Symptoms

Toe walking is walking on the toes or the ball of the foot.

When to see a doctor
Mention the toe walking at your child's next checkup. Make an appointment sooner if the toe walking is accompanied by tight leg muscles or a lack of muscle coordination.

Causes

Typically, toe walking is simply a habit that develops when a child learns to walk. In a few cases, toe walking is caused by an underlying condition, such as:

• A short Achilles tendon. This tendon links the lower leg muscles to the back of the heel bone. If it's too short, it can prevent the heel from touching the ground.
• Cerebral palsy. Toe walking can be caused by cerebral palsy — a disorder of movement, muscle tone or posture that is caused by injury or abnormal development in the immature brain, most often before or surrounding birth.
• Muscular dystrophy. Toe walking sometimes occurs in muscular dystrophy, a genetic disease in which muscle fibers are unusually susceptible to damage and weaken over time. This diagnosis may be more likely if your child initially walked normally before starting to toe walk.
• Autism. Toe walking has also been linked to autism, a complex group of disorders that affect a child's ability to communicate and interact with others.

Risk factors

Toe walking out of habit, also known as idiopathic toe walking, sometimes runs in families.

Complications

Persistent toe walking may increase a child's risk of falling.

Preparing for your appointment

You'll probably first bring your concerns to the attention of your family doctor or pediatrician. He or she may refer you to a doctor specializing in nerve function (neurologist) or orthopedic surgery.

What you can do
Before your appointment, you may want to write a list of questions for the doctor, including:

• What could be causing toe walking in my child?
• Are any tests needed? If so, what are they?
• What treatments are recommended for this problem?

What to expect from your doctor
Your doctor may ask some of the following questions:

• Does your child have any other medical problems?
• Do you have a family history of muscular dystrophy or autism?
• Was your child born prematurely?
• Did your child previously walk flat-footed and only recently begin to toe walk?
• Can your child walk on his or her heels if you ask?
• Does your child avoid eye contact or exhibit repetitive behaviors such as rocking or spinning?

Tests and diagnosis

Toe walking can be observed during a physical exam. In some cases, the doctor may do an in-depth gait analysis or an exam known as electromyography (EMG). During EMG, a thin needle with an electrode is inserted into a muscle in the leg. The electrode measures the electrical activity in the affected nerve or muscle.

If the doctor suspects an underlying condition such as cerebral palsy or autism, he or she may recommend a neurological exam or testing for developmental delays.

Treatment and drugs

If your child is toe walking out of habit, treatment isn't needed. He or she is likely to outgrow the habit. Your doctor may simply monitor your child's gait during regular office visits. If a physical problem is contributing to toe walking, treatment options may include:

• Physical therapy. Gentle stretching of the leg and foot muscles may improve your child's gait.
• Leg braces or splints. Sometimes leg braces or splints help promote a normal gait.
• Serial casting. If physical therapy or leg braces aren't helpful, your doctor may suggest trying a series of below-the-knee casts to progressively improve the ability to bring the toes toward the shin.
• Surgery. If conservative treatments fail, the doctor may recommend surgery to lengthen the muscles or tendons at the back of the lower leg.

If the toe walking is associated with cerebral palsy, autism or other problems, treatment focuses on the underlying condition.