Toe Walking

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
  • Bracing
  • Stretching
  • 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:

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.

Make Lifestyle Changes

  • 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 a Clean Diet

Use Only High-Quality Fats

  • Coconut oil
  • Olive oil (unheated)
  • Avocados
  • 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

  • Canola
  • Corn
  • Soy
  • Safflower
  • Sunflower
  • Hydrogenated vegetable oils (Crisco, etc.)
  • Margarine

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
  • Legumes
  • Nuts

Eliminate High-Glutamate Foods

These foods and ingredients can exacerbate neurological symptoms because of the excitoxicity they cause in the brain. These are some of the most-common, high-glutamate foods to remove:

  • Monosodium glutamate (MSG)
  • Hydrolyzed vegetable protein
  • Soy protein isolate
  • Yeast extract
  • Gelatin
  • Barley malt
  • Bouillon
  • Natural flavors
  • Artificial flavors
  • Soy sauce
  • Corn starch
  • Others

Add Fermented Foods and Probiotics

These will keep the gastrointestinal system and microbiome healthy and strong which in turn will keep the immune system strong.

  • 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.

Optimize Blood Sugar

Blood sugar that is too high can lead to excess inflammation and hormonal imbalances.

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.

Do an Elimination Diet

Children with chronic health conditions often have hidden food sensitivities and intolerances that exacerbate their symptoms. With an elimination diet, remove potentially inflammatory foods such as:

  • Casein
  • Gluten
  • Soy
  • Corn
  • Eggs
  • Fish
  • Shellfish
  • Nuts
  • Peanuts

Clean up Your Environment

  • 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.

Practitioners of techniques such as EMDR (Eye Movement Desensitization Retraining) and jin shin jyutsu can lower stress levels for your child, as well.

See a Homeopath, Naturopath or Homotoxicologist

These practitioners can diagnose and treat gastrointestinal disorders naturally so that the child’s immune, sensory, neurological and nervous systems develop without being compromised.

Ask Your Practitioner to Run Some Laboratory Tests

  • 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)

Have Your Child Tested for PANS/PANDAS

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
  • Mold

Use Digestive Aids with your Practitioner's Guidance

  • Betaine hydrochloric acid
  • Digestive enzymes with DPP-IV for gluten and casein intolerances
  • Proteolytic enzymes
  • BiCarb
  • Bromelain
  • Papaya

Use Supplements with Your Practitioner's Guidance

Always work with your practitioner to determine the brand, type and dosage of supplements. Common supplements include the following:

  • Cod liver oil
  • Probiotics
  • Vitamin D3
  • Methylated B complex vitamins
  • GABA, especially PharmaGABA
  • N-acetylcysteine (NAC)
  • Magnesium, zinc, selenium, iodine and other minerals
  • Others

Help Your Child Detoxify

  • 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.

Integrate 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

Chiropractic neurology is patient focused and utilizes the latest assessment techniques to create an individualized protocol to rehabilitate the central nervous system and develop neuroplasticity (changes in the brain) when addressing neurological conditions.

Children with developmental delays, cognitive issues and deficits have improper communication between the right and left sides of the brain.

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. Doing so can improve hand-eye coordination and school performance.

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 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

These occupational therapists 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 perform spinal cord adjustments, which can improve communication in the nervous system.

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. These programs can retrain the brain, calm down the nervous system and reduce sound sensitivities.

Find a Brain Gym Practitioner

A Brain Gym practitioner can have your child do exercises for sensorimotor coordination, self-calming and self-management.

Work with a Health Coach

Our Epidemic Answers health coaches are trained to understand the root causes of your child's chronic health condition.

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.

See an Acupuncturist

Acupuncture can help lower stress and anxiety associated with sensory processing. It can also help with blood-sugar and hormonal regulation.

See a NAET or BioSET Practitioner

Children with chronic health conditions 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.

Use Sensory Therapies and Tools

Activities for Toe Walking

  • See the University of Rochester’s guide to Activities for Children Who Walk on Their Toes
  • See’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?

Visit the Epidemic Answers Practitioner Directory to find a practitioner near you.

Join us at Healing Together, where you’ll find even more resources plus a community to support you, every step of the way.

  • 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.

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