Many parents want to know if toe-walking is a sign of autism. In truth, however, all children walk on their toes when they take their first steps and learn to walk. Eventually, however, as walking is mastered, toe walking usually corrects itself. Persistent toe walking is the term used when a child’s toe walking persists after the age of two.
But why do autistic children commonly walk on their toes? And, is toe walking a sign of autism? Let’s explore this today.
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Is Toe Walking a Sign of Autism?
Persistent toe-walking is seen in autistic children at a greater rate compared to the general population. A 2019 meta-analysis of various studies found that 8.5% of autistic children are toe walkers.
Autistic people often struggle with sensory integration dysfunction (sometimes called sensory processing disorder, SPD). Some experts believe that toe walking is related to a dysfunctional vestibular system.
Vestibular System and Toe Walking
The vestibular sensory system takes in sensory information from the spinal cord to the brain. Vestibular input is related to:
- Head position,
- Inner ear,
- Balance,
- Spatial awareness and orientation
Further, the vestibular system is intimately connected to the visual system. As such, it’s believed that the cause of toe walking is related to how the brain processes information related to both vision and balance.
Vestibular dysfunction, when not treated, can lead to or explain other forms of developmental delay:
- Delayed sitting,
- Crawling,
- Walking
These three challenges are common in autism and may be related to differences in the cerebellum of the autistic brain. The cerebellum is located at the base of the brain and is pivotal in motor coordination and balance.
Language and Toe Walking
Studies of children suggest that when combined with language delays, persistent toe walking (PTW) may be considered a symptom of autism. In other words, there’s evidence of a relationship between communication challenges and toe walking.
Further, one study suggests a correlation between the severity of language delay with tip-toe behavior patterns. This makes sense because motor planning impacts both spoken language and walking.
More on Toe Walking
Toe walking is a gait or pattern of walking in which the foot heel doesn’t touch the ground. It’s common for autistic children to walk on their tiptoes.
While it’s developmentally expected for young children learning to walk to do so on their tiptoes, it’s typically resolved after the age of two. In a small number of cases, toe walking can be related to neurological conditions such as:
- Cerebral palsy:
- a nervous system condition related to muscle tone and control
- Muscular Dystrophy:
- a medical condition related to muscle weakness that progressively worsens
There is a subset of children (about 5% of the population), who with no known underlying cause, continue tiptoe walking without graduating to a typical gait. Toe-walking after the age of 3 is referred to as Idiopathic Toe Walking (ITW).
Some children have severe tightening of the Achilles tendons. But, again, the cause of idiopathic toe walking is unclear. However, some experts believe that it can be associated with developmental disorders (or conditions) such as autism.
Toe Walking Treatment Options
If your child persists in walking on their tip toes after the age of 2-3 years of age, seek professional help to discuss the root issue. After a physical examination, your child’s pediatrician may refer them to a pediatric physical therapist or an occupational therapist.
Private Occupational Therapy
A private occupational therapist doesn’t just help kids with weak fine motor skills. Rather, a PRIVATE OT knows that working on fine motor skills before addressing root issues is a waste of time.
In the end, a good OT will have expertise in the brain and behavior. Additionally, they should have a solid understanding of sensory processing dysfunction.
As such, they’ll be able to evaluate your child for root issues related to both sensory processing and toe walking. Types of occupational therapy treatment to correct toe walking may include:
- Reflex integration exercises
- Sensory integration exercises related to both proprioceptive and vestibular input
- crab walks,
- frog jumps,
- picking up objects with toes
Physical Therapy for Toe Walking
A physical therapy approach might include stretching a child’s call and foot muscles to improve range of motion.
Other Toe Walking Treatment Options
Other more invasive toe-walking treatments include:
- Serial casting:
- Child wears a series of casts that are changed each week
- each cast stretches the child’s foot and calf muscles while allowing them to walk
- The duration of the correction phase depends on the child’s age.
- Older children typically need to wear casts longer which is why early intervention helps.
- Bracing:
- AFO is a plastic brace that extends up the back of the lower legs
- Bracing takes months compared to weeks with serial casting
- Surgical intervention:
- If other treatments aren’t effective in providing a full range of motion
Surgical options only in extreme cases if toe-walking is bothersome to the child. For example, if it limits their abilities in sports and other areas of importance.
Do You Have to Treat Toe-Walking?
The main reason you’d want to treat toe walking is if it’s harming or has the potential to hurt your child. In the end, discuss with your child, your child’s doctor, and their support team to decide what’s best.
In general, when older children persist in the toe-walking pattern, especially with other developmental delays, you may want to consider seeking an autism diagnosis.
What is the Vestibular System?
Imagine lying on your back on your bed with your head hanging off the edge. When your vestibular system is functioning properly, you can close your eyes and your brain still knows its physical orientation. Meaning, the brain knows it’s upside down without “seeing” with your eyes.
Recap: Why Do Autistic Kids Walk on Their Toes?
So, why do autistic kids walk on their toes?
Most toddlers spend a lot of time walking on their toes when learning to walk. As they become more steady, they gradually place that heel bone on the ground and walk with a typical walking pattern.
Toe walking may be a sign of autism when combined with a speech delay. As always, discuss any concerns with your child’s healthcare provider.
About the Author:
Lindsay is a trauma-informed educator with a Master’s Degree in Teaching. Her mission is to support moms to equip neurodivergent kids (ADHD, Autism, Dyslexia, Anxiety) to thrive as exactly who they’ve been created to be. Wait until you hear the story that led to it all…
This was so interesting! I was a toe walker on and off in my younger years and I often wonder if I’m autistic after learning so much from my autistic 12 year old.
You’re amazing, Sweet Lady! You never know. Have you read any books about autism in women and girls? Perhaps that will lead you to a greater understanding of your potential autistic brain. https://aheartforallstudents.com/books-about-autism-by-autistic-authors/
So excited for you! 🙂