walking?

Nicole Kaiser, MD, a pediatrician at University Hospitals Rainbow Children’s Medical Group says, “Watching your little one closely as they reach milestones doesn’t just keep them safe. It also offers important clues about their development.”

What Causes Toe Walking?

Many times, toe walking can’t be tied to a specific cause. For a small number of children, toe walking after age 2 is related to another condition, such as:

• Autism
• Conditions that affect the brain, spine, or nerves
• Cerebral palsy
• Muscular dystrophy
• Tight Achilles tendons

Based on your child’s specific situation, a pediatrician may monitor their progress with regular office visits. You might also get a referral to see an orthopedist or other specialist for further evaluation or treatment.

What Are the Risks of Toe Walking?

“Over time, toe walking can lead to problems like muscle and tendon tightness, trouble wearing shoes, or difficulty standing,” Dr. Kaiser explains, “So it’s important to talk with your child’s pediatrician if they don’t outgrow it. She further advises that you observe your child closely so you can share details like whether your child toe walks on one foot or both feet.

Still worried? Schedule a developmental screening, which includes answering a series of questions and a physical exam. The American Academy of Pediatrics recommends children have developmental screenings whenever a parent has a concern, as well as at regular intervals between 9 and 30 months.

“Acting early can make treatment more effective, improving the outcome for your child,” says Dr. Kaiser. What happens after a developmental screening depends on the results and your child’s age and medical history.

Treatment for Older Children

Around age 4, your child’s healthcare team may suggest one or more of the following to treat toe walking:

• Physical therapy
• A series of short-term casts on the lower leg (serial casting)
• Leg bracing or splinting
• Botox injections to relax the tendons

If other measures haven’t helped, surgery may be recommended after age 5 to lengthen the Achilles tendons. These procedures increase the foot and ankle’s range of motion.

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University Hospitals Rainbow Babies & Children’s has a wide network of highly skilled pediatricians at convenient locations across the region. Our specialists have the advanced training and experience to care for children of all ages and provide parents with the support and encouragement they need.