Causes of Toe Walking in Children

When children learn to walk for the first time, many begin to step on their toes. This is called toe walking. Children usually start walking at the age of 12-15 months. During this period, they can try different stepping positions, fingertip pressing is one of them. By the 24th month, they should be able to fully press the soles of their feet on the ground. By the age of three, most children walk with their feet fully imprinted. If toe walking is still present after the age of three, it is recommended to be examined by a doctor.

The majority of children who tip their toes after the age of three do so out of habit. In other respects, if the child’s growth and development is normal, toe walking may not be a cause for concern. However, sometimes it is a symptom of conditions such as muscle disease, problems affecting the brain, and autism.

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When Should You See a Doctor?

If your child continues to walk on their toes after 2-3 years of age, you should consult your doctor. If the leg muscles are stiff, Achilles tendon is tense, muscle coordination is not good, movement skills are not at the expected level, there is a regression in the movements that he has learned and can do before, if there is a history of premature birth, if there is a family history of muscular dystrophy or autism, he avoids eye contact and avoids repetitive movements such as rocking or turning. If he is making movements, have him examined without delay.

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Causes of Toe Walking

Cerebral palsy: Damages in the parts of the immature brain that control the muscles can cause effects such as movement disorder, muscle tone abnormality, and posture disorder. As a result, toe walking can be seen.

Muscular dystrophy: Toe walking may occur in cases where muscle fibers are damaged and weakened due to a genetic disease. If the child presses his heel normally when he first starts walking, but toe walking develops over time, it may be caused by muscular dystrophy.

Short Achilles tendon: If this tendon, which connects the calf muscles to the back of the heel bone, is short, it can prevent the heel from touching the ground.

Autism: Toe walking may be associated with autism spectrum disorders. In this case, there are also problems in communication and interaction with other people.

Habit: Toe walking, which is thought to be a habit, may show a familial predisposition.


The child’s gait, muscle tone, joint structure and neurological status are evaluated by examination. Gait analysis can be done with computerized measurements. EMG shows possible problems in muscle and nerve fibers. Brain imaging (CT or MRI) is ordered if cerebral palsy is suspected. Testing can be applied for autism and developmental delay.


If toe walking is habitual, no treatment is required. As you get older, this habit disappears. By the age of 5, more than half of habitual toe walking is self-correcting. Sometimes they can switch to this pressing pattern from time to time and then return to normal. Toe pressing is more common when walking barefoot.

If there is a physical problem, treatments such as physical therapy, use of foot-ankle orthosis, serial casting, botulinum toxin A injection, surgery can be applied. In physical therapy, stretching the leg and foot muscles, strengthening exercises, exercises for balance and coordination are applied. Botulinum toxin A injection is effective in relaxing tense muscles. If the muscle or tendon shortness cannot be eliminated with the mentioned methods, muscle-tendon release operations are performed. If toe walking is a symptom of another disease, the treatment of the main disease is also important.

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