Parents wait expectantly for the day their child toddles uneasily across the floor for the first time. Unfortunately the triumph and pride can turn to concern and worry when a toddler is moving in atypical ways like toe-walking. But a toddler walking on toes is not necessarily in-itself a reason for parents to be on red alert. There are a number of potential reasons for tip toe walking and only rarely do they relate to larger concerns like autism or cerebral palsy.
Here’s what parents of toe walking toddlers need to know.
Babies typically have about six-months of walking practice before they take their first uneasy steps on their own. But they start the process with essentially no control over their foot and ankle, according to Dr. Stacey Dusing, a certified specialist in pediatric physical therapy and Sykes Family Chair of Pediatric Physical Therapy, Health and Development in the Division of Biokinesiology and Physical Therapy at the University of Southern California.
“We describe initial walking as a controlled fall,” Dusing says. “Babies are just able to keep themselves upright and they use their hips to control their movements because they don’t have great control of their feet and ankles. That’s why they look like they’re waddling.”
During the practice period, whether it be cruising or holding on to parents hands while stepping, babies will step in whatever way their foot happens to fall. Some babies my step down heel first. Other babies will stomp around with flat feet. And other babies keep on their tippy toes. Up until just after the first year pretty much all of those modes of stepping are normal.
“Before 18 months we are never worried about the kid who is occasionally toe walking,” Dusing says. “It’s pretty normal to have that variability in kids take steps and how they move.”
Why Do Toddlers Toe Walk
Until babies start to get up on their feet, the muscles around the ankles aren’t typically activated. So they aren’t being developed and strengthened. In fact it isn’t until 3-years-old that children start developing arches and the small musculature and shape of the feet continue to develop until age 5.
So it’s not uncommon to see some variation in the way a child steps. Even for older kids some toe walking may be mixed in with typical walking. That might concern some parents but Dusing encourages her clients to consider the context in which toe-walking occurs.
“If they only walk on their toes when they are outside on bare feet, or on hardwood floors and not carpet, then maybe it’s sensory — they don’t like the feel of the ground,” she explains. “I’m less worried about it being related to things like autism, or contractures and shortness of muscles.”
When Toe Walking Matters
While toe walking is associated with developmental delays, the act of toe walking itself does not necessarily mean a child is developing atypically. Usually, developmental issues connected to toe walking, including autism and cerebral palsy, will present with other symptoms.
So, toe walking in an older child might mean something more significant if the child is also engaging in sensory self-stimulation, or stimming, and finding it difficult to socially connect. Likewise, toe walking related to cerebral palsy is generally paired with additional difficulty in moving and controlling other limbs.
How to Help a Child Who Toe Walks
There are some ways to encourage children to walk in a typical way. But Dusing notes that your run-of-the-mill physical therapy isn’t going to cut it. Kids don’t generally get excited about doing reps to make their feet stronger and more flexible. “It has to be fun,” Dusing notes. “The way we’ll tell parents to do that is use obstacle courses.”
She suggests encouraging a kid to walk on ramps, in particular, to help a child start to use their heels. Ramps are difficult to toe walk on, so children are more likely to use flat feet. Some parents may even use a wedge in places where a child might otherwise use a step stool.
That said, for typically-developing children who occasionally toe-walk, the practice will resolve itself in time. Still, parents who remain worried should not hesitate to contact their pediatrician for guidance.