Toe Walking in Children

Toe walking is a gait pattern in children aged more than 3 years characterised by the absence of heel contact with the ground (“walking on tiptoes”). It is a clinical diagnosis that requires ruling out other neurological or orthopaedic conditions that may cause a similar walking pattern. Before age 2 years, this pattern is considered normal, and it generally resolves spontaneously in most children.

Based on several studies, the prevalence of toe walking in healthy children is estimated at 7–24%. In addition to pain and increased instability, children with persistent toe walking can lose the ability to flex the ankle, which results in a shortened Achilles tendon.

When it comes to the cause of toe walking, a hereditary pattern has been described in many early studies. Other studies have proposed impairments in sensory processing and proprioception (balance) as the cause of this gait pattern.

The increased prevalence of toe walking in children with autism spectrum disorder is well known, but several studies have also reported an association with other neurodevelopmental disorders. Some research shows those children who walked on their toes were more likely to have language disorders and others had hyperactivity and motor impairments (gross and fine motor skills affected).

Just as the incidence of toe walking is higher in children with neurodevelopmental disorders, there is also a higher probability of its occurrence in association with different learning disorders. The latest study (April 2018) to appear in the journal Anales de Pediatría (English Edition) aimed to determine the frequency of toe walking in children with attention deficit disorder and hyperactivity (ADHD). They concluded that children with ADHD have frequently more toe walking and Achilles shortening than controls, especially if they presented with a social communication disorder or a family history of toe walking. An early diagnosis is essential to establish effective treatments, so if you are concerned about your child’s toe walking, visit us today.