Toe Walking In Toddlers: What's Normal And What's Not

What happens when your baby is unable to come out of this phase of tippy-toeing and turns into a toe walking toddler?

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As parents, we eagerly await the moment when our tiny tot takes his first steps. Standing on his tippy toes, and wobbling slightly on his cushy and soft feet, your baby achieves his first big milestone. It is a moment of great joy and pride. But what happens when your baby is unable to come out of this phase of tippy toeing and turns into a toe walking toddler?
 
A toe walking toddler may not always be a reason for worry. Walking on the toes is fairly common in children who are just beginning to walk and most children outgrow it. Some kids also often continue toe walking beyond the toddler years, purely out of habit.
 
But, toe walking toddler who is past two years and refuses to stabilise his/her feet on the ground can point to serious underlying conditions. This is a guide for parents who still find it tough to get toe walking toddler to ground his/her feet.  

Toe Walking Toddler: Is This Normal?

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Children who continue toe walking beyond the toddler years often do so out of habit. As long as your toddler is growing and developing
normally, toe walking is unlikely to be a cause for concern.
 
When babies start walking, they typically have no control over the foot and ankle and are often seen waddling. So they might step anywhere their foot happens to fall. You will find some babies will step down their heel first, while some others move around with flat feet.
 
Talking about the subject, Dr. Stacey Dusing, certified specialist in pediatric physical therapy and Sykes Family Chair of Pediatric Physical Therapy, Health and Development in the Division of Biokinesiology and Physical Therapy at the University of Southern California, says, "Before 18 months we are never worried about the kid who is occasionally toe walking. It’s pretty normal to have that variability in kids take steps and how they move.”
 
Some of you have also noticed your older kids doing some toe walking along with the typical walking. This might concern you. But, you also need to understand the context. For instance, if your toddler is toe walking in the garden, there is a chance that they don't like the feel of the ground. Maybe it is too rough or hot.
 
So, before you panic, understand the context if you find your toddler toe walking.

Toe Walking Toddler: Red Flags To Watch Out

You may have a toe walking toddler due to some serious health issues. The idea is not to scare you, but to inform you that chances are that your toddler may have cerebral palsy or autism.
 
But, these developmental issues, including autism might be present with other symptoms. Similarly, toe walking related to cerebral palsy is paired with extra difficulty in controlling their limbs.
 
Here are some of the reasons why you may have a toe walking toddler.

A short Achilles tendon

Achilles 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. In this case, your toddler may be toe walking.

Muscular dystrophy

This is a genetic disease in which muscle fibers are unusually prone to damage and weaken over time. This can also happen if your toddler initially walked normally before starting to toe walking.
 
This damage and weakness is due to the lack of a protein called dystrophin. It is necessary for normal muscle function. In case of the absence of dystrophin, your kids may have problems with walking, swallowing, and muscle coordination.

Cerebral palsy

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Cerebral palsy (CP) affects a person's ability to move, maintain balance, and posture. CP is the most common motor disability in childhood and is caused by abnormal brain development or damage to the developing brain. This can affect your toddler's ability to control his or her muscles.

Cerebral palsy can also pull the Achilles tendon up too tight and because of this, your toddler may not be able to place their feet flat. This condition is known as Spastic Hemiplegia. 

Autism

Autism is a developmental disorder characterised by difficulties with social interaction and communication. If your toddler is suffering from autism, you may find them to be sensitive to touch, heat, and light. Your toddler may also do repetitive behaviour like hand-flapping, rocking, jumping, or twirling.

Sometimes it is difficult to understand a toddler's behaviour. Your child may repeat certain actions because they are bored. It can also be a way of getting your attention. So in this case, your toddler's toe walking is not a reason of concern.
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Disclaimer: Walking on the tips of the toes is not an indication of Autism.

How You Can Help Your Toe Walking Toddler

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  • Encourage your toddler to walk with his/her fleet planted on the floor
  • Help your toddler stretch their calf muscle. You can make them do some squats as well.
  • Lead by example and make the exercise a fun activity by doing it along with them. 
  • You can also encourage your toddler to walk on ramps. They are usually difficult to walk on, on toes. So, most likely your toddler will use their feet.
  • Don't pass on your stress to the toddler. It will affect their self-confidence.
  • Don't discuss the problem in front of your toddler. They may feel encouraged to repeat the action.
If you are worried about your toddler's toe walking, then fix an appointment with their doctor.

Diagnosis Of A Toe Walking Toddler

If however, your toddler continues to walk on his toes, it is advisable to consult with a doctor. Your doctor will conduct a physical examination of your toddler. In some cases, they may do a gait analysis or known as electromyography (EMG).
 
As part of the examination, 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 conditions such as cerebral palsy or autism are suspected, the doctor may recommend a neurological exam also.

Treatment Of A Toe Walking Toddler

If the doctor finds that your toddler is toe walking out of just habit, he or she is likely to outgrow it. The doctor may just monitor your toddler's gait.
 
Here are some other treatments that your toddler's doctor can suggest.
  • Physical therapy. This includes gentle stretching of the leg and foot muscles. This might improve your child's gait.
  • Leg braces or splints. Use of these may help your child get a normal gait.
  • Casts: The doctor may suggest your toddler try a series of below-the-knee casts. They can improve the ability to bring the toes toward the shin.
  • Surgery: If none of the conservative treatments work, the doctor might resort to surgery. This will help to lengthen the muscles or tendons at the back of the lower leg.
So mums, keep an eye on your toddler's development. If you feel anything is amiss, immediately consult a medical professional because early diagnosis can help toddler child recover from this, if it is in fact an underlying problem. 
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Source: Mayoclinic
 
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Written by

Sarmistha Neogy