As little babies develop in the wombs of their beautiful mummies, their feet are often pressed against their buttocks, with their toes pointed down. This shortens the Achilles tendons (the connective tissues between the heel bone and calves), making it difficult for them to walk with their heels down during the first few years of their lives. Hence, it is actually normal for toddlers to walk on their toes! However, as they start learning to stand and walk, their Achilles tendons and calf muscles will eventually stretch out. By 2-3 years old, they should be walking perfectly with their whole feet on the ground! Yet, that is not the case for all children, especially so for children with autism.
So… why do children with autism walk on their toes?
Since they have been walking on their toes from the very beginning, it may be that they have developed a habit to walk on their toes.
2. Sensory Issues.
As mentioned in our previous posts, many children with autism have issues processing their senses. The texture of the ground could potentially make them feel uncomfortable or anxious. Hence, they result in tiptoeing to avoid the overstimulation in their feet. Conversely, the child could also be seeking extrasensory input to their joints such as their knees and ankles, which will be achieved by toe walking.
3. Poor proprioception.
In simple words, the lack of body awareness and control. Some children with autism have no clear sensation of where their limbs are attached or how to control them. The uncertainty of where your body parts are can be very daunting and one of their coping mechanisms is walking on their toes. This weighs them down and allows them to feel their legs better.
4. Poor vestibular system.
A vestibular system controls a child’s balance and overall coordination. When a child has a poor vestibular system, they tend to lean forward and balance on their toes for stabilisation.
Why should I be concerned?
The more your child walks on their toes, the more arch their feet will develop. This will cause their Achilles tendons to tighten and cause pain. In the long run, it may even require more severe interventions like wearing braces or having a foot surgery for your child to walk properly again. Hence, it is crucial to correct it as soon as possible before habits or physiological changes form.
What can I do at home?
1. Walk up a slanted platform.
This forces your child to place their whole feet down for more balance as they walk up a slanted platform.
2. Use songs and games!
Songs like: “Walking In The Jungle”, “When The Band Comes Marching In”, “The Ants Go Marching One By One” are great to get children to practice walking with their entire feet on the ground in a fun and engaging way. You can even choose to play a game of jumping with your child! Apart from increasing play/interactive opportunities with them, it also serves as exercise as they are strengthening their leg muscles when jumping. Or… Bring it outdoors and go to your nearby playground for a swing! Swinging is a great exercise for your child's vestibular system.
3. Remind them.
Gently tap their shoulders to push them down and remind them to “walk nicely”. Note that this can be very disconcerting for children who are trying to avoid uncomfortable sensations, and you should aim to increase their tolerance over a period of time rather than forcing them to do it all at once.
4. Catch them in action and praise them!
When you catch your child walking nicely with their whole feet on the ground, take the opportunity to praise them, “Hey, I like the way you are walking so nicely!” Remember, positive reinforcements will increase the chances of them doing it more often.
With that said, do note that this article is not all there is to toe-walking. Seek professional help if the issue persists beyond the age of 3 as it may be due to other causes like cerebral palsy or muscular dystrophy.
Written by Geraldine.
Williams, C. M., Tinley, P., & Curtin, M. (2010). Idiopathic toe walking and sensory processing dysfunction. Journal of foot and ankle research, 3(1), 16.
Morozova, O. M., Chang, T. F., & Brown, M. E. (2017). Toe walking: when do we need to worry?. Current problems in pediatric and adolescent health care, 47(7), 156-160.
Ilana Danneman (2019). Heel First! Strategies to Prevent and Reduce Toe Walking. Retrieved from https://funandfunction.com/blog/prevent-reduce-toe-walking
Shobha Bhasker (2015). Toe Walking: Should you be concerned? Retrieved from https://childrensmd.org/browse-by-age-group/toddler-pre-school/toe-walking-should-you-be-concerned/
The Truth About Toe Walking and Solutions For Your Young One (2017). Retrieved from https://www.greaterlearninglp.com/truth-toe-walking/