When I searched for information on this topic I was overloaded with information. Toe walking is hugely common in kids with Autism and I wanted to find out why.
First, what is toe walking? Toe walking is when a child or individual chooses to walk on the balls of their feet and toes, as opposed to using the whole foot while walking. When humans walk we typically strike the ground first with our heel then roll forward to the toes, using the whole foot to walk. Toe walking in young children and toddlers is quite common among typical children. In fact, Health Day, sites that as many as one in 20 children will toe walk in their early childhood. An interesting fact from the Johns Hopkins Children's Center states that approximately 70% of children who toe walk have at least one family member who also toe walked as a child, indicating that toe walking is hereditary. Usually toe walking will disappear in neurotypical children. If toe walking persists past the age of five doctors will usually consider it as a sign of neurological immaturity, according to the Autism Research Institute.
First, what is toe walking? Toe walking is when a child or individual chooses to walk on the balls of their feet and toes, as opposed to using the whole foot while walking. When humans walk we typically strike the ground first with our heel then roll forward to the toes, using the whole foot to walk. Toe walking in young children and toddlers is quite common among typical children. In fact, Health Day, sites that as many as one in 20 children will toe walk in their early childhood. An interesting fact from the Johns Hopkins Children's Center states that approximately 70% of children who toe walk have at least one family member who also toe walked as a child, indicating that toe walking is hereditary. Usually toe walking will disappear in neurotypical children. If toe walking persists past the age of five doctors will usually consider it as a sign of neurological immaturity, according to the Autism Research Institute.
In 2011, SFARI published an article siting research published in the Journal of Child Neurology. This study showed of 954 children referred to a developmental clinic showed that 115 were persistent toe walkers and 75 were toe walkers due to tight heel cords. The toe walking was higher in the subset of children who had ASD. In that subset group of 324 children with Autism, 65 were toe walkers and 39 were toe walkers due to tight heel cords. Therefore, these researchers conclude that children who walk on their toes are more likely to have Autism than other forms of developmental delay disorders, such as cerebral palsy. Toe walking is also seen in CP. They conclude that children who do toe walk beyond an appropriate age should be tested for Autism and children with Autism should have their walking gait studied and if necessary participate in physical therapy to alleviate walking difficulties, like toe walking.
This brings us to the causes of toe walking. There are a few reasons why your loved one maybe toe walking. Autism is not a cause of toe walking. Toe walking maybe a symptom of Autism, but not in all cases:
- Tight Heel Cords: As discussed above, toe walking maybe due to tight heel cords, or Achilles tendons. The Achilles tendons connect your heel bone to the bottom of your calf muscle. Children with Autism, who toe walk, have a difficult time with the range of motion in their ankles and typically cannot rotate their foot past a 90 degree angle. A physical therapist can assist you and your loved one with tight heel cord issues. Through a series of stretching and exercises they can help to correct this issue.
- Short Achilles Tendons: This is something that a child is born with. Their Achilles tendons are shorter than average, which causes them to toe walk. I could not find the average length of a normal Achilles tendon. All my reading suggests that the length varies per individual and is genetically predetermined. Sometimes this issue can be corrected with braces and if not surgery can correct short Achilles tendons.
- Sensory Processing Disorder: The nerve endings on the bottom of your feet are very sensitive. Some toe walking, without physical contributions, such as tight cords, may be due to sensory processing disorder. To cut down on the overload of input from the nerves in this area a child with Autism may toe walk. If there is no medical explanation for the toe walking consulting an occupational therapist on this topic maybe helpful.
- Hypertonia: An interesting blog on Williams Syndrome described the muscular condition hypertonia as a toe walking cause. Hypertonia is the exact opposite of hypotonia, and is described as high muscle tone. High amounts of muscle tone in the calf muscles may pull up on the Achilles causing toe walking to be prominent.
- Vestibular System: Dysfunction of the vestibular system, common in Autism, may be responsible for toe walking. Found in the ear, the vestibular system is responsible for relaying information to the brain about the bodies position in the world around it. The vestibular system also relays information about body movement. A disruption in this function maybe responsible for toe walking and can be addressed by your doctor.
- Other Disorders: Sometimes toe walking occurs in other disorders such as cerebral palsy or muscular dystrophy. Both of these involve muscle tone concerns, which is also seen in Autism.
For more information on toe walking, please see these articles:
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