From Our 2012 Archives

Children's Toe Walking Not a Sign of Bigger Problems

Swedish Study Finds Most Kids Grow Out of It

By Matt McMillen
WebMD Health News

Reviewed by Louise Chang, MD

July 23, 2012 -- More than half of young children who toe walk will stop doing so on their own by about age 5. And most children who are toe walkers will not have any developmental or neuropsychiatric problems, a new study finds.

"Walking is such a notable milestone, and if it is not typical, it is often a concern for parents and physicians," says pediatrician Lee Beers, MD, who practices at Children's National Medical Center in Washington, D.C., and who reviewed the study for WebMD. It appears in the journal Pediatrics. "This study certainly makes me feel more comfortable when I see toe walking in children who are otherwise developing well."

Toe walking can accompany disorders such as cerebral palsy and muscular dystrophy, but it also occurs among children who have no such underlying conditions. In such cases, children are said to be idiopathic toe walkers.

The cause is unknown, lead author Pahr Engstrom, MD, of the Karolinska Institutet in Stockholm, says in an email.

It could be related to nerves, muscles, a mixture of both, or another unknown factor, he says.

Prior to this study, the number of children who were idiopathic toe walkers was also unknown.

The Study

The parents of more than 1,400 children participated in the study, which was conducted in Blekinge County in southeast Sweden. At their child's routine 5.5-year checkup, parents were asked questions about their child and toe walking. Here's what the researchers found:

  • Nearly 5% of all young children had toe walked at some time. However, by age 5 1/2, fewer than half of them were still doing so.
  • Toe walkers typically begin doing so when they first walk independently, though some walk normally during the first year and beyond.
  • Former toe walkers did so for one to two years before walking normally.
  • Children still toe walking at age 5 1/2 do so about 25% of the time.
  • Children with a diagnosed cognitive or neuropsychiatric disorder such as autism were more likely to toe walk; in the study, 41% of such children were current or past toe walkers.

What Parents Should Know

For parents, it is important to understand that toe walking does not indicate an underlying problem for most children, says Jonathan Strober, MD, a pediatric neurologist at UCSF Benioff Children's Hospital in San Francisco. He was not involved in the research.

Nevertheless, he says, many parents become understandably alarmed when their child starts to toe walk. He was no exception. His 3-year-old daughter is a toe walker.

"I freaked out," he says. "As a neurologist, the worst possibilities went through my head."

Fortunately, Strober's daughter is just fine. And what he likes most about this study is that it offers reassuring evidence that the same can be said for most toe walkers.

"The fact that your kid toe walks is not a sign that they have autism," he says.

Beers agrees.

"A lot of kids who toe walk are developing normally," she says, "If it's an isolated finding, it is not something to be too worried about. If there are no underlying concerns, it's just something to keep an eye on."

However, Beers does say that kids who spend a lot of time on their toes can develop stiffness, tightening, and pain in their Achilles tendon, which can be eased with stretching exercises.

"Parents can help their kids to stretch while reading or watching TV," says Beers. "That helps keep the Achilles tendon supple and stretched out."

Treatment for toe walking is seldom necessary for children ages 6 and under, unless the condition has caused a shortening of the Achilles tendon or calf muscles. If that has happened, surgery may be required, Engstrom says.

Although different treatments have been suggested, Engstrom says more studies are needed to determine the best one.

SOURCES: Engstrom, P. Pediatrics, July 2012. Pahr Engstrom, MD, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. Lee Beers, MD, pediatrician, Children's National Medical Center, Washington, D.C. Jonathan Strober, MD, pediatric neurologist, UCSF Benioff Children's Hospital, San Francisco.

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