It’s not unusual to see a two-year-old child toe walking. 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 Healing Checklist
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.
- Get 10 hours of sleep per night (or more if your child is under 10)
- Get outside every day
- Get an hour of exercise or movement per day
- Sync circadian rhythm by getting up when the sun does and going to bed after it sets
- Limit screen time as much as possible
- Use blue-blocking lightbulbs and glasses at night, especially when looking at screens
- Put bare feet in wet ground when possible
- Drink half body weight in ounces of water
- Eat whole foods
- Buy organic foods
- Eat a clean diet
- Remove all GMO foods
- Remove all fast and processed foods
- Remove all foods with artificial colors, artificial ingredients, artificial flavors, natural flavors, preservatives, phenols and salicylates
- Strictly limit sugars, refined salt and refined carbohydrates
- Consider implementing a low-glutamate diet and/or the Feingold diet
Use Only High-Quality Fats
- Coconut oil
- Olive oil (unheated)
- Medium-Chain Triglycerides (MCT) oil
- Grass-fed ghee
- Duck fat
- Grass-fed beef tallow
- Cod liver oil (unheated)
- Walnut oil (unheated)
Remove Vegetable Oils and Trans Fats
- Hydrogenated vegetable oils (Crisco, etc.)
Include High-Quality Protein with Every Meal
- Pasture-raised eggs, chicken and other fowl
- Grass-fed beef, lamb and other red meats
- Wild-caught fish
- Monosodium glutamate (MSG)
- Hydrolyzed vegetable protein
- Soy protein isolate
- Yeast extract
- Barley malt
- Natural flavors
- Artificial flavors
- Soy sauce
- Corn starch
Add Fermented Foods and Probiotics
- Eat kefir yogurts, if dairy is tolerated
- Eat fermented vegetables such as sauerkraut and kim chi
- Eat umeboshi plums, which are very alkalizing
- Eat miso soup, if soy is tolerated
- Take a quality probiotic, such as VSL #3, Gut Pro, Dr. Ohirra’s Live Cultured Probiotics, Garden of Life, Klaire Labs. Work with your practitioner for a more targeted probiotic.
Blood sugar that is too low can lead to attention and behavioral problems.
We recommend keeping blood sugar optimized so that it's neither too low nor too high.
- Identify and remove possible environmental triggers, such as mold, dust, pet dander, and electromagnetic fields (EMFs)
- Identify and remove 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
Lower Stress Levels
Viruses, bacteria and other pathogens become more active when the body is in a state of stress.
By teaching your child ways to self-regulate with practices such as prayer, reiki, meditation, yoga, qi gong, tai chi and the Emotional Freedom Technique (tapping), they can become good advocates for themselves and become active participants in the recovery process.
- Enzyme-Linked Immunosorbent Assay (ELISA) for possible food sensitivities and allergies
- Nutritional deficiencies in vitamins and minerals, especially vitamin D
- NutrEval by Genova Diagnostics Labs for malabsorption, gut dysbiosis, cellular energy, mitochondrial metabolism, neurotransmitter metabolism, vitamin deficiencies, toxin exposure and detoxification need
- Organic Acid Test (OAT) for yeast overgrowth, other microbial infections and oxalates
- Inflammation markers such as C-Reactive Protein (CRP)
- Fasting blood sugar and insulin levels
- Comprehensive Digestive Stool Analysis (CDSA)
Pathogenic infections and environmental offenders can cross the blood-brain barrier and cause neurological symptoms known collectively as PANS/PANDAS. However, not many practitioners know how to test for and treat these conditions. Common tests are:
- Serum Anti-Streptolysin O (ASO) titer
- Serum Anti-Streptococcal DNase B (ASDB) titer
- Cunningham panel
- Lyme disease and Lyme co-infections
- Specific viruses, especially herpetic viruses
- Mycoplasma pneumoniae infection
- Heavy metals and other toxins
Use Digestive Aids with your Practitioner's Guidance
- Betaine hydrochloric acid
- Digestive enzymes with DPP-IV for gluten and casein intolerances
- Proteolytic enzymes
- Cod liver oil
- Vitamin D3
- Methylated B complex vitamins
- GABA, especially PharmaGABA
- N-acetylcysteine (NAC)
- Magnesium, zinc, selenium, iodine and other minerals
- Make sure your child is pooping every day. Learn more about how to clear up constipation and diarrhea.
- Have your child exercise or move every day. Sweating carries toxins out of the body.
- See a homotoxicologist, naturopath or homeopath for drainage remedies and detoxification aids.
- Optimize blood sugar to allow the liver to spend more time detoxing rather than processing sugar.
- 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.
- Epsom salt baths add sulfur transdermally to help with detox.
Children with developmental delays, cognitive issues and deficits have improper communication between the right and left sides of the brain.
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.
An auditory therapist can devise a listening program that is specific to your child's needs. These programs can retrain the brain, calm down the nervous system and reduce sound sensitivities.
They provide hands-on helping with the practical matters of healing such as cooking healthy foods, removing toxins from the household and helping you work more efficiently with your practitioner.
NAET (Namudripad's Allergy Elimination Technique) and BioSET are two non-invasive methods of allergy elimination.
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?
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- 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.
Sources & References
Accardo, P.J., et al. Toe walking in autism: further observations. J Child Neurol. 2015 Apr;30(5):606-9.
Engstrom, P., et al. The Prevalence and Course of Idiopathic Toe-Walking in 5-Year-Old Children. Pediatrics. 2012 Aug;130(2):279-84.