The Association Between Toe Walking and Autism

A cute baby learning to stand up or walking with support. First steps. Standing on toes abnormally.
Table of Contents

The pattern of walking in which the toes and balls of the feet come in contact with the ground instead of the heels is known as toe walking. This is a common walking pattern in children who are younger than 2 years and are trying to walk.

But if your child continues to toe walk after the age of 2, there might be some complications or it could be the early signs of a medical condition.

So, you need to be highly attentive to your child’s walking patterns and although toe walking normally doesn’t get accounted as a serious cause of concern, if your child does not eventually adapt to a heel-to-toe walking pattern, it will be harder for them to walk when they grow old.

In this detailed article, we will discuss what is toe walking, what age is appropriate for toe walking, when as parents you need to get concerned about this condition of your child, and why children who are diagnosed with ASD tend to toe walk, and what are the support systems or professional help that is available for your child to get out of this medical condition.

Why do Children Diagnosed with Autism Spectrum Disorder tend to Toe Walk?

There are three primary reasons why autistic children walk on their toes. They are as follows:

Sensory Difficulties

Children who have an autism diagnosis may toe walk as they have sensory difficulties. Some children with autism spectrum disorder experience a feeling of discomfort in certain areas of the feet when they touch the ground.

For example, they may have a sensitivity towards textures on the bottom of their feet, therefore by walking on their toes, they can reduce the amount of surface area that they are touching those particular textures.

Hyper-extended Back Posture

Children with autism have a problem with decreased muscle tone or increased muscle weaknesses. As a result, their body posture falls in the forward direction putting their weight over their toes.

This is why they tend to walk on their toes rather than their feet.

Vestibular Difficulties

The vestibular system deals with the body’s movements, posture, and muscle coordination.

Children with autism often experience vestibular difficulties which again push their weight forward and end up encouraging toe walking.

What is Toe Walking?

Toe Walking is a walking pattern in which your children’s toes and balls of the feet make contact with the ground, but their heels do not touch the ground.

Typically this walking pattern is extremely common in children who are learning to walk. But if your beloved child continues to walk on their toes even after they are well past their ‘learning-to-walk’ stage, then it might be a cause of concern.

What Age is Appropriate for Toe Walking?

Children who are under the age of 2, typically walk on their toes but quickly adapt to a heel-to-toe walking pattern, as they grow older.

If your child continues to walk on their toes even when they are past their 2-year mark, it could very well be because of the problem of tight calf muscles, which your child had developed due to consistent toe walking.

If this is not the case, there might be some other medical condition or reason.

What are the Causes of Toe Walking?

There have been many studies to find the exact causes behind toe walking, but to date, it has eluded medical professionals and researchers alike. In most cases, the condition of persistent toe walking has been diagnosed as an idiopathic condition.

If your child does not stop toe walking after the age of 2 on their own, chances are that the doctors will call it idiopathic toe walking, where your child walks unusually in a heel-to-toe walking pattern but is comfortable walking on their tiptoes.

Although doctors have not been able to identify the exact causes behind this, they have been able to identify a few conditions that might result in persistent toe walking. These are as follows:

Cerebral Palsy

A medical condition in which muscle coordination, muscle tone, and body posture all get affected. Cerebral palsy makes the muscles extremely stiff, resulting in unusual walking patterns, including that of idiopathic toe walking.

Muscular Dystrophy

This is a genetic condition that results in muscle wasting and muscle weakness. If your child has the medical condition of muscular dystrophy, one of the side effects could very well be toe walking.]

Autism Spectrum Disorder

Children who are diagnosed with autism spectrum disorders have various muscle and sensory problems. They often experience vestibular difficulties like problems in balancing, coordination, and movement.

So, if your child walks on their toes at the age of 3 or is older and your child is diagnosed with autism, this could be a contributing cause.

What are the Symptoms of Toe Walking?

Symptoms of toe walking involve an unusual walking pattern where a child prefers walking on their toes, rather than the comfortable posture of heel-to-toe walking.

They do not put their heels on the ground first and always try to get up and walk, balancing on their toes. Children who constantly toe walk may have poor body balance and coordination and that’s why they tend to fall more frequently than other kids.

When Do You Need to Get Concerned About Your Child’s Toe Walking?

Typically, most children walk on their toes till the age of 2. However, it is not at all uncommon if your child starts to walk a little late and continues to toe walk till the age of 3 before developing a normal walking pattern.

But there is a problem if this unusual walking pattern continues well beyond the age of 2 or 3 years. Then there is a high chance that your child could have some medical condition that you need to be attentive to and look for possible diagnosis and treatment.

Toe Walking Treatments & Help

Treatments to eliminate toe walking depend on the child’s age, how severe the condition is, and what are the underlying causes of the problem. The non-surgical methods of treatment include help from physiotherapists or consistent support from Occupational Therapists.

However, the first point of call is to go to your child’s doctor. Talk about the concerns that you have and your doctor can do further assessments to see if there are any underlying reasons why your child might be toe walking.

If there are underlying conditions such as an autism diagnosis, then consult a physiotherapist and an occupational therapist. Depending on whether it is a physical or sensory issue that is impacting your child’s toe walking behavior, both health professionals can help address these concerns.

Here are some of the differences between a physiotherapist and occupational therapists:

Physiotherapy

A physiotherapist will involve physical therapy in terms of stretching or strengthening exercises so that your child’s muscle tissues get tightened and the coordination between them increases.

They will also give your children easy-to-do exercises that will strengthen their calves, help their body balance, improve their posture, and enable them to walk with proper gait.

Occupational Therapy

An OT will also assess the underlying cause of toe walking as in whether it’s an effect of your child’s sensory preferences or other developmental delay issues.

Once that is assessed by a suitable Pediatrician, the OT will move on to treatments that will help your child with the sensory issues related to walking.

They will suggest games, and activities that involve tactile stimulation on the feet, and also work on reducing the child’s fear that they experience while walking normally, without the support of their toes. 

However, if your child does not have any underlying conditions, it is best to contact a physiotherapist who will look at your child’s gait and provide physical exercises to encourage them to walk with a heel-to-toe gait.

Conclusion

If your child is autistic and toe walks, it is essential to get them assessed by a pediatrician who specializes in developmental delays and autism.

Research studies show that early intervention is very effective, therefore if you have concerns, go to your doctor as soon as possible. This will help in getting them the right kind of therapy that they need to overcome this delay.

However, if your child does not have autism, you can still go for physiotherapy or occupational therapy which can help eliminate toe walking.

References

Acorn Autism. (2021, September 14). Why does my child with autism walk on their toes? Acorn Autism. Retrieved April 5, 2022, from https://www.acornautism.co.nz/blog/2018/5/30/why-does-my-child-with-autism-walk-on-their-toes 

Mayo Foundation for Medical Education and Research. (2022, March 23). Toe walking in children. Mayo Clinic. Retrieved April 5, 2022, from https://www.mayoclinic.org/diseases-conditions/toe-walking/symptoms-causes/syc-20378410#:~:text=Overview,do%20so%20out%20of%20habit. 

Moore, J. (n.d.). Should you be concerned about toe walking? WebMD. Retrieved April 5, 2022, from https://www.webmd.com/children/what-to-know-toe-walking 

Nall, R. (2018, December 10). Toe walking: Causes and treatment. Healthline. Retrieved April 5, 2022, from https://www.healthline.com/health/toe-walking 

Toe walking: Symptoms, causes, treatments. Cleveland Clinic. (n.d.). Retrieved April 5, 2022, from https://my.clevelandclinic.org/health/diseases/21017-toe-walking 

Toe walking and ASD. Autism Research Institute. (2022, February 24). Retrieved April 5, 2022, from https://www.autism.org/toe-walking-and-asd/ 

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