This just may be how they are learning to navigate their world, but then again, there may be some other issues of concern, especially if the toe walking simply does not phase out at all.
A Swedish study in 2012 was conducted with the parents of almost 1,500 children and the results were published in Pediatrics.
The study’s findings indicated that children with developmental delays and cognitive disorders such as autism spectrum disorder were more likely to walk on their toes.
Other disorders such as cerebral palsy or muscular dystrophy also exhibited toe walking.
However, neurotypical children, without any underlying neurological condition, also used their toes instead of their typical gait.
This condition is known as “idiopathic” or “habitual” toe walking and more than half of these children grew out of their toe walking by 5-½ years of age.
It is perfectly understandable why parents have tremendous anxiety surrounding this condition because walking is an important milestone.
When You Should Be Concerned
If your child is over the age of two and still toe walking, then there is reason to be concerned about what the possible causes are and what steps need to be taken to resolve the contributing factors.
If your child is beyond two years of age, develops decreased eye contact, coordination difficulties and fine and gross motor problems, then attention to this condition is warranted.
If a child continues to toe walk past the age of three, it is generally considered appropriate to have an evaluation for underlying neurological issues or physical problems (such as a short Achilles tendon) or a condition such as cerebral palsy.
However, when a specific cause such as cerebral palsy is ruled out, further investigation may be warranted.
What Your Doctor May Tell You About Toe Walking
Your child’s pediatrician may give you a list of reasons for your child’s toe walking.
The big question is “why do children walk on their toes?”
There are a variety of possible reasons as to why children toe-walk: structural, sensory, developmental, biomedical and neurological. It can be due to:
- A learned habit known as “habitual” or “idiopathic” toe-walking
- Found in multiple family members and possibly genetic called “familial toe-walking’
- Due to short or tight Achilles tendon (the tendon that links the lower muscles to the back of the heel bone) in cerebral palsy, muscular dystrophy and other generalized diseases of nerve and muscle
- An inability to bear weight on flat feet
- In a child with more flexible joints such as generalized joint hypermobility(GJH)
- Due to tight calf muscles as in the case of cerebral palsy or muscular dystrophy
- Due to an orthopedic condition such as congenital talipes equinovarus (club foot)
- Due to inflammation of the growth plate in the heel called calcaneal apophysitis
- In a child with other medical problems
Your doctor may suggest:
- Verbal reminders
- Heavy footwear such as still boots or high-top tennis shoes
- Full-length orthotics
- Ankle foot orthotics
- Plaster casts to stretch the calf muscles
- Botox injections in calf muscles
- Surgical intervention to lengthen the Achilles tendon
The physician may also recommend having an evaluation with a physical therapist for further therapy.
Another Way to Think About Toe Walking
Toe walking can be symptomatic of a host of neurodevelopmental disorders and dysfunction, which many pediatricians are not as well versed in, such as:
- Experiencing motor skills, balance and coordination challenges (vestibular system dysfunction)
- Sensory Processing Disorder (SPD) with difficulties related to the poor vestibular system which regulates body motion and position, balance and seeking out movement
- Visual-vestibular issues
- Sensory-seeking behavior: Child receives intense proprioceptive input to the calf muscle in their legs
- Speech and language delays (common in autism and other neurodevelopmental disorders)
- Difficulty with gross or fine motor activities
- Learning challenges
- Poor behavior
- Aversion to socks, shoes and bare feet
- Poor self-awareness
- Rigid gait, rigid legs and leaning forward with walk (gait is off)
- Loss of already developed motor skills
- Overstimulation in the feet that occurs from walking on the entire foot (tactile defensiveness)
- Hypersensitive child who is sensitive to sensations on the bottom of their feet and does not want their feet touching any type of surface (tactile defensiveness)
- Liking the pressure toe-walking puts on their ankle (proprioceptive feedback)
- Sympathetic overdrive (fight or flight) of the nervous systems contributing to keeping the child on their toes, literally
- Delays in reaching developmental milestones (developmental delays)
- Premature birth (preemie) or birth trauma
- Exhibiting poor eye contact, ritualistic, spinning, repetitive or stereotypical behaviors (autism)
- Inner ear may be off from a dysfunctional balance system
- Needing glasses at a young age (3 to 6), which is a sign of a developmental vision problem
- seems to not hear so well in the classroom
- An inability to copy information from the blackboard
- Trouble tracking words for reading; blinks to refocus
- Clumsy, unbalanced and uncoordinated
- Impacted stools and chronic constipation
Many motor delays in children both on and off the autism spectrum are related to mitochondrial dysfunction; therefore, it is hypothesized that toe walking may be yet another physical manifestation of muscle groups affected by mitochondrial dysfunction.
Toe Walking Checklist to Start
Make dietary changes:
Is your child craving and eating primarily a refined carbohydrate, high sugar, trans-fatty acids and fast food diet?
Eliminate all processed foods, and eat a whole foods diet.
Gluten- and dairy-containing foods are commonly known to produce an inability to focus when eaten.
- Eat whole foods
- Buy organic foods
- Remove all GMO foods
- Remove all fast and processed foods
- Remove all foods with:
- Artificial colors
- Artificial ingredients
- Remove potentially inflammatory foods such as
- Strictly limit:
- Refined salt
- Refined carbohydrates
- Join the Feingold Association www.Feingold.org to learn more.
Include plenty of good quality fats, such as:
- Coconut oil
- Olive oil
- Wild salmon
- Organic chicken
- Organic turkey
- Grass-fed ghee
- Pasture-raised eggs
- Grass-fed beef
- Essential fatty acids from:
- Cod liver oil
- Hemp seeds
- Flax seeds
- Evening primrose oil
- Borage oil
- Walnut oil
Remove vegetable oils such as:
Include plenty of high-quality proteins with every meal, such as:
- Pasture-raised eggs and chicken
- Grass-fed beef
- Wild-caught fish
Heal the gut with special diets such as:
- GAPS (Gut And Psychology Syndrome) diet
- Paleo diet
- GF/CF (gluten-free/casein-free) diet
- Body Ecology Diet
- Modified Atkins Diet (replaces the Ketogenic diet)
Learn more about healing diets and foods.
Use digestive aids with your practitioner’s guidance:
- Betaine hydrochloric acid
- Digestive enzymes with DPP-IV for gluten and casein intolerances
- Proteolytic enzymes
Clean up your environment:
Have you identified and removed possible environmental triggers, such as mold, dust, pet dander, and electromagnetic fields (EMFs)?
Have you identified and removed possible toxic exposures in the home from purchased products, such as detergents, soaps, lotions, and other cleaning and personal care products?
- Remove animals (both live and stuffed!)
- Remove carpets
- Use non-toxic cleaners
- Use non-toxic building materials
- Green your home
Avoid exposing your child to chlorine, fluoride, and bromine because all three are in the same family as iodine and can displace iodine in the thyroid gland.
Ask your pediatrician to run some laboratory tests for:
- Possible food sensitivities and allergies
- Enzyme-Linked Immunosorbent Assay (ELISA) IgG, IgA, IgE and IgM
- Nutritional deficiencies in vitamins and minerals. The NutrEval by Genova Diagnostics Labs covers the following areas:
- Cellular energy
- Mitochondrial metabolism
- Neurotransmitter metabolism
- Vitamin deficiencies
- Toxin exposure
- Detoxification need
- Bacterial and yeast overgrowth
- Gluten and casein sensitivities
- Organic acids: The organic acid test by Great Plains Laboratory for:
- Yeast overgrowth (Candida)
- Other microbial infections
- Comprehensive Stool Analysis by Genova Diagnostic Labs to identify:
- Altered gastrointestinal function
- Bacterial/fungal overgrowth
- Chronic dysbiosis
Use homeopathy specific for Sensory Processing Issues
- Nux vomica
- Tarantula hispana
Consider using Schueller’s cell tissue salts, which can be effective as well.
Sequential homeopathy can also be specific for sensory processing symptoms if needed.
Add fermented foods and probiotics daily:
These will keep the gastrointestinal system and microbiome healthy and strong which in turn will keep the immune system strong.
- Eat kefir yogurts
- Eat fermented vegetables
- Eat umeboshi plums (very alkalizing)
- Eat miso soup, if soy is tolerated
Some good probiotics are:
- Gut Pro
- Dr. Ohirra’s Live Cultured Probiotics
- Garden of Life
- Klaire Labs
Use herbs, essential oils and natural supplements with your practitioner’s guidance:
- Cod liver oil
- Other omega fatty acids
- Vitamin C
- Vitamin D3
- Herbal iron
- Methylcobalamin B12
- Folinic acid
- Trace minerals
- Fat soluble antioxidants, such as vitamin E and/or vitamin A
- Vitamin B6 (as P5P)
- Other B vitamins
- Alpha lipoic acid
- Calendula flower essence
- Bergamot essential oil
- Geranium essential oil
- Neroli essential oil
- Lavender essential oil
- Wintergreen essential oil
- Skullcap herb
- Golden rod herb
- Gingko biloba
- Lemon balm herb
- N-acetylcysteine (NAC)
- MSM transdermal cream
- Epsom salts bath
Help your child detoxify:
- Ionic foot baths can help detox unwanted pathogens and are easy to do with children
- Infared saunas can detox heavy metals through the skin by sweating. However, this form of detoxification may not be suitable for young children who lack the ability to sweat.
Learn about retained primitive reflexes:
Most, if not all, children with neurodevelopmental disorders including learning disabilities, have retained primitive reflexes.
Find a therapist that is trained in integrating primitive reflexes, which can cause imbalances in the way your child’s brain performs.
See a chiropractic neurologist at a Brain Balance Center:
The Brain Balance program can help balance the right and left brain hemispheres and make neural connections to extinguish primitive reflexes.
See a neurofeedback practitioner:
Neurofeedback is approved as a level-one intervention by the American Academy of Pediatrics for ADD and ADHD, which are learning disabilities.
Even if your child doesn’t have ADD or ADHD, they may still benefit from neurofeedback.
Find a practitioner that can perform a QEEG (quantitative electroencephalograph) brain map first so you can understand how your child’s brain works.
See a sensory-integration occupational therapist (OT):
These OTs address a variety of sensory issues with a child using hands-on equipment.
This type of therapy calms down the nervous system to help integrate the senses and retained reflexes.
See a chiropractor:
A chiropractor can help with spinal cord adjustments, treatment of subluxations and improvement of neurological flow.
Chiropractic care can improve nervous-system functioning and calm down the “fight or flight” sympathetic overdrive.
See a craniosacral practitioner:
Craniosacral therapy can reestablish central nervous system functioning.
These practitioners use approaches rich in vestibular, proprioceptive and tactile input and may also do oral motor therapy.
See a behavioral/developmental optometrist:
A developmental optometrist can check for convergence and tracking problems with your child’s vision.
He or she can correct these issues with vision therapy, lens and prisms.
Melvin Kaplan, OD at the Center for Visual Management in Tarrytown, NY conducted studies and found that toe-walking was eliminated seconds after the child began wearing prism lenses.
Doing so can improve hand-eye coordination and school performance.
Vision therapy is also highly recommended for children to improve their visual-motor skills and following that the prism lenses can be eliminated.
See an auditory therapist:
Many children with learning disabilities have auditory processing problems that may be causing problems with focus and concentration.
An auditory therapist can devise a listening program that is specific to your child’s needs.
Auditory Integration Therapy (Berard) or Sound Stimulation (Tomatis) can retrain the brain, calm down the nervous system, reduce sound sensitivities.
Calming down the nervous systems can help the child come down off their toes.
Find a therapist doing Brain Gym:
A Brain Gym practitioner can have your child do exercises for sensorimotor coordination, self-calming and self-management.
See a homeopath or naturopath:
These practitioners can diagnose and treat gastrointestinal disorders naturally so that the child’s immune, sensory, neurological and nervous systems develop without being compromised.
See a well-trained acupuncturist:
Acupuncture can help lower stress and anxiety associated with sensory processing.
See a NAET or BioSET practitioner:
Children with Sensory Processing Disorder typically also have food allergies and/or food sensitivities and intolerances. NAET (Namudripad’s Allergy Elimination Technique) and BioSET are two non-invasive methods of allergy elimination.
Sensory therapies and tools:
- Super brain yoga
- Rock climbing
- Weighted vests, blanket and belts
- HANDLE therapy
- Sensory Learning
- Tool Chest
- Squeeze Machine
- Music therapy
- Sensory gym
- Deep pressure brushing therapy
- Sensory tactile toys
Do home-based sensory-integration therapies:
- Wilbarger protocol (brushing therapy) for sensory integration: This protocol provides proprioceptive input with deep pressure to feet, ankles and shoulders. It calms the nervous system down, releasing serotonin from the brain and relaxing muscles.
- Therapeutic vestibular stimulation such as swings, glider swings, obstacle courses, trampolines, therapy balls, auditory and visual activities that incorporate movement all improve body motion, position and balance.
- Improve tactile defensiveness by creating a multi-textured pathway for your child to walk on barefoot:
- Plastic door mats
- Rubber car mats
- Pillowcases filled with rice
- Buckwheat hulls, corn or twigs
- Soft blankets
- Shaving cream
- Cardboard covered in tin foil
- Art painting with feet
- Play games on sand or grass barefoot to improves tactile processing and self-awareness so your child has more control.
Relieve chronic constipation:
Chronic constipation can cause impacted stools and may result in toe-walking.
See our page on constipation and diarrhea for dietary suggestions to eliminate the impacted stool.
Activities for Toe Walking
- See the University of Rochester’s guide to Activities for Children Who Walk on Their Toes
- See mendability.com’s Sensory Enrichment Therapy guide
- See a Brain Balance center for an assessment of retained primitive reflexes.
- Implement marching and stomping games with your child with music so your child’s feet contact the ground (grounding).
- Try having your child run up and down hills to stretch those tendons and keep the feet down.
- Buy your child scuba flippers and have them try walking at home with them on… it’s very difficult to get up on the toes!
- Buy squeakers that have squeaky noises; it’s an incentive to get the heels on the ground.
- Buy wheeled shoes that requires the child to pick up their toes off the ground to roll. This places pressure on the heels and helps stretch the tendons as well.
- Play a fun stretching exercise game that teaches them how to hold their feet while pretend driving.
- Eliminate the baby walker, which is a common source of toe-walking.
Still Looking for Answers?
- Has your child had many infections treated with antibiotics? If so, consider lab testing for high levels of antibodies to organisms, such as strep and other bacteria and viruses, as well as an evaluation of gut bacteria, including yeasts and Candida.
- Did your child have a difficult birth that included a long labor, forceps or vacuum aspiration, or low Apgar scores? Consider an evaluation by an osteopath, craniosacral therapist or chiropractor for structural impediments.
- Is your child feeling stressed, anxious or upset? Consider family therapy, a school change, or other support.
- Consider alternative interventions, such as homeopathy, neurofeedback, essential oils, reiki, or energy medicine.
Visit the Epidemic Answers Provider Directory to find a practitioner near you.
Engstrom, P., et al. The Prevalence and Course of Idiopathic Toe-Walking in 5-Year-Old Children. Pediatrics. 2012 Aug;130(2):279-84.