It is common for parents to get a bit worried when they see their little ones walking on tiptoes for a prolonged amount of time. Although usually, it is nothing and part and parcel of normal development, there are rare cases of underlying health, medical or developmental conditions that parents need to be aware of.
Why does this happen?
Simply put, walking on tiptoes has a lot to do with the time your child spent in-utero. As babies, they are curled up into a ball in the uterus with heels touching their buttocks and toes pointing downwards. The result is a tight Achilles tendon that will stretch over time after they are born.
Most of the stretching happens when the child is about 12 – 14 months and just starting to learn to walk. In the beginning, your little one may start off walking on the balls of their feet for a bit before walking flat-footed, with heels on the ground. But as your child practices walking more, their Achilles tendon will begin to relax. You should notice a reduction in tiptoe walking, and this can take anywhere from 3 to 6 months.
By the age of 3, your toddler should be standing with both feet flat on the ground. But because every child develops at a different pace, some might still run or walk on their toes for a little longer.
Short Achilles Tendon and Idiopathic Toe Walking
These are the two most common reason why children walk on tiptoe:
- Short Achilles tendon – Some children are naturally born with short Achilles tendons, which is why they are unable to stretch their tendon completely to stand flat on their feet.
- Idiopathic toe walking – A doctor will diagnose your child with idiopathic toe walking when he or she seems to be walking on their toes out of habit for no known reason.
Most children with idiopathic toe walking can stand flat-footed and walk normally when in front of the doctor. But the moment they lose focus, they revert to walking on their toes. Even children who walk better with shoes tend to go back to tiptoeing once they are barefooted again.
It is crucial that idiopathic toe walking is detected earlier because you need to remember that your child is learning how to walk. The motion of walking does not only involve your child’s muscles alone; the brain and body are also learning at a neurological level. So if it is not detected or corrected earlier, it could become a habit as walking on tiptoes would be ingrained into the brain as the right way to walk.
Exercise that can help
Exercises that stretch out the calves’ muscles is very beneficial because it can build stronger front leg muscles for children with idiopathic toe walking. Simple home exercises like stretches can help loosen tight calf muscles and increase the ankles’ range of motion.
For younger children, try this:
- Lay your child down and push his or her foot upwards towards the shin. Hold that position for a couple of seconds for a good stretch.
- Pull your child from a sitting position to stand.
- Walking on uneven surfaces also helps. You can also try introducing tactile training to teach them to feel with their entire foot instead of using their toes only.
For older kids:
- Get your child to stand on a wedge or any incline while playing a game for a few minutes to create a prolonged stretch.
- You can also have older kids stand at the edge of a step. Get them to lower the heels while you keep them steady by holding both arms.
- Alternatively, you can get them to copy you doing a runner’s calf stretch next to a chair or table so that they have something to hold on to.
When should you worry?
Parents should start paying attention if their little one continues to walk on tiptoes past the age of 3 because this could be a sign of some other underlying problem. Typically, there would be other accompanying signs. Still, it is best to get your child properly assessed by a doctor or an experienced physiotherapist if he or she is taking too long to outgrow this.
Early detection is vital because severe cases of prolonged tiptoe walking could indicate Cerebral Palsy, which causes severe muscle stiffness. Nerve damage in the brain due to premature birth can also result in muscle issues. It could also be a sign of Autism if your child continues to walk on tiptoes and is coupled with social and speech delays. Understandably as parents, we do not wish this on any child. Hence it is good to get your child assessed early to rule out the possibilities. If there are underlying problems, early detection also means your child would be able to get the treatment needed promptly. Your doctor will need to do a thorough assessment of your child’s development, motor skills, and brain function to determine this.
A short Achilles tendon can be treated with stretching exercises and physical therapy. If needed, your child may have to wear a brace for some time. The brace will ensure that the foot is kept at a 90-degree position at all times. There is a possibility of surgery if the Achilles tendon does not respond to initial treatments.
Know that if your child is still walking on tiptoes under the age of three, this is completely normal. But if your child continues to do so after 3 years of age, then perhaps it is time to schedule a doctors appointment just to be sure. Early detection also means early rectification for your little one.