Riya would always walk on her toes. While it was ‘cute’ at first, her mother grew concerned when Riya continued walking on her toes even past her third birthday. It soon became apparent that Riya was not outgrowing this phase and that is when her mother decided to visit a paediatric orthopedician in Mumbai. A lot of parents notice that their children walk on their toes or the ball of their foot without the heel touching the floor. They often have the question – why does my child walk on her toes? Let us look at the causes of toe walking:
Causes of Toe Walking:
The causes of toe walking can be very diverse ranging from “it’s just a habit” to serious disorders which need treatment. Up to the age of three years, toe walking is often normal and is just a part of learning to walk. However, if this persists beyond the age of 3 years, you should visit your paediatric orthopedician to get your child examined for stiff muscles or poor muscle co-ordination. Here are the major causes of toe-walking:
- Habitual:
This is the most common cause of toe walking. These kids can walk flat-footed or even on their heels when commanded to. There is no known cause of toe walking, other than it being a habit, which is usually out grown like kids do with thumb sucking.
- Short Achilles Tendon:
We all have a fibrous cord at the back of our lower leg that connects our calf muscles to our heel bone. This is called as the Achilles Tendon after the Greek Hero Achilles who died from an arrow to the only weak area in his body – his heel. Sometimes this tendon can be tight or short, causing your child’s heel to be pulled up. This prevents the heel from touching the ground and hence, the toe walking.
- Cerebral Palsy:
Cerebral Palsy is a disorder in which there is trouble with the child’s muscle tone and co-ordination due to damage to the child’s brain before or during birth. There is an abnormal increase in the stiffness of the calf muscles in Cerebral Palsy, so that the child points his toes while sitting or is up on his toes while standing. Over a period of time, if this muscle stiffness is not corrected, the muscle gets used to being shortened and becomes even tighter.
- Autism:
Autism is a developmental disorder in which kids have difficulty communicating and relating to people. In Autistic children, there is usually no shortening of tendons or tightness of muscles. They need a certain sensory stimulation which is present when they walk on their toes.
- Muscular Dystrophy:
Muscular Dystrophy is a genetic disease in which there is progressive weakening of the muscles. In the early stages of the illness, there is strength in the calf muscles, but the hip muscles are weak, and this combination results in toe walking.
- Syringomyelia:
This tongue-twister of a disease is a rare condition in which a cavity is formed in the spinal cord which may grow to cause destruction of nerves and consequent weakness of muscles. Toe walking may be one of the initial symptoms of this spinal condition.
This was a short over view of the causes of toe walking. However, it must be re-iterated that more often than not, the cause is just habitual and the child often outgrows this phase, as it turned out for Riya. However, if the question of why does my child walk on her toes continues to plague your mind, it is worthwhile to have her examined by a paediatric orthopedician. Once your paediatric orthopedician has ruled out all these other frightening causes of toe walking, you can rest assured that your child will soon outgrow this cute phase.
Dr. Mandar Agashe is a Paediatric Orthopedician practicing at Agashe Paediatric SuperSpeciality Care in Mumbai. Dr Agashe has done his super specialisation in Paediatric Orthopaedics (Fellowship) from BJ Wadia Hospital in Mumbai and Korea University Medical Centre in Seoul, amongst others. Dr Agashe can be contacted at 022-42435000 at Kurla, Mumbai.
