Children often experiment with walking on their toes when first toddling around. Most tots outgrow this by age 2, but some children continue past this point. Although occasional toe-walking doesn't usually indicate a serious problem, take your child to her doctor for a medical evaluation if she can't or won't put her weight on a flat foot, so he can rule out physical conditions or developmental problems.
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Although teetering on tip-toes may not seem like a big deal, the Children's Hospitals and Clinics of Minnesota note that after 20-months-old the inability walk in a heel-toe manner may signal a problem. As long as your child’s growth and development are on track, the toe-walking may not necessarily pose a significant concern. In some cases, however, it can serve as a “red flag” for more serious issues. Take note of any signs or symptoms you notice along with the tip-toe walking so your doctor can make an accurate diagnosis of the underlying cause of your child’s unusual gait.
A child who cannot bear weight on her foot and appears physically unable to walk flat-footed might have a physical problem, such as a shortened Achilles tendon, that prevents her from walking with a normal gait.
The BabyCenter website suggests that consistent toe-walking often indicates motor disorders, particularly cerebral palsy. The most common type of cerebral palsy — diplegia — affects the lower part of the body and might cause your child to toe-walk due to too-tight Achilles tendon and calf muscles.
If your doctor cannot find a physical cause for the toe-walking, he will probably label it as “idiopathic.” Idiopathic toe-walking is at times associated with language delays and certain forms of autism, making it essential to pay attention to your child’s communication and socialization to catch any delays as early as possible. BabyCenter recommends scheduling a developmental assessment with a specialist to ensure that your child’s development is on track.
The Doctor's Expertise
To determine the cause of your child’s toe-walking, the doctor will probably observe your child during a physical exam. He might also do a gait analysis or an electromyography. To conduct an EMG, the doctor inserts a small needle attached to an electrode into the muscle of the leg and records the electrical activity in the area of concern.
If a doctor determines that your child toe-walks out of habit, she will probably recommend waiting for your child to outgrow the habit. In a child older than 2, the doctor might recommend using an orthotic device to encourage her to bend her foot at the ankle. When a physical condition contributes to the condition, physical therapy — through exercises consisting of a series of gentle stretching exercises — can often improve your child's range of movement. In rare cases, a doctor might advise below-the-knee casting or surgery to help correct the problem.