Toe Walking & Cerebral Palsy - What You Should Know (2023)

Home / Blog / Cerebral palsy toe walking: What causes it, and can it be treated?

By Cerebral Palsy Guide on July 28, 2022August 1, 2022

4 Min Read

Toe Walking & Cerebral Palsy - What You Should Know (1)

Toe walking is very common in children who are just learning to walk. Sometimes, though, it can be a sign of a medical condition like cerebral palsy (CP). Learn more about toe walking in children with CP, including what causes it as well as potential treatment options.

What is toe walking?

Toe walking is when a child walks on the balls of their feet, with no contact between their heels and the ground. This can happen when they are barefoot or wearing shoes, and it looks similar to standing on your tiptoes.

It’s fairly common for children just beginning to walk to use their tiptoes as they learn how to balance their body weight.

The majority of toe walking is idiopathic (meaning the exact cause isn’t known). Most children outgrow toe walking after the age of 2 and start to walk with a normal heel-to-toe pattern.

Many older children who continue to walk on their tiptoes simply do so out of habit. However, toe walking can sometimes be caused by cerebral palsy or another underlying condition that affects a child’s muscles and body movements.

If your child is 2 or older and walks on their toes most of the time, contact us today to learn more. Our team can help determine if your child may have cerebral palsy.

What causes toe walking in children with cerebral palsy?

The most common cause of toe walking in those with cerebral palsy is spasticity.

Spasticity refers to involuntary muscle contractions caused by damage to the brain. Spasticity can pull a child’s limbs in abnormal positions and cause stiff movements.

(Video) Meet Cameron - What Every Parent Should Know About Toe Walking

According to the Centers for Disease Control and Prevention (CDC), most (about 75%-85%) of children who’ve been diagnosed with CP have spastic CP.

Children with spastic CP have stiff muscles, and their movements can be awkward as a result.

A specific type of CP called spastic diplegia that mostly affects the legs is a primary cause of toe walking in children with CP. Spastic diplegia can cause a child’s calf muscles to continuously contract and pull on their heels, keeping them from touching the ground.

Over time, the leg muscles can get used to being in this shortened position, which makes it harder to reverse toe walking in a child with CP. Identifying and treating toe walking early on can help minimize any discomfort and possibly correct this pattern before it becomes a habit.

If your child is aged 2 or older and walks on their tiptoes at least half the time, it’s important to have them evaluated by a doctor.

Does toe walking have any risks?

Yes. When a child walks on their toes for a long period of time, the bones and ligaments in the lower back, knees, and hips are tensed unnaturally.

This can lead to improper bone growth and/or ligament overstretching, which can put children with CP at risk for injury and joint discomfort as they get older.

Other possible complications associated with toe walking include:

  • Chronic pain caused by muscle tightness and excess pressure on the ankles
  • Difficulty riding a bike, squatting, or climbing stairs
  • Frequent falls due to poor balance and stability
  • Inability to walk flat-footed
  • Poor posture
  • Problems wearing shoes
  • Social stigma from walking differently than their peers
  • Soreness after walking
  • Stiffness, tightening, and pain in their Achilles tendon (the band of tissue that connects the calf muscles to the heel bone)

Catching toe walking early on can help reduce some of the physical risks listed above.

Toe walking is usually easily observed by parents, but it can be officially diagnosed through a physical exam.

During the exam, the doctor will observe the way your child walks (their gait) as well as their range of motion and muscle tone.

If the doctor suspects your child has cerebral palsy or another underlying condition, they may recommend a neurological exam or tests to check for developmental delays.

(Video) TIPS TO CORRECT TIP TOE WALKING IN CEREBRAL PALSY

What treatment options can help with toe walking?

Treatment for toe walking in children with CP depends on how old the child is and whether they’re physically able to walk flat on their feet.

Most podiatrists (doctors that treat foot problems) will start conservatively with treatment. Surgery is usually recommended only as a last resort when there is an issue with the Achilles tendon or calf muscles.

Toe-walking treatments might include:

  • Physical therapy: Physical therapy sessions to stretch and strengthen the muscles can help a child improve their gait.
  • Bracing: A custom plastic brace called an ankle-foot orthosis (AFO) can help encourage a flat foot when walking. It can be worn during the day or at night to stretch tight calf muscles and tendons.
  • Serial casting: Short leg casts applied for 1-2 week intervals can stretch tight muscles over time and improve the position of the foot and ankle.
  • Botox® injections: Children over the age of 2 can be given an injection of botulinum A toxin (Botox) to temporarily relax their calf muscles. This helps the muscles stretch more easily during serial casting or bracing.
  • Achilles tendon lengthening: If a child’s calf muscles and Achilles tendons are so tight that walking flat-footed is not possible, surgery can be performed to lengthen the tight Achilles tendon. This can increase the range of motion and function of the child’s foot and ankle.

Your child’s doctor or physical therapist may also recommend specific stretches that can be done at home to ease muscle tension.

We’re also here to help. Chat with one of our registered nurse advocates to see if there are any resources that may help with your child’s treatment.

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(Video) toe walking with cerebral palsy ways to subside it

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Learn more about foot problems in children with cerebral palsy

Toe walking and other foot issues in children with cerebral palsy can be better managed with early intervention and treatment. Having an orthopedic specialist on your child’s medical team is especially important to help prevent any negative effects of long-term toe walking.

To learn more about mobility and support options that may be available to your child, download our free Cerebral Palsy Guide.

Written by:Cerebral Palsy Guide

Cerebral Palsy Guide was founded upon the goal of educating families about cerebral palsy, raising awareness, and providing support for children, parents, and caregivers affected by the condition. Our easy-to-use website offers simple, straightforward information that provides families with medical and legal solutions. We are devoted to helping parents and children access the tools they need to live a life full of happiness

View 6 SourcesLast modified: August 1, 2022

  1. American Academy of Orthopaedic Surgeons. (April 2022). Toe walking. Retrieved July 27, 2022, from https://orthoinfo.aaos.org/en/diseases--conditions/toe-walking/
  2. Centers for Disease Control and Prevention. (2022, May 2). 11 things to know about cerebral palsy. Retrieved July 27, 2022, from https://www.cdc.gov/ncbddd/cp/features/cerebral-palsy-11-things.html
  3. Dr. Mikkel Jarman, Pediatric Foot and Ankle. (n.d.). Toe walking in children (pediatric equinus) Retrieved July 27, 2022, from https://pediatricfootankle.com/foot-conditions/toe-walking-pediatric-equinus/
  4. Johns Hopkins Medicine. (n.d.). Toe walking. Retrieved July 27, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/toe-walking
  5. Mayo Clinic. (2022, March 23). Toe walking in children. Retrieved July 27, 2022, from https://www.mayoclinic.org/diseases-conditions/toe-walking/symptoms-causes/syc-20378410
  6. Ruzbarsky JJ, Scher D, Dodwell E. Toe walking: causes, epidemiology, assessment, and treatment. Curr Opin Pediatr. 2016 Feb;28(1):40-6. doi: 10.1097/MOP.0000000000000302. PMID: 26709689.

FAQs

Why do people with cerebral palsy walk on their toes? ›

Cerebral palsy.

Toe walking can be caused by a disorder of movement, muscle tone or posture caused by injury or abnormal development in the parts of the immature brain that control muscle function.

Do people with cerebral palsy walk on their toes? ›

Toe walking is very common in children who are just learning to walk. Sometimes, though, it can be a sign of a medical condition like cerebral palsy (CP). Learn more about toe walking in children with CP, including what causes it as well as potential treatment options.

What problems can toe walking cause? ›

Persistent toe walking may cause your child's calf muscles and Achilles tendons to tighten even further. This can make it difficult or even impossible for your child to walk flat-footed.

When should I worry about toe walking? ›

Most Children Outgrow Toe Walking

This by itself usually isn't anything you need to be concerned about as long as your child is developing and growing normally, but toe walking after the age of 3, referred to as Idiopathic Toe Walking, may not be normal and should be looked into.

How do you correct toe walking? ›

If a physical problem is contributing to toe walking, treatment options might include:
  1. Physical therapy. Gentle stretching of the leg and foot muscles might improve your child's gait.
  2. Leg braces or splints. Sometimes these help promote a normal gait.
  3. Serial casting. ...
  4. OnabotulinumtoxinA. ...
  5. Surgery.
23 Mar 2022

What are 3 facts about cerebral palsy? ›

CP is more common among boys than girls, and more common among black children than among white children. Most (about 75%-85%) children with CP have spastic CP. This means that their muscles are stiff, and as a result, their movements can be awkward. Over half (about 50%-60%) of children with CP can walk independently.

Is toe walking a developmental delay? ›

There is also a theory that toe walking may be an element of a more global development delay. Although it is not clear what specifically causes the abnormality in the child's gait pattern, research has shown that many children who toe walk also have speech delays and other developmental delays.

What are the long term effects of toe walking? ›

The following are negative consequences of toe walking: Tight ankles or contractures can develop. Poor balance reactions, frequent falling. Muscle imbalances “up the chain” meaning decreased hip or core strength due to the different postural alignment.

Is toe walking associated with developmental delays or other conditions? ›

Toe walking is a physical sign associated with several diagnoses such as spastic cerebral palsy, spinal dysraphism/injury, myopathy, neuropathy, autism, and pervasive developmental disorder. In other children the cause of toe walking remains unknown.

What neurological conditions affect toes? ›

Neurological Conditions That Affect Feet

These include such issues as peripheral neuropathy, cerebral palsy, Charcot-Marie-Tooth disease, and certain toe deformities like hammertoe, mallet toe, and claw toe.

What muscles does toe walking weaken? ›

Children who walk on their toes can develop tight calf muscles on the backs of their legs and have decreased movement of their ankles. In addition, the muscles on the front of their legs may become weak. If there is tightness and weakness, your child will have difficulty walking on their heels.

What muscles are weakening when walking on toes? ›

Toe walking results from the relatively greater weakening of the dorsiflexors of the foot as compared with the plantarflexors. Toe walking also develops to compensate for the weakening quadriceps muscle.

Is toe walking autism? ›

Toe walking is not only autism related, it is also found among individuals with conditions such as cerebral palsy, muscular dystrophy, Charcot-Marie-Tooth Disease, and other neuropathies and myopathies. The main reason for this is that toe walking is associated with an anatomical pathology present in these conditions.

Which toe is most important for walking? ›

It probably is no surprise that your big toe is the most important when maintaining balance and bearing body weight. Your big toes bear just about 2 times the amount of weight as all your other toes combined! It still should not shock you that the pinky toes are the least important.

Does toe walking improve with age? ›

Toe walking is common in children who are learning to walk. After the age of 2, however, most children outgrow toe walking and begin to walk with a normal heel-to-toe pattern. In very rare cases, continuing to toe walk after age 2 may be a sign of an underlying medical condition.

What are the two biggest causes of cerebral palsy? ›

There's no single cause of cerebral palsy, though prematurity and stroke are two of the biggest causes. While the personal cause remains unknown for most cerebral palsy cases, researchers now know that only a tiny percentage of cerebral palsy cases arise from birth-related complications, such as lack of oxygen.

What is the root cause of cerebral palsy? ›

Cerebral palsy is usually caused by a problem that affects the development of a baby's brain while it's growing in the womb. These include: damage to part of the brain called white matter, possibly as a result of a reduced blood or oxygen supply – this is known as periventricular leukomalacia (PVL)

What helps cerebral palsy? ›

A variety of therapies play an important role in treating cerebral palsy:
  • Physical therapy. Muscle training and exercises can help your child's strength, flexibility, balance, motor development and mobility. ...
  • Occupational therapy. ...
  • Speech and language therapy. ...
  • Recreational therapy.
1 Sept 2021

What are some warning signs for developmental delays? ›

Signs and Symptoms of Developmental Delay

Learning and developing more slowly than other children same age. Rolling over, sitting up, crawling, or walking much later than developmentally appropriate. Difficulty communicating or socializing with others. Lower than average scores on IQ tests.

What are the five areas of developmental delay? ›

Developmental delays can occur in all five areas of development or may just occur in one or more of those areas. The five areas of development are: Physical development, cognitive development, communication development, social and emotional development, and adaptive skills.

Why is it not good for kids to walk on their toes? ›

Kids who spend a lot of time on their toes can develop stiffness, tightening, and pain in their Achilles tendon, which can be treated with physical therapy and stretching exercises. Rarely surgery may be required (usually after age 6) if the toe walking is the result of (or results in) tendon stiffness.

Why you shouldn't walk on your tippy toes? ›

Aside from the stigma of being different, walking on tiptoes also inhibits balance and coordination. The continued application of unnatural strain on the leg muscles can lead to stiffness, tightening of leg and calf muscles, pain in the Achilles tendon and other muscular problems.

What are the benefits of toe walking? ›

Conclusion: Toe walking may require less ankle plantarflexor, ankle dorsiflexor, and knee extensor strength than normal heel-toe walking and thus may have compensatory advantages for patients with upper motor neuron injury and distal lower extremity weakness.

Is toe walking a phase? ›

Toe walking refers to the lack of heel strike during the stance phase of the gait cycle. It is a common variation of normal gait development in children.

What brain part controls toes? ›

The Cerebellum

This area of the brain is responsible for fine motor movement, balance, and the brain's ability to determine limb position.

What are the first signs of nerve damage? ›

The signs of nerve damage
  • Numbness or tingling in the hands and feet.
  • Feeling like you're wearing a tight glove or sock.
  • Muscle weakness, especially in your arms or legs.
  • Regularly dropping objects that you're holding.
  • Sharp pains in your hands, arms, legs, or feet.
  • A buzzing sensation that feels like a mild electrical shock.

What spinal nerves affect the toes? ›

The peroneal nerve is a branch of the sciatic nerve. It supplies movement and sensation to the lower leg, foot and toes.

Does toe affect balance? ›

Despite the small size of the bones the toes are comprised of, they are necessary in maintaining proper balance, while walking and running.

Do autistic kids grow out of toe walking? ›

Many children walk on their toes or the balls of their feet (also known as toe walking) as they learn to walk. Some children with autism don't outgrow it on their own.

Do children with Aspergers walk on their toes? ›

Many studies of children with autism report problems with gait, or alignment while walking. Of these, one of the most commonly described is persistent toe walking — for longer than three months after learning to walk — and tight heel cords, which restrict ankles to a 90 degree angle.

What percent of toe walkers are autistic? ›

Our results demonstrate that roughly 9% of patients with ASD have a diagnosis of toe-walking as compared with less than 0.5% of children with no ASD diagnosis.

What toes affect balance? ›

Of all your toes, your big toes are the most important. They play the most critical role in maintaining your balance. They also bear the most weight when standing. Your big toes can bear almost twice as much weight as the other toes combined.

Which toe is least important? ›

The least important of your toes are undoubtedly your pinky toes. As the smallest toes, they bear the least weight and have the least impact on maintaining balance. People born without pinky toes or those who lose one in an accident will see very little, if any, changes to how their feet function.

Why are toes important for balance? ›

Our toes play an important role in our balance and movement. Approximately 75% of our bodyweight is supported by them and the balls of the feet when walking. Generally speaking, we need our toes to be able to spread wide, to provide a good, stable foundation for the rest of our body!

Why do some special needs kids walk on their toes? ›

A dysfunctional vestibular system, a common problem in autism, may be responsible for toe walking. The vestibular system provides the brain with feedback regarding body motion and position.

How does a person with cerebral palsy walk? ›

Ataxic Cerebral Palsy

People with ataxic CP have problems with balance and coordination. They might be unsteady when they walk. They might have a hard time with quick movements or movements that need a lot of control, like writing.

How does cerebral palsy affect feet? ›

Foot disorders are common in children with cerebral palsy. The most common deformity is called equinus, or plantar flexion deformities. In this condition, the foot points downwards. This deformity is often part of a larger lower extremity deformity.

How does cerebral palsy affect walking? ›

Tight, stiff, overly toned muscles make controlling movements difficult. If it affects the muscles of the lower body, this type of cerebral palsy also makes walking difficult and causes a jerky, awkward gait. With dyskinetic cerebral palsy, a person struggles with involuntary movements in the muscles.

Is toe walking always autistic? ›

"The fact that your kid toe walks is not a sign that they have autism," he says. Beers agrees. "A lot of kids who toe walk are developing normally," she says, "If it's an isolated finding, it is not something to be too worried about. If there are no underlying concerns, it's just something to keep an eye on."

Is walking on your toes an autistic thing? ›

Toeing the line: Many children with autism cannot easily flex their ankles past 90 degrees, causing them to walk on tiptoes. Children who walk on their toes are more likely to have autism than other forms of developmental delay, according to a study published in January in The Journal of Child Neurology.

How do you calm cerebral palsy? ›

A variety of therapies play an important role in treating cerebral palsy:
  1. Physical therapy. Muscle training and exercises can help your child's strength, flexibility, balance, motor development and mobility. ...
  2. Occupational therapy. ...
  3. Speech and language therapy. ...
  4. Recreational therapy.
1 Sept 2021

What does very mild cerebral palsy look like? ›

Mild cerebral palsy may not be noticed until a child begins walking and has symptoms that may include stiffness or tightness in joints, a limp, uncontrolled movement, or difficulty controlling muscles in the hands and feet.

What can make cerebral palsy worse? ›

The brain disorder causing cerebral palsy doesn't change with time, so the symptoms usually don't worsen with age. However, as the child gets older, some symptoms might become more or less apparent. And muscle shortening and muscle rigidity can worsen if not treated aggressively.

Does cerebral palsy affect toileting? ›

Yes — bladder and bowel incontinence are common problems affecting children and adults with cerebral palsy. 70-80% of cerebral palsy patients have issues with incontinence, and 85% of patients have bladder overactivity. This may be due to neurological impairment.

What organs does cerebral palsy affect? ›

Cerebral palsy affects the motor area of the brain's outer layer (called the cerebral cortex), the part of the brain that directs muscle movement. In some cases, the cerebral motor cortex hasn't developed normally during fetal growth.

What are some specific challenges a person with cerebral palsy may need to overcome? ›

Children with cerebral palsy may experience specific learning difficulties. These may include a short attention span, motor planning difficulties (organisation and sequencing), perceptual difficulties and language difficulties. These can impact on literacy, numeracy and other skills.

Is it painful to walk with cerebral palsy? ›

Some children may experience little to no pain, whereas others may require medical treatment to manage painful symptoms. According to a 2020 study from BMC Neurology involving 3,545 children and adolescents with cerebral palsy, 42.5% of patients reported experiencing some type of pain.

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