Toe Walking and Autism

A question from Dave, a parent: "Just wonder if anyone has had any success with breaking the tip-toe walking. David started walking at 10-11 months and then started some tip-toe walking around 18 months, gradually increasing frequency to 24 months, then by 2 1/2 years old he was tip-toe walking all the time. Now he is 4 years old and I'm wondering if there is any hope at stopping this without surgery. If cannot be stopped - I would like to hear from anyone with older children who still do it so they could tell me what's in store for us in terms of possible long term damage, etc. Also, if anyone has gone the surgery route, was it successful?"

---

As with just about everything on this web site, it starts with a parent's question. But toe walking is also a personal issue for me. I frequently walked on my toes as a child and young adult. For me, it was a sensory thing. I still do it if I am walking on a cold floor or outside without shoes on. But now I can catch myself and force myself to walk heel-to-toe.

Toe walking appears to be a sensory issue for many children. It has been associated with a vestibular system dysfunction and has been treated with extra vestibular input. Swinging, spinning, balancing on objects, etc. have all been recommended. It has also been treated with vision therapy and prism-lensed eyeglasses (see link below).

It has also been treated as a learned behavior and interventions have included positive reinforcement for correct walking. Simply instructing the child to walk heel-to-toe when he is not and then reinforcing it can be helpful. An interesting idea along these lines was using a squeaker device in the child's shoe (at the heel) - as the child walked he heard the squeak (this would only work on its own if he liked squeaks) - the child could be reinforced for a certain number of squeaks.

Toe walking has also been treated as a proprioceptive system (ability to correctly respond to differing pressure on the joints) dysfunction. Treatments include massage, joint compression, ankle and leg weights, etc.

Toe walking becomes a problem because over the years the achilles tendon adapts and shortens or tightens. What started out as a habit or sensory problem becomes physical. Exercises (to include: stretching the achilles tendon by standing 18-24 inches from the wall, hands on the wall, and leaning forward without the heel lifting from the floor; stretching the tendon by sitting on the floor, legs out, grabbing toes with hands and pulling toward you, etc.) should be tried first. Splints, casts, and surgeries have been used to correct this problem - unfortunately with variable results.

If your child toe walks please have him or her evaluated by a physician first and then seek an orthopedic and/or occupational therapy appointment as soon as possible. Toe walking has been associated with cerebral palsy and other medical conditions. Your physician can rules these out.

Below are several links that address toe walking and offer potential solutions.  

Linked Articles:

Toe Walking - Center for the Study of Autism

Evaluation and Management of Tip-Toe Walking in Children

Use of Physical Activity to Improve Behavior of Children with Autism - Two for One Benefits

Idiopathic Toe Walking: A Review  - Developmental Medicine and Child Neurology

Success with Learning Disabilities: Autism Spectrum Disorders and Eyesight

Through Different Eyes: How People with Autism Experience the World

Toe Walking Message Board - Autism Speaks

---