Toe Walking in Children: When to Seek Medical Advice

Children walking on their tiptoes?

Hello Doctor: My daughter is now 6 years old.
Since she started walking, she has been walking on her tiptoes.
I initially thought she was just having fun, but I have noticed that her balance is significantly worse than that of other children her age! She easily falls while running and even has difficulty squatting (she tends to fall backward).
She cannot squat as easily as other children! (*My daughter likely does not have flat feet, as she has an arch.) I would like to ask which specialist I should take my daughter to for an evaluation.

Xiao Ai, 20~29 year old female. Ask Date: 2011/08/01

Dr. Pei Rensheng reply Pediatrics

Dear Xiao Ai,
Hello! After a child learns to walk, it is indeed concerning if they frequently walk on tiptoes, as this improper walking pattern can lead to conditions such as pes planus (flatfoot) and may affect their stability while walking, potentially causing spinal deformities.
Additionally, it is important to note that after a child reaches one and a half years of age, they may occasionally walk in different ways for fun.
Parents should not panic excessively; however, if the child consistently exhibits a habit of walking on tiptoes, it is essential to consult a medical expert to find the best strategies.
It is crucial not to let this develop unchecked, as it may severely impact their walking posture in the future.
To prevent tiptoe walking issues, consider the following:
1.
Avoid training the child to stand or walk too early.
2.
Correct the child’s center of gravity while standing or walking, and provide balance training.
For example, place colored tape on the floor and ask the child to walk forward using a "heel-to-toe" method.
Once they are proficient, encourage them to walk backward.
Parents should be patient and make this a game.
3.
Children are prone to falling, so you can provide guidance at home:
- When children have insufficient opportunities for physical activity, it can lead to delays in gross motor development and low muscle tone.
Arrange a play space for the child to increase opportunities for physical activity, enhancing their agility and reducing the risk of injuries.
- To compensate for clumsiness leading to falls, use toys to help.
When selecting toys, choose those that provide various "kinesthetic experiences," such as throwing balls, pull toys, and tricycles.
- Various play equipment in small parks can promote agility in gross motor skills and hand-eye coordination, such as monkey bars and seesaws.
Regular use of these facilities can significantly improve a child's motor control.
If you still have concerns, consider consulting an orthopedic or rehabilitation specialist.
Wishing you health and happiness!
Sincerely,
Dr.
Pei Ren-Sheng
Director of Pediatrics, Taoyuan Hospital, Department of Health

Reply Date: 2011/08/01

More Info

Toe walking, or walking on tiptoes, is a common behavior observed in young children, particularly those under the age of 5. While many children outgrow this habit without any intervention, persistent toe walking can sometimes indicate underlying issues that may require medical attention. In your case, your daughter’s toe walking, combined with her balance difficulties and challenges in squatting, suggests that it may be prudent to seek a professional evaluation.

When to Seek Medical Advice
Given your daughter's age and the symptoms you've described, it is advisable to consult a pediatric specialist. Specifically, you may want to consider visiting a pediatric orthopedic surgeon or a pediatric neurologist. These specialists can assess her motor skills, balance, and overall gait pattern. They will look for any neurological or musculoskeletal issues that could be contributing to her toe walking and balance problems.

Possible Causes of Toe Walking
1. Habitual Toe Walking: Many children walk on their toes as a phase of development. If there are no other concerning symptoms, this may simply be a habit that she will outgrow.

2. Muscle Tightness: Tightness in the calf muscles (gastrocnemius and soleus) can lead to toe walking. A physical examination can help determine if this is the case.

3. Neurological Conditions: Conditions such as cerebral palsy or other neurological disorders can affect muscle tone and coordination, leading to toe walking and balance issues.

4. Sensory Processing Issues: Some children with sensory processing disorders may prefer toe walking due to the way it feels or because they are trying to avoid certain sensory experiences.

5. Flat Feet or High Arches: While you mentioned that your daughter does not have flat feet, it is essential to evaluate her foot structure, as both flat feet and high arches can affect gait and balance.

Evaluation and Treatment
During the evaluation, the specialist will likely conduct a thorough physical examination, including assessing her muscle strength, flexibility, and coordination. They may also observe her walking pattern and perform specific tests to evaluate her balance.

If the evaluation indicates that her toe walking is due to muscle tightness, a treatment plan may include:
- Physical Therapy: A physical therapist can work with your daughter to improve her strength, flexibility, and balance. They may provide exercises to stretch tight muscles and improve her overall gait.

- Orthotic Devices: In some cases, custom orthotics may be recommended to provide support and improve her walking pattern.

- Neurological Assessment: If there are concerns about neurological issues, further testing may be necessary, including imaging studies or referrals to other specialists.

Conclusion
In summary, while toe walking can be a normal part of development, your daughter's balance issues and difficulty with squatting warrant further investigation. Consulting with a pediatric orthopedic surgeon or neurologist will provide you with a clearer understanding of her condition and the best course of action. Early intervention can be crucial in addressing any underlying issues and helping her develop the skills she needs to walk and play confidently with her peers.

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