Parents have been stepping up to ask me about their toddler walking on their toes rather than their feet. Let me try to toe the line on this interesting topic.

“Toe walking” is when a child walks on the balls of their feet without their heels touching the ground. Normally, flat-footed walking happens by age 2. By age 3, heel-toe walking should be in place. 

Toe-walking usually occurs out of habit and runs in families. More than half of children who toe walk will stop doing so on their own by age 5. 

There are, however, situations where a developmental and neurologic assessment should be sought:

  • If your child toe walks most of the time
  • Has stiff muscles
  • Is uncoordinated
  • Walks awkwardly
  • Is unable to weight bear on their feet

In these rare circumstances, toe walking might represent a sign of:

  • A short Achilles tendon
  • Cerebral palsy
  • A form of muscular dystrophy
  • Possible autism spectrum disorder

It is common that a child’s health care professional will find none of these causes for toe-walking. It may just be what’s called “toe walking of no known cause.” In that case, it’s likely to be a habit that will go away over time.

Stretching exercises, however, may still be useful while your child demonstrates this behavior. Stretching can reduce stiffness or tightening of the Achilles tendon. 

If a nerve or muscle problem is found, physical therapy and sometimes surgery can improve motor skills and muscle strength. These types of therapies can also prevent further muscle damage.

Hopefully tips like these will allow you to put your best foot forward when it comes to your child’s toe-walking.  

Lewis First, MD, is chief of Pediatrics at The University of Vermont Children’s Hospital and chair of the Department of Pediatrics at the Robert Larner, M.D. College of Medicine at the University of Vermont.  You can also catch “First with Kids” weekly on WOKO 98.9FM and MyNBC 5, or visit the “First with Kids” video archives at www.UVMHealth.org/MedCenterFirstWithKids.

Lewis First, MD, is chief of Pediatrics at The University of Vermont Children’s Hospital and chair of the Department of Pediatrics at the Robert Larner, M.D. College of Medicine at the University of Vermont.

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