When Is Toe Walking a Problem?
Family lore has it that my brother-in-law was still walking on his toes around age 4, so his worried mother took him to the pediatrician. After examining him, the doctor explained that everything was fine, there was nothing to worry about. His mother asked, “But when will he stop?” The doctor turned to the tippy-toed kid and bellowed, “Stop walking on your toes right … now!” The boy was so scared he did.
While we practice pediatrics more gently these days, toe walking is still something that understandably concerns parents. However, it’s usually not something to worry about!
When babies learn to walk, many start off walking on their tippy-toes. They usually stop by ages 2 to 3 as they get stronger and used to how it feels to have their feet flat on the ground.
Toe walking can be a hard habit to break for some kiddos, but in time … they learn to walk flat-footed. As long as they’re growing and developing normally, there’s usually nothing to be concerned about.
However, you should let your pediatrician know if your child is still walking on their toes past their 2nd birthday. They will examine your child and discuss their medical history with you.
We’d be more concerned if your child is toe walking and:
- Does this only on one side.
- Isn’t able to walk flat-footed.
- Was born prematurely.
- Was a late walker (after age 15 months).
- Has an abnormal physical exam.
Very rarely persistent toe walking can indicate a problem (such as cerebral palsy, a spinal cord abnormality, or muscular dystrophy), but most of the time it doesn’t. Sometimes it may be caused by tight calf muscles and tendons. But usually we never find out why a child is still walking on their toes – this is called “idiopathic toe walking.”
Toe walking can also simply be a habit. If your child is growing and developing normally, in most cases there’s nothing to worry about.
How is toe walking treated?
There are different types of treatment, depending on the cause. If toe walking is caused by a:
- Disorder, we’ll treat the underlying disorder.
- Physical problem (like persistently tight calf muscles and tendons), treatment can include physical therapy, bracing, serial casting, or injections – but these aren’t usually needed.
In very unusual cases when a child is still toe walking into childhood, and has tried all the other options, surgery may be needed. Your pediatrician will help guide your child’s care and connect you to specialists, if needed.
In the most common case – when we don’t uncover the cause of toe walking or it’s caused by a habit – it just needs time to be outgrown and isn’t a long-term problem.
We do know that children who were habitual toe walkers don’t have problems walking or running as older kids and adults. So the only treatment for this is observation and gentle reminders from you to walk flat-footed.
Resources for parents
American Academy of Orthopedic Surgeons:
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