Musculoskeletal Series Part 3: Toe-Walking
Does your child walk on their toes sometimes or all the time? Have you ever wondered if this was "normal" or not? This is another common concern parents have as they watch their children learn to walk. So let's go over toe-walking and find out it if or when to be concerned.
What is toe-walking?
Toe-walking generally refers to a child walking on their toes or the balls of their feet without their heels contacting the ground. This differs from the typical heel-toe pattern of walking, that most parents are anticipating, where the foot flattens on the ground with each step.
Most babies begin walking between 12 to 15 months of age, although this can vary greatly. When babies start walking, they will unconsciously try different foot positions and mentally take notes on how it feels to walk in different positions. Walking on their toes is often a part of this. Toe-walking (or toe-standing) is very common in infants as they start to learn what it feels like to bear weight on their legs.
By about 2 years of age, most children will walk with their feet flat on the ground most of the time. By 3 years of age, children should walk with a typical heel-toe pattern.
What causes toe-walking?
For the large majority of children who toe-walk, there is no specific cause. Sometimes toe-walking runs in families and without any other developmental, muscular, or neuropsychiatric issues. You should not be concerned about your child's toe-walking if they meet all or most of these criteria:
Your child is under age 2
Your child is able to flatten their foot (you can move their foot freely without pain and they sometimes flatten their own feet when standing or walking)
Your child has no major medical conditions, particularly any conditions of the muscle, brain, or nervous system
Your child has been meeting all of their developmental milestones
Your child's height and weight are normal for age
If you are still not sure, you can always check with your child's doctor. Most toe-walkers will have a normal exam when evaluated and your child's doctor will not be concerned.
When should I be concerned about my child's toe-walking?
There are a few medical conditions that can cause toe-walking, including a short Achilles tendon, cerebral palsy, muscular dystrophy, spinal cord abnormalities, or other muscular or nervous system disorders. Toe-walking is also more common among children with autism and sensory processing disorders; however, autism does not cause toe-walking is likely more of a sensory-related preference in some children with autism.
Consult your child's doctor if your child meets some or all of these criteria:
Your child is over age 2, or especially over age 5, and still toe-walks
Your child walks on his/her toes most or all of the time
Your child has stiff muscles (you cannot freely move their feet or your child cannot completely flatten their foot on the ground)
Your child is unbalanced or awkward in their walking (over age 2)
Your child trips and falls often (over age 2)
Your child is not meeting all of their developmental milestones
Your child has other medical problems, especially cerebral palsy or a muscle, spine, or nerve disorder
You have a family history of muscular dystrophy or other muscle or nerve disorders
Your child has autism or a sensory processing disorder or you have concern for this for reasons other than toe-walking
If your child meets one or more of these criteria, discuss with your child's doctor right away to find out if your child may need intervention to help with his/her toe-walking and any related issues.
Can my child's toe-walking lead to any problems or complications?
Even if there is no specific cause or underlying medical condition causing your child's toe-walking, persistent or prolonged toe-walking can lead to tightening of the muscles and tendons over time. This can lead to complications, such as uncoordinated walking and running, frequent trips or falls, problems wearing shoes, and difficulty participating in sports or physical activities.
If your child has been toe-walking for a long time (typically for years) and develops this type of stiffness, they may need physical therapy, orthotics, serial casting/bracing, and occasionally, surgery to correct the stiffness and restore a normal gait.
Continue reading the Musculoskeletal Series for other related topics such as:
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