Child walks on toes

Child walks on toes: something we see more often in children of 2, 3 and 4 years old. This is especially common in toddlers. Parents often worry: is this harmful? Sometimes there appears to be ADHD or autism, and the question is whether toe walking is actually related to this. The cause is sometimes hereditary, and we often see this occur in several brothers or sisters. Treatment is not always necessary.

Toddler walks on toes

A child who is just learning to walk often walks on tiptoes. This is a normal phenomenon. The young child does not yet use the entire foot but mainly relies on the front of the foot and on the toes. A toddler walking on tiptoes is therefore not a strange sight. This disappears naturally with age.

Toddler: Toe walking

A toddler aged 2 to 4 years old sometimes also walks on their toes. At 2 years old, the child is just at the limit of switching toe walking for normal walking. When the child is 3 years old and still walks on toes, this is something that happens less often. The toe walk is also called toe walk. In general, toe walking can disappear on its own after 3 years.

Preschooler: 4 years

A toddler from the age of 4 should normally support the entire foot. Walking on toes is something that is absolutely not appropriate for children aged 4 years and older. Very few toddlers still have toe movement. When this is the case, it is often the result of an underlying disease or condition.

Causes

Walking on toes is more common within one family. Usually brothers and sisters walk on tiptoes up to a certain age. When it occurs within the family, we often see that it disappears on its own around the age of 3. The hereditary factor can therefore ensure that the toe walking lasts a little longer but eventually disappears, at least before or around the age of 3. Children older than 3 years who still walk on their toes should always be examined further.
Sometimes the Achilles tendon is too short. The Achilles tendon is found at the back of the leg and connects the fibula to the heel. When the Achilles tendon is too short, the heel is pulled up. The result is that the child starts walking on toes. An Achilles tendon that is too short is a congenital defect.
Muscle spasm is also a cause. This increases muscle tension, causing the heel to be pulled up. These children also walk on tiptoes. Muscle spasm often occurs in multiple limbs, including the arms. Muscle spasm or increased muscle tension can have various causes. It often occurs in children who have had a lack of oxygen during birth, but also due to an abnormality in the spinal cord or brain. Toe walking is also more common in Duchenne muscular dystrophy.
It often happens that children with ADHD and autism walk on their toes. This does not have to do with a physical abnormality but more with the mind. The child feels safe or comfortable while walking on toes. In these children, toe walking can be alternated with normal walking. It does not have to be continuously present, something that we do see with a physical abnormality.
A congenital defect in the foot can also cause a child to walk on toes and continue to walk. This abnormality can often be noticed immediately at birth. Sometimes the deviation is so minor that it is not noticed but only becomes characteristic during the walking phase.

The consequences

If the child starts walking on the entire foot around the age of 3, this will in most cases have no consequences. It is important to monitor whether the child does not start walking on toes again. Some children are so used to it that it quickly creeps in again. Children who walk on their toes for too long shorten their Achilles tendon. The Achilles tendon adapts to the way you walk and can shorten. Once this has happened, it is often impossible for the child to place the foot flat on the ground and walk normally. A growth abnormality in the foot and toes may also occur.

Therapy

A wait-and-see attitude is often adopted in young children. Most children naturally start walking flat on their feet. Sometimes physiotherapy is used to stimulate the child to walk normally. This is done through playful exercises. The Achilles tendon can be slowly stretched through stretching exercises. This will cause the Achilles tendon to lengthen again. However, this can take several months, sometimes even longer. Sometimes the Achilles tendon can also be surgically removed. Using a plaster cast or a splint, the doctor may decide to force the foot into a normal position. This forced position is maintained for several weeks to several months, sometimes for a few hours a day. The treatment depends entirely on the cause and the length of the Achilles tendon. That is why early treatment is necessary, but earlier than three years is often not necessary. The doctor will regularly monitor how the Achilles tendon and bone growth are developing.

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