The joy of your little one starting to walk! But sometimes you may have seen a baby walking not with their entire foot on the ground, but with their toes as if they were dancing. It's very normal for a mother or father to feel a little scared and nervous when they see this. "Oh, is something wrong with my baby?" You may think. Is this really something to be afraid of? Let's talk about all this today.
Simply put, what is toe walking?
The English name for this is toe walking . Simply put, this is when your child walks without putting the heel on the ground, but only on the tips of their toes and the front of their feet. Just like a ballet dancer.
But remember this. It is very common and normal for children under 2 years old , that is, when they are just learning to walk, to walk like this. There is no need to worry about it at all. Over time, they will gradually learn to walk with their heels on the ground and in a normal heel-to-toe pattern. This usually does not require any treatment.
However, if your child continues to tiptoe even after the age of 2 , it could be a sign of another underlying health condition, so it's a good idea to be a little concerned.
How common is this condition?
This is actually more common than you might think. According to data, about 2 out of 100 (2%) of typically developing children still tiptoe by the age of 5 1/2. However, this number is much higher among children with developmental delays or other developmental problems. About 41 out of 100 (41%) of such children have been found to still tiptoe at this age.
What are other characteristics of tiptoe walking?
The main and most obvious sign is tiptoe walking. But when you tell your child, "Son/daughter, walk normally with your feet on the ground," most young children will be able to walk that way. But if this habit persists, you will also see the following signs. Let's look at it this way to understand it clearly.
| Visible feature | What does that mean? |
|---|---|
| Decreased balance and coordination | The child seems to have poor balance. He is unsteady when walking and running. |
| Always falling | Falls and stumbles more often than an average child. |
| Difficulty putting on shoes | Some types of shoes are difficult to put on. They don't fit your feet exactly. |
| Difficulty participating in sports | They have more difficulty than other children in games that require them to run and jump. |
| Complaining about leg pain | It refers to pain or stiffness, especially in the groin area or soles of the feet. |
| Tight heel cords | The muscles and veins in the groin area feel tight. The ability to bend the leg up and down is reduced. |
Why do children walk like this? Let's explore some of the reasons.
In most cases, that is, in the vast majority of cases, no specific cause can be found for persistent tiptoeing. In medical terms, this is called ' idiopathic ' . That means "no known cause."
However, in some cases, there may be several reasons for this.
1. Shortened Achilles Tendon
The muscles in our heel area come together and connect to the heel bone, which is a strong tendon. This is called the 'Achilles tendon' . When we use our heel muscles, this tendon is what pulls the heel up. Some children may be born with this tendon slightly shortened. Or, over time, it may become even shorter due to constant tiptoe walking. This makes it difficult for them to put their heels on the ground and walk normally.
2. Something that is done as a habit
Some older children do this out of habit. Perhaps because their knee muscles and tendons have been tight for a long time, causing pain when they walk normally.
3. Rare underlying medical conditions
Very rarely, this gait can be a sign of a serious medical condition. In such cases, it appears along with a number of other symptoms.
- A brain-related disease, for example , cerebral palsy .
- A disease involving muscles or nerves, for example , muscular dystrophy .
- Some abnormality in the spine.
- Autism Spectrum Disorder (ASD) .
Is there a connection between autism and this way of walking?
Yes, toe walking is more common among children with autism spectrum disorder (ASD) than among children without the condition. One large study found that about 9% of children with autism walk this way. But among children without autism, this percentage is less than 0.5% .
The exact cause of this is not yet clear. However, it is believed that several factors may contribute to this. One is that the range of motion of the leg is limited due to tightness in the hamstring muscles.
Another major cause may be a sensory-related issue . Many children with autism have some changes in the functioning of the vestibular system , the system that provides information to the brain about our body's balance, movement, and spatial orientation. Changes in this sensory system can also cause a child to tiptoe.
How does a doctor diagnose this?
When you take your child to a doctor, he or she will first ask you about your child's medical history. Then, he or she will perform a complete examination of the child. During this examination,
- Observes the way the child walks: Sees how the child walks and runs.
- Examines the legs and feet: Checks for any problems with the legs or feet.
- Range of Motion Test: Checks how far you can bend your ankle and foot.
- Nervous system tests: Sometimes a few small tests are done to check for any problems with the nervous system. For example, they may check your knee reflexes , check how your legs feel, and measure your muscle strength.
What treatments can be done to stop this way of walking?
The treatment for this depends on several factors. The doctor will consider factors such as the child's age, the severity of the condition, and the underlying cause to determine the most appropriate treatment. In most cases, non-surgical treatments are recommended first.
| Treatment method | What happens to it? |
|---|---|
| Physical Therapy | Stretching exercises are performed on the muscles of the ankle and foot. This helps to loosen tight muscles and tendons and increase range of motion. You may also need to wear a serial casting on your leg for several weeks. |
| Ankle-foot orthotics/braces | A special plastic brace is worn throughout the day. It holds the leg at a 90-degree angle and stretches the muscles and ligaments as you walk. |
| Observation | Sometimes the doctor may take a "wait-and-see" approach. They will wait for about 6 months to see if the condition improves on its own. |
| Botulinum A toxin (Botox®) injections | This temporarily weakens the muscles of the knee, making it easier to stretch those muscles with physical therapy exercises. |
If your child is over 5 years old and these treatments are not effective, your doctor may recommend surgery . This involves surgically stretching and loosening the tight calf muscle or Achilles tendon.
What complications could arise if this continues?
If left untreated, the child's calf muscles and Achilles tendon can become even tighter. This can make it very difficult, if not impossible, to walk normally with the heel on the ground. In addition, the range of motion of the leg may be reduced, some types of shoes may not fit, and other muscle and bone problems and pain may develop as the child grows older . Therefore, it is not a good idea to ignore this.
Important questions to ask your doctor
If your child continues to tiptoe after the age of 2, it is very important to see the doctor and ask these questions.
- Which specialist should I refer my child to for treatment? (e.g., pediatrician, orthopedic specialist)
- Will my child need casts or braces?
- What tests should be done to ensure that there are no other medical conditions such as cerebral palsy?
- Should I be concerned about symptoms of another condition, such as autism spectrum disorder (ASD)?
- If this situation continues, how will it affect my child's future life?
Take-Home Message
- Toe walking is very common and normal for new toddlers, especially children under 2 years old. There is no need to be afraid of this.
- If your child continues to walk like this after the age of 2, it is very important to seek medical advice.
- In most cases, no specific cause can be found (idiopathic), and it can be cured with simple treatments such as physical therapy.
- Rarely, this can be a sign of an underlying condition, such as cerebral palsy or autism, so it's wise to get checked out by a doctor.
- Avoid ignoring this condition, as it can lead to muscle stiffness, pain, and other complications in the future if not treated properly.
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