Toe Walking in Autism

Reviewed by:
Hannah Andreasen
M.Ed BCBA

October 18, 2022

Toe walking is walking on the ball of the foot without letting the heel touch the ground. Toe walking has been observed in children diagnosed with autism spectrum disorder (ASD) more frequently than in children who are not diagnosed with ASD.  

ASD is a developmental disability that can cause differences in behavior and social communication. Caregivers and healthcare providers should monitor developmental milestones closely to check for signs and symptoms of autism. It is possible to detect autism in children as young as 18 months

Common signs of autism in young children include:

  • Avoiding eye contact
  • Not smiling back at you
  • Not responding to their name when called
  • Repeating phrases
  • Repetitive movements like hand flapping or rocking

What Is Toe Walking?

Toe walking is a specific gait (or way of walking) where walking on the ball of the foot is favored, with little or no contact of the heels to the ground. 

Toe walking is common in young children and usually isn’t a cause for concern. However, if toe walking continues past age 3, it may be considered persistent toe walking and should be evaluated by a healthcare professional.

What Causes Toe Walking?

Children may walk on their toes for many reasons. Toe walking on its own is not usually a cause for concern. Most children with a history of toe walking develop a typical gait by the age of 10 without any intervention.

If there is no known reason for toe walking, doctors refer to it as idiopathic toe walking. 

In some cases, toe walking is caused by an underlying condition.  

Children who have issues with posture, muscle tone, or muscle function, such as those with cerebral palsy or muscular dystrophy, may walk on their toes. 

Children may walk on their toes if they have a short Achilles tendon that restricts movement in their ankles. 

Toe walking can also be a sign of a developmental disorder, such as ASD, or other conditions with communication or learning disabilities.

What Causes Toe Walking in Children With Autism?

Studies have found that toe walking is more common in children with ASD than in the general population. One study found that 8.4 percent of children with ASD also had a diagnosis of toe walking compared to only 0.47 percent of children without ASD. Among children diagnosed with ASD, toe walking was found to be more common in boys and children with an intellectual disability or language delay.

The reason for toe walking in children with ASD is unclear, but it may be related to sensory differences in children with autism. Up to 90 percent of children with autism experience differences in their response to sensory information. 

Toe walking in children with ASD may be related to deficits in sensory integration. Sensory integration involves three senses—tactile, vestibular, and proprioceptive systems. The tactile system involves your sense of touch. The vestibular system involves your sense of balance and movement. The proprioceptive system involves awareness of where your body is and includes your muscles, joints, and tendons. 

If any of these sensory systems are dysregulated, it may lead to toe walking.

What Are the Long-Term Effects of Toe Walking?

The long-term effects of toe walking are not well understood. If toe walking continues untreated for a long period of time, it can cause problems, including:

  • Pain
  • Shortened Achilles tendon
  • Limited range of motion  
  • Damage to the lower legs

What Should You Do if Your Child Is Toe Walking?

For children under three years old, toe walking is usually not something to worry about. Because toe walking is associated with autism and other developmental disorders, you may want to talk to your doctor about developmental screening

Developmental Monitoring and Screening

While your child is growing, you should periodically check to make sure they are meeting developmental milestones. The Centers for Disease Control and Prevention (CDC) provides a free milestone tracker. Parents, caregivers, and healthcare providers can use this checklist to make sure that milestones are not missed. 

Developmental screening uses questionnaires and checklists to take a closer look at how your child is developing. During a developmental screening, your doctor will evaluate several factors, including:

  • Language
  • Movement
  • Thinking
  • Behavior
  • Emotions 

The American Academy of Pediatrics (AAP) recommends developmental screening at the ages of 9 months, 18 months, and 30 months. Additionally, they recommend screening specifically for autism at ages 18 months and 24 months. 

Treatment for Children Who Walk On Their Toes

If your child is older and continues to walk on their toes, you should talk to your child’s pediatrician to discuss treatment options

However, doctors do not agree on how or even whether to treat toe walking at all. 

Your doctor may recommend physical therapy for toe walking. An occupational therapist can also help with sensory integration issues. 

Other treatment options for toe walking include:

  • Serial casting
  • Leg braces 
  • Surgery  

Activities for Children Who Walk On Their Toes

Physical therapists can teach children and caregivers specific activities that may be able to improve symptoms of toe walking. Examples of activities for children who toe walk include:

  • Calf stretches
  • Heel walking
  • Yoga poses like downward-facing dog
  • Squat play

Conclusion

Toe walking may be more common in children with autism. Although it can be worrying to some families, it is usually not a cause for concern and resolves on its own without treatment. If necessary, physical therapy or other medical interventions can help prevent complications. 

‍Songbird Therapy is a technology-enabled provider setting a higher standard for children’s autism care. With a deeply passionate team and innovative technology, we’re building a world where every child can access world-class care at home, uniquely tailored to them.

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