Rehabify
In brief
Many toddlers walk on their toes now and then while they learn to walk, and it often settles by about age 2 to 3. Toe walking should be checked if it continues after that age, affects one leg only, started after your child had been walking flat-footed, or comes with stiffness, falls or delays in other skills. At Rehabify in Bengaluru, Dr. Dharshan N A, a physiatrist, checks children who walk on their toes and helps families decide whether to watch, stretch or treat.
Why young children walk on their toes
When children first start walking, their balance and muscle control are still developing. Walking on tiptoe now and then is a normal part of learning. Most children slowly move to a heel-to-toe walk as they get steadier.
Some children carry on walking on their toes after age 2 or 3 even though their muscles, nerves and development are otherwise normal. Doctors call this idiopathic toe walking, which means no cause is found. It often runs in families and many of these children improve over time. But toe walking can also be an early sign of another condition, so it is worth checking when it does not settle.
When it is usually not a worry
Toe walking is less likely to be a concern if your child:
- Is under 2 and still new to walking
- Toe walks only sometimes, for example on cold floors or when excited
- Can stand and walk flat-footed when asked
- Is meeting other milestones, such as running, climbing and using their hands
- Has no stiffness, pain or frequent falls
When to get it checked
Book a check if your child:
- Still walks on their toes most of the time after age 2 to 3
- Toe walks on one side only
- Cannot put their heels down when standing, even when asked
- Started toe walking after already walking flat-footed
- Falls often, seems clumsy, or tires more than other children
- Has stiff or very floppy legs, or uses one hand much more than the other
- Is late with sitting, walking, speech or play
- Has trouble climbing stairs or getting up from the floor
- Has back pain, leg weakness or changes in bladder or bowel control
What can be behind toe walking
- Tight calf muscles or Achilles tendon, present from birth or developing over time
- Mild cerebral palsy, which can show as toe walking, often more on one side
- Muscular dystrophy, especially in boys who also have large calves, falls and trouble with stairs
- Autism and sensory differences, where toe walking is common
- Problems in the spine or nerves, which are less common but important to find
- Idiopathic toe walking, where no cause is found after a full check
What happens at the check
- Your story. When your child started walking, when toe walking began, family history, birth history and other milestones.
- Watching your child move. Walking, running, squatting, standing on heels and getting up from the floor, done as play.
- Examination. How far the ankles bend, muscle tone, strength, reflexes, the spine and the hips.
- Tests if needed. Most children do not need any. Blood tests, nerve tests or scans are used only when the examination points to a cause.
- A clear plan, explained in plain words.
Short videos of your child walking at home, barefoot and in shoes, are very helpful.
What helps
Treatment depends on the cause, your child's age and how tight the calves are:
- Watching and reviewing for younger children whose ankles still move well
- Daily calf stretches shown by a physiotherapist, done at home as part of routine
- Activities that use the heels and calves, such as walking uphill, heel walking games and squatting play
- Supportive shoes or orthoses (ankle foot orthoses) to hold the foot in a better position
- Serial casting, where a series of plaster casts gently stretches tight calves over a few weeks
- Targeted injections into tight calf muscles in some children, always combined with stretching and therapy
- Referral to an orthopaedic surgeon for lengthening of the calf or tendon, if the tightness is fixed and other steps have not helped
If another condition is found, such as cerebral palsy or muscular dystrophy, care is planned for that condition too.
What you can do now
- Encourage barefoot play on safe surfaces, such as grass or sand
- Make stretching part of a daily routine, such as after a bath
- Take short videos every few weeks so you can see changes over time
- Do not force your child to walk flat-footed or scold them for toe walking
How Rehabify helps
Dr. Dharshan N A examines your child through play, looks for any cause behind the toe walking, and plans stretching, orthoses or casting with your child's physiotherapist. When needed, he refers you to a paediatric neurologist, developmental paediatrician or orthopaedic surgeon. Follow-ups can be at the clinic or by video consult.
When to get help urgently
Medical emergency
See a doctor within days if toe walking starts suddenly with back pain, leg weakness, or new problems with bladder or bowel control. Call 108 or 112 or go to an emergency department if your child has sudden weakness, a seizure, a fall with a head injury, or is very drowsy and hard to wake.
Common questions
At what age should toe walking stop?
Most children walk with a heel-to-toe pattern by about age 2 to 3. Occasional toe walking after that can still be normal, especially when excited. If your child toe walks most of the time after age 3, or cannot put their heels down when asked, it is worth a check with a doctor.
Is toe walking a sign of autism?
It can be. Toe walking is more common in autistic children, often linked to sensory differences. But most children who toe walk are not autistic. If you also notice delays in speech, play or social skills, mention them at the check, and the doctor can refer you to a specialist who assesses autism.
Will my child grow out of toe walking?
Many children do, especially when no cause is found and the ankles still move well. Some keep toe walking and develop tight calves, which can make walking and running harder. Regular reviews help catch tightness early, when stretching and orthoses are more likely to help.
Do special shoes help?
Supportive shoes alone rarely stop toe walking. Ankle foot orthoses, which are custom-made splints worn inside shoes, can hold the foot in a better position and stretch the calf. The doctor will advise if your child needs them and check the fit as your child grows.
Is surgery needed for toe walking?
Rarely. Surgery to lengthen the calf muscle or Achilles tendon is considered only when tightness is fixed and has not improved with stretching, orthoses or casting. If this applies to your child, the doctor will explain why and refer you to a paediatric orthopaedic surgeon.
Sources
- [1]
American Academy of Orthopaedic Surgeons (AAOS). OrthoInfo: Toe walking in children
- [2]
Centers for Disease Control and Prevention (CDC) and American Academy of Pediatrics (AAP). Learn the Signs. Act Early. developmental milestones, 2022
- [3]
National Institute for Health and Care Excellence (NICE) guideline NG62. Cerebral palsy in under 25s: assessment and management
This guide is for general education and does not replace a consultation. Read how we write and review guides in our editorial policy.
