Toe walking

Toe walking
Toe walking
Specialty	Pediatrics

Toe walking is a term describing a type of walking style. Toe walking is when a person walks on their toes or the ball of their foot, without putting much or any weight on the heel or any other part of the foot.^[1] Toe walking in toddlers is common. Children who toe walk as toddlers commonly adopt a heel-toe walking pattern as they grow older. If a child continues to walk on their toes past the age of three, or cannot get their heels to the ground at all, they should be examined by a health professional who is experienced in assessing children's walking.^[2]

Toe walking can be associated with a number of health conditions, or have an unknown reason. When no medical reason for toe walking and no underlying condition can be identified, health professionals will commonly refer to it as "idiopathic" toe walking. This is not a formal or recognized diagnosis; rather, it is simply a term indicating that there is no identifiable reason or cause for the toe walking at that time. The child may have a diagnosis that becomes more apparent as they grow or never have a diagnosis that causes the toe walking.^[3] Idiopathic toe walking should only be considered after all other conditions have been excluded. ^[4]

Other causes for toe walking include a congenital short Achilles tendon, muscle spasticity (commonly associated with cerebral palsy) or genetic diseases muscle disease such as Duchenne muscular dystrophy.^[5] Toe walking may also be caused by a bone block located at the ankle which prevents the ankle from moving. This may be as the result of trauma or arthritis.^[6] Toe walking may also be one way of accommodating a separate condition, foot drop. Persistent toe walking in children is also associated with developmental disabilities, such as autism.^[7][8] In a recent study, 68% of children with an Autism Spectrum Disorder report experiencing walking changes.^[9][10] Those with sensitive nervous systems, such as people with Autism Spectrum Disorder, Sensory Prosessing Disorder, or giftedness are also reported to be prone to toe walking.

It is estimated that 5% of healthy children have no reason for their toe walking (idiopathic toe walking).^[11] Idiopathic toe walking has also been observed more in males than females when very large groups of children with toe walking are observed. One study looked for a family history of toe walking, and found a connection with family members all toe walking with no medical reason (idiopathic toe walking). This means there may be a genetic link with idiopathic toe walking.^[12] Idiopathic toe walking spontaneously disappears over the years in the majority of cases and is most often not associated with a motor or cognitive issue.^[13]