Children walking on tiptoes: Causes, treatment and when to worry

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Is your child walking on tiptoes out of habit or because of an underlying cause? Read on to find out.

You've got to admit that the sight of children walking on tiptoes is pretty cute. Parents don't usually think too much of it and assume it's just the way they learn to walk. Asians also believe in an old wives' tale that children who walk on tiptoes are mischievous! But is there more to it?

If a child walks on tiptoes before the age of three, you don't have to worry too much just yet. At that stage it probably is part of the mechanism from when they were learning to walk. If they keep walking on tiptoes past this stage, it could be a red flag for problems with coordination, muscles and development. In more serious cases, it can also be a sign of a neurological problem.

Why it's normal for children to tiptoe before they turn three

In the uterus, our precious little buns curl themselves into a tight little ball. Their heels push against their bum and their toes are downward. This results in a very tight Achilles tendon (a tough band of tissue that connects the calf muscles to the heel bone). This tendon needs sufficient time to stretch out after the baby is born.

Somewhere between 11 to 14 months, it's common to see children walking on tiptoes. Usually the tiptoeing habit stops within six months of them walking. By the age of three, they mostly stand with their feet flat but might run or walk on their toes.

Causes for concern

Children walking on tiptoes isn't usually a cause for concern and it should stop by the time they turn three. But if it doesn't, it could be because of one of these reasons:

1. Cerebral Palsy 

It's unlikely that you would have attributed tiptoeing to this but yes, it's possible. There are different types of cerebral palsy and one type of it affects the feet and walking. Spastic cerebral palsy causes severe muscle stiffness and this in turn affects the muscles surrounding the feet. Walking is difficult because of this.

If your child was born premature and suffered from brain haemorrhage, it can cause cerebral palsy and in turn, problems with walking.

children walking on tiptoes

Premature babies with brain haemorrhage may suffer from cerebral palsy.

Cerebral palsy can also pull the Achilles tendon up too tight and because of this, children may not be able to place their feet flat. This condition is known as Spastic Hemiplegia.

2. Periventricular Leukomalacia

Also as a result of premature birth, some babies have nerve damage in their brain. Consequently, they have trouble using their muscles and this causes problems with walking and other motor skills.

2. Autism and language delays

If your child's tiptoeing habit persists, and you also notice difficulties in his speech or socialising, then autism is a possibility. Children walking on tiptoes in itself is not an indication of autism. 

3. Short Achilles Tendon

The Achilles tendon gradually stretches out after the baby is born and as he starts to grow and develop. However, some children aren't able to fully stretch out this tendon and this results in them walking on tiptoes for an extended period. This will also hinder them from being able to stand flat on their feet.

4. Idiopathic Toe Walking

Upon performing a thorough assessment on your child and affirming that your child can move his ankle joint normally, this is the diagnosis your doctor will give you. It simply means - the tiptoeing is unexplained and there are no serious underlying causes. Similar to its name, it could be just another one of your child's idiosyncrasies!

children walking on tiptoes

Children have their little idiosyncrasies and tiptoeing is one of them!

Children who are diagnosed with idiopathic toe walking also tend to stand with their knees locked and straight while walking.

Helping children who walk on tiptoes

Doing some simple exercises at home on a daily basis, can go a long way in helping children with idiopathic toe walking. The aim of such exercises is to help stretch the muscles in their calves and to add strength to the muscles in the front of their legs. This will help them to walk more normally and to stand with their feet flat on the ground.

There are two steps to these exercises. Firstly, for children walking on tiptoes, you want to get them to stretch to loosen out their stiff calf muscles. When this is done, you want them to do exercises that target these stretched out muscles.

Exercises for children under the age of six

1. Calf stretch

  • Get your child to lay on his back. Ensure that the surface is firm.
  • Keeping his knee straight, bend his foot up to point towards the knee. Bend it upwards at the ankle joint. Do this for as much as possible without causing pain to your child.
  • Return his foot to resting position.
  • Repeat this for up to 10 times on each side.

2. Achilles tendon stretch 

  • Get your child to lay on his back. Ensure that the surface is firm.
  • Bend your child's knee and point his toe upwards in the direction of his knee. Do this gently.
  • Hold this position for 15 to 30 seconds, or for as long as possible without causing him pain.
  • Return his foot to resting position.
  • Repeat this up to 10 times.

3. Sit to stand 

  • Get your child to sit on a chair that is small enough for his feet to touch the ground.
  • Hold both his legs (below the knees) and push his feet flat to the ground. Get your child to stand while doing this.
  • Make this more fun by blowing bubbles and singing.
Children walking on tiptoes

Kids always need the element of fun so try to make the exercises enjoyable.

Exercises for children over the age of six

1. Calf Stretch

  • Have your child standing facing the wall (about two feet away).
  • Get your child to place his hands on the wall (at shoulder level).
  • Get him to step into the wall with the right foot. Keep the left leg in the same position. The left heel should be flat on the floor.
  • Hold the stretch for 10 to 15 minutes then repeat on the opposite side.

2. Squats

  • No explanation needed here, I think everyone knows how to perform a squat.
  • Do at least 10 squats.

3. Other exercises

  • Try making this into a little challenge - walk only using the heels with toes pointed towards the sky!
  • March on the spot, raise the knees and place the feet flat with each step down
  • Walk uphill or on uneven terrain

To make it more fun, join your kids in doing these exercises! 

When to call a doctor for children walking on tiptoes

If your child is past the age of three and displays any of the following signs, it's a cause for concern and you should get your child assessed as soon as possible.

  1. Your child loses motor skills that he used to have
  2. Walking predominantly happens on tiptoes
  3. Your child can't seem to bear his weight with his feet flat
  4. Your child's muscles are constantly stiff and tight
  5. Your child is unable to perform simple motor tasks like buttoning a shirt
  6. Your child has trouble coordinating and falls easily

What will the doctor do?

1. Assessment

Of course, as with any condition, your paediatrician will do a thorough assessment. This includes checking on your child's motor skill and brain function development.

The earlier any condition is detected, the better. Therapy and treatment can be put in place before the joins and muscles are permanently damaged.

Children walking on tiptoes

The doctor will assess your child and advice you on the best treatment options.

2. Therapy

If it's a case of a short Achilles Tendon, it's pretty straight-forward. Stretching exercises and physical therapy should solve the problem. The doctor may also recommend using an 'ankle-foot orthosis' to keep your child's foot at a 90 degree position at all times.

3. Serial Casting

Sometimes, doctors may use casts of different sizes and positions to aid the tendon in stretching to improve the range of motion to the ankle. If your child has to put on a cast, it cannot be removed even for bathing or exercising.

4. Surgery

Not the favourite, but if therapy and exercises can't correct the Achilles tendon then surgery is required to lengthen the tendon.

5. Neurological & Developmental Evaluation 

If it's a case of autism of cerebral palsy, the treatment cannot be just therapy or physical exercise. It requires treatment specifically targetted at the neurological effects of these conditions. A neurological and developmental evaluation is necessary to determine what treatment is best.

So moms and dads, remember that while it's cute to look at children walking on tiptoes, do monitor the situation and get your children checked if the need arises!

Source: New Kids-Center

Republished with permission from: theAsianParent Singapore

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