Children’s toe walking not a sign of bigger problems

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.[1]

Matt McMillen, Medscape July 24, 2012

“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 DC, and who reviewed the study [1] 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,[1] 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 ½, 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 ½ 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.

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 DC.
Jonathan Strober MD, pediatric neurologist, UCSF Benioff Children’s Hospital, San Francisco.

Source Medscape


1. The prevalence and course of idiopathic toe-walking in 5-year-old children, Engström P, Tedroff K. Pediatrics. 2012 Aug;130(2):279-84. doi: 10.1542/peds.2012-0225. Epub 2012 Jul 23.

2. Idiopathic Toe-Walking: Prevalence and Natural History from Birth to Ten Years of Age, Engström P, Tedroff K. J Bone Joint Surg Am. 2018 Apr 18;100(8):640-647. doi: 10.2106/JBJS.17.00851.

3. Automated method to distinguish toe walking strides from normal strides in the gait of idiopathic toe walking children from heel accelerometry data, Pendharkar G, Percival P, Morgan D, Lai D. Gait Posture. 2012 Mar;35(3):478-82. doi: 10.1016/j.gaitpost.2011.11.011. Epub 2012 Jan 31.

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