No child is born knowing how to walk. All children take their tentative first steps with help and coaching from their parents. But some tiny children stand on their toes while they're entering the world of walking. Sometimes, that habit doesn't fade with time.
Toe walking and autism are connected, although researchers aren't quite sure why. While this unusual gait can't be used to definitively diagnose autism, parents who see it can use the information to ensure a child gets early, helpful interventions.
How Do Toe Walking & Autism Connect?
Autism is a developmental disorder. When people describe symptoms, they often focus on the way people talk or the way they interact with others.
People with autism can also develop physical symptoms. Toe walking is one of them.
Simply put, children who toe walk:
- Keep their heels lifted. Whenever they're standing, their weight is in their toes.
- Persist in the behavior. They keep walking like this for at least three months after they learn to walk, experts say.
- Develop tight heel cords. Normal foot movement keeps tendons and ligaments limber, so they can flex and stretch. Children who walk on their heels don't stretch critical tissues, and they grow rigid and stiff. Those changes make a toe walk harder to correct.
Most children take their first, wobbling steps while standing on their toes. It's a common and natural behavior that most children outgrow completely by the time they reach 3 years of age.
If your child is very young and just learning to walk, a few tentative steps on their toes shouldn't cause you concern. But if the child keeps walking this way, it's time to visit a doctor.
Can Toe Walking Help to Diagnose Autism?
Researchers say many children with autism walk on their toes. In a 2011 study, for example, researchers said 20% of children with autism walked on their toes. This is a strikingly high proportion, but it's important to understand that toe walking alone isn't enough for doctors to consider an autism diagnosis.
Children with autism have a variety of signs and symptoms in early childhood, including:
- An inability to speak.
- An ability to speak one or two words, but an inability to string these words together.
- Lack of response to a parent calling the child by name.
- Lack of interest in repeating words or sounds.
- Reluctance to babble or make pre-language noises.
If toe walking combines with language delays, experts explain, autism can be suspected.
But children can walk on their toes for all sorts of reasons. They may have genetic malformations in their legs, heels, or feet that keep them from walking flat-footed. Or they may have another medical condition that attacks the bones or tendons.
If your doctor suspects autism, behavioral screening is the next step. No blood test, x-ray, or brain scan can aid in an autism spectrum disorder diagnosis. Instead, doctors make observations about how their patients are developing, and they ask parents to complete behavior questionnaires. Using that data, doctors can make a diagnosis of autism.
Since autism tests are observational, some doctors prefer to avoid a definitive autism diagnosis until a child is older. Some children age through their language delays, and they don't qualify for the diagnosis later in life. But parents can ask for a second opinion and an expert's help if they believe autism exists and the child's doctor is overlooking important signs.
Treatments for Toe Walking
Children who continue to walk on their toes do need help. Shortened tendons are painful, and they lock children into a walking pattern that's very hard to break. Therapy can make flat-footed walking possible.
Experts say toe-walking treatments include:
- Physical exercises. Parents can use passive stretching techniques to help loosen tense tendons and encourage a normal heel-to-toe relationship. Parents can also entice their children to drop their heels quickly. These exercises aren't always helpful in young children with communication deficits, but some families find them useful.
- Visual interventions. Doctors find prism lenses helpful in some children. These devices look like glasses, but they correct the visual disturbances that can come along with autism. Children who use this therapy also have daily visual-motor exercises to perform to retrain the eyes. Eventually, these children no longer need their special glasses.
- Casting. Tendons stretch via this technique. Every two weeks, the child visits a doctor for a new cast that pushes the foot slowly into the proper position. The child wears the cast both day and night, and in time, the tendon loosens and the child learns to walk with their heels on the ground. This mode of treatment takes up to six weeks to complete.
Interventions like this work. For example, researchers say children who use casts improve their gait, and they maintain those improvements years later.
But it's critical to understand that changing a child's gait doesn't amend the child's autism. Children with autism benefit from structured, tailored therapy performed by a trained professional. Oftentimes, these sessions take the form of applied behavior analysis (ABA) therapy.
In sessions with this therapist, children can build up their verbal skills. Sometimes, children learn enough in these sessions that they can head to mainstream kindergarten. These therapies are vital, and they should happen alongside treatments to amend their gait. The earlier these interventions begin, the better.
- Clinical Research: Toe Walking in Toddlers Signals Autism. (March 2011). Spectrum.
- What It Means When Kids Walk on Their Toes. (July 2016). The Conversation.
- Persistent Toe Walking in Autism. (May 2011). Journal of Child Neurology.
- Toe Walking in Autism. (2014). Comprehensive Guide to Autism.
- Toe Walking and ASD. Autism Research Institute.
- Kinematic Gait Changes Following Serial Casting and Bracing to Treat Toe Walking in a Child With Autism. (July 2017). Pediatric Physical Therapy.