Causes of tiptoe walking in babies

If a doctor determines that tiptoe walking is detrimental to a child's health and development, they may recommend physical therapy, exercise, and massage, and in extreme cases, refer the child for surgery.

Does your child play catch? What to do if your child tiptoes?

Have you noticed that your child tiptoes sometimes or all the time? It's not uncommon for parents and others to be amused by it because it looks funny at times. In reality, this is not a child's cute gimmick or a ballet performance, but a serious pathology. And the sooner parents become aware of this and take action, the greater the chances that the child will grow into a healthy person and reach their full potential.

What the 'sticks' are all about, whether the child will 'grow out of the problem' and what can be done about it says, among other things. Vladimir Zhivotov, an osteopathic doctor.

Why bad?

The osteopath points out that it is not physiological for a child to tiptoe. 'Is it normal for a child who has just started to walk to still have balance problems, let alone be able to walk well? Obviously not. Because in order to keep your balance, you need maximum support over the entire foot surface. Why does the child make this task difficult for itself by only shifting its weight to the front foot or only occasionally? In fact, in the child's particular situation, this is an adaptive response and the least bad thing,' says Vladimir Zhivotov. – says Vladimir Zhivotov.

'The spikes are a dangerous sign,' warns the osteopath. And he immediately mentions several problems. The first of these is muscle hypertonicity.

'Constantly tense muscles are a direct result of birth trauma, which led to dysfunction of the nerve centers that regulate skeletal muscle tone. Flexor muscle tone is increased. That's why the legs go into this position,' warns Vladimir Zhivotov.

According to the osteopath, this explains why boys are more likely to walk on their toes than girls. The fact is, on average, boys have larger heads than girls, which means they are more likely to experience birth trauma.

Another effect of birth trauma that causes a baby to tiptoe is the acute and severe strain on the neck muscles. 'Absolutely all babies who walk on tiptoe put excessive strain on their necks! This tension is created to protect the neck damaged at birth and spreads to the entire posterior superficial chain and transfers to the calf muscles'. – says Vladimir Zhivotov.

There is another important mechanism that plays a role in the development of the pathology, explains the osteopath. 'When the skull is compressed and twisted during birth, the dura mater is stretched. Their tension is transmitted through special ligaments between the cervical vertebrae to the neck muscles and down to the sacrum, which creates a background for tension in the leg muscles, the specialist emphasizes.

Your child tiptoes. Is this a normal process?

Yes, in most cases it is perfectly normal if:

• the child is healthy and developing well,
• the child has no developmental delay,
• the child regularly tiptoes and is able to walk comfortably with the whole foot,
• the child does not have a coordination disorder and does not kneel when walking,
• the child is able to support itself on the toes of both feet,
• The child's motor skills are constantly developing.

If toe walking is not accompanied by the above symptoms, it is considered idiopathic (ie, of unclear origin). As the name suggests, the causes of this behavior are unknown.

Why do children even walk on tiptoe?

according to dr Para Engstrom from the Karolinska Institute in Stockholm, he and his colleagues came to the conclusion in a study that healthy children often walk on their toes because their nervous and muscular systems are simply not yet perfect.

According to the Ukrainian pediatrician Evgeny Komarovsky, toe walking is evidence that young children up to the age of three have highly developed ankle muscles, since learning to walk requires great physical effort.

Idiopathic toe-walking is hereditary - if a parent walked on their toes as a child, there is a high probability that the child will also acquire the habit.

What are the causes?

In most cases, toe walking is simply a phase in motor development. It is not uncommon for children to first walk with their feet fully extended and then stand on their toes.

Safe (not medical) reasons for toe walking:

• Some toddlers under the age of one have overdeveloped calf muscles and are better able to walk on their toes. This habit wears off as you get older.
• Walking on tiptoe may be associated with the child's interest in a new skill, the desire to learn about the world, curiosity, the ability to see into previously inaccessible corners of the apartment and reach forbidden objects. Older children use this ability to attract adults' attention as they see their admiration for the children's abilities. In this way they can imitate their parents: when the child stands on tiptoe, it makes it feel grown up and strong like dad, or big and beautiful like mom when she walks on high heels.
• Reflexive standing on tiptoe may be triggered by unpleasant memories of pain and discomfort if the child has previously stepped on a cold or dirty floor or cut their foot.
• The use of a walker is indicated for young patients with limited mobility to support their movement. Healthy children should not use this device as it may be detrimental to their development. It is not uncommon for a child to stand on tiptoe on the walker and later use it.

When the cause of the child's toe walking cannot be determined and there are no signs of nerve damage or orthopedic disorders, experts classify it as idiopathic. It is not uncommon for the condition to be hereditary (when parents talk to their child, they or their relatives also walked on tiptoe up to the age of one).

Idiopathic gait decreases with age, and these children do not need treatment or orthopedic shoes.

When is it not the norm?

The following pathological causes should be considered:

• Emotional Disorders. Toe walking can be caused by stress and anxiety. The child stands on tiptoe in moments of mental stress, so this habit is seen as a need for emotional relaxation. Toe walking is occasionally seen in hyperactive, excitable, anxious, and shy children.
• Periventricular leukomalacia. This condition, which occurs in premature babies, is associated with damage to the white matter of the brain. It manifests itself in disturbed motor coordination and motor dysfunction.
• Orthopedic' Disorders in the form of a shortening of the calf muscle or Achilles tendon, an abnormal formation of the arch of the foot, inflammation of the heel bone. A clumsy gait forces the child to tiptoe.
• mental retardation. Tiptoeing is the result of an immaturity of the pyramidal tract, which transmits impulses from the brain to the lower limbs. Compulsive movements and stereotypical behaviors typical of children with intellectual disabilities (finger or pacifier sucking, hand waving, jumping, hair twirling, etc.) are also classified as autism.
• Neurological Spectrum DisordersIncreased muscle tone is characteristic of the child's diseases (cerebral palsy and others). Muscle hypertonia is diagnosed at birth and is usually associated with delayed psychomotor development, incoordination and mental retardation. Neurological abnormalities are caused by brain damage that can occur as a result of viral infections during pregnancy, toxoplasmosis, entanglement of the umbilical cord, rhesus, fetal hypoxia.

Language – the child's ability to communicate.

The lack of language alone is not proof. A normal or developmentally retarded child will try to 'translate' with gestures, pointing with their finger what they want and responding with a smile, etc.

'Communication disorder' does not mean speech or hearing loss, but communication itself. A child with a hearing or speech disorder will try to compensate for the sensory deficit through gestures, facial expressions or lip reading. In contrast, a child with autistic symptoms will try to ignore any attempts to communicate with them.

Such children either have a sharp delay in the development of speech, start speaking late, or sometimes have no speech at all. In contrast, another group of children with autism are very 'talkative'. They may start saying difficult words early on, but don't use them to communicate.

Communicative signs of autism include:

• Echolalia - the child spontaneously repeats words, snippets of songs, quotes from favorite cartoons that are not addressed to other people but are spoken 'into the void'
• It does not use gestures and facial expressions
• Can use an adult's hand to indicate or ask for help, or to guide them to an object
• Avoid eye contact

In addition to communication difficulties, other serious aspects of autism in children are aggression and self-aggression (self-injurious behavior such as skin scratching, hair pulling, slapping, etc.).

It is very important for parents to know the main symptoms of autism in children; this provides them with a kind of framework that allows them to critically consider the opinions of different people about their child, from relatives to different specialists.

The opinion of E. Komarowski

A well-known pediatrician describes toe walking as the norm in children up to the age of two or three and says that almost all toddlers go through the walking phase in this way when they acquire the ability to walk, especially if the child often walks in one Walker is running. The popular doctor notes that special attention is paid to this symptom, because it is associated with some serious neurological diseases. However, according to Komarowski, nothing needs to be done in situations where toe walking is not accompanied by symptoms of nervous system disorders.

Read more about this topic in Dr. Komarowski's program.

Julia Bodniak

What Conditions Can Cause a Child to Shake?

In general, there are four groups of disorders that can make a child sway: The root cause is in the brain.

The most common brain-related cause is mild cerebral palsy. If the child has a complicated history, if the child was born prematurely, if there was hypoxia, the child will develop with a delay.

An example.A child who cannot stand by the age of one and a half or two will immediately start walking and crossing their fingers by the age of two. With high tone in the legs, enlarged cerebral ventricles according to ultrasound, it is also better to see a specialist - among other things. Neurologist and orthopedist, among others..

The cause lies in the area of the spinal cord:

1. – Congenital anomalies of the spinal cord, e.g. B. Spinal fatom - a benign tumor often found in the lumbar region.
2. – Spina bifida (but not Occulta L5-S1, which many in the population have, but true spina bifida, sometimes with herniation at the level of the bifida).
3. - Immobilization of the spinal cord. The spinal cord itself is a tube of nerves that runs inside the vertebrae. Compressing these nerves at any level can also lead to toe tip formation.

However, there are many nuances. For example, if it is spinal cord fixation syndrome (the spinal cord is attached to the vertebrae), then as the child grows, the vertebrae will stretch and the spinal cord will stretch, meaning it will not straighten up as it should. This leads to disturbances in the gait pattern.

Urological disorders (urinary incontinence, fecal incontinence) are the most common. There is often reduced sensation in the lower limbs. These symptoms appear earlier than with toe walking. The cause lies at the level of the nerves that run from the brain to the muscles. The nerves are our conduits to the muscles.

One of the largest groups of diseases are polyneuropathies. These can occur for a variety of reasons. One of the largest groups is hereditary sensorimotor polyneuropathy, including Charcot-Marie-Tooth disease.

Diagnosing the cause of toe walking

In most cases (about 90 %) the cause of the toe walk cannot be determined. This is referred to as 'toe walking'. idiopathic toe walking. However, in order to make this diagnosis, it is important to exclude the above diseases.

A special examination protocol is recommended in the Mechnikov MI Turner Scientific and Research Center for Pediatric Traumatology and Orthopedics of the Russian Ministry of Health:

• Ultrasound of the brain and ultrasound of the lumbar spine in children up to about 3-4 years of age,
• over 3-4 years – magnetic resonance imaging.
• Electroneuromyography - Tests that show the speed of impulse conduction along the nerve.
• Mainly blood tests for CPK, ALT, AST, LDH.

If levels, particularly creatine phosphokinase (CPK), are in the tens of thousands, a neurologist and orthopedist should be consulted.

In 90 % of patients who walk on tiptoe, the cause is mostly unclear but is most commonly caused by increased anxiety.

Anxious children are more at risk of developing toe gait - it's like a 'stuttering gait'. Toe Walking in Autism Spectrum Disorders According to the literature, up to 40 % children with ASD have some form of gait disorder, including toe walking.

Most often, children with ASD tiptoe because they are stepping or because they are stereotyped. It is not yet known why children with ASD walk on tiptoe. Parents often ask if it will pass. This is the case for some children and not for others. Behavioral therapy can help with toe walking when a child is affected with ASD.

frequently asked Questions

Toe walking can be a deviation from the norm or a consequence of a pathological process. It is most commonly caused by a neurological disorder. It can easily be compensated for if a doctor is consulted in good time and appropriate treatment is initiated.

The habit should be controlled if the child has been walking on tiptoe continuously for more than three years. With such a gait there is a risk of abnormal development of the ligaments and tendons, which over time can lead to negative consequences. A series of simple foot muscle development exercises — squatting in a low chair, walking on an uneven surface and a massage mat, drawing shapes in the air with your feet and toes — will help manage the problem. If the child walks and runs on tiptoe, then swimming will help a lot, and a special massage will be effective for tiptoe walking.

Yes, if you start using a walker early, before 6 months of age. dr Komarovsky believes that this device was invented for the convenience of parents, does not serve the child and does not have a positive impact on development. In contrast, the dangers of baby walkers have been proven. Premature vertical loading is dangerous for the immature spine, leading to poor posture and other serious consequences. Another disadvantage is that the child tiptoes on the baby walker and does not take a full step. Parents may have to spend a lot of time training the child.

Botulinum toxin therapy is used when the child is constantly standing on tiptoe and walking is accompanied by local spasticity. Injection of botulinum toxin helps relax the spastic muscles and the child can walk with the whole foot. The treatment has a minimal list of contraindications and is suitable from the age of two. Timely treatment will help prevent permanent foot deformities and other complications.

start walking When tiptoeing is the norm

Your child's first steps bring great joy to the whole family. Even if the little 'walker' now needs a watchful eye, learning to walk independently is an important step in human development.

Your child will usually start walking independently around the age of one year. He is learning more and more to move on his own feet and trying different ways to use his feet. This includes walking on your toes.

There are many logical explanations for why a child sometimes tiptoes:

• It uses the properties of its feet to reach and grab an object from a certain height.
• Toe walking is simply a new mode of locomotion that the child is learning.
• By imitating a dancer by standing on tiptoe, the child imitates a rabbit under the Christmas tree or a cunning fox.
• We adults often stand on tiptoe to avoid stepping on mud or small objects that are placed in our path. The child does the same - starts walking on tiptoe.
• A very active baby likes to tiptoe. This type of walking helps the child release energy. This type of 'walking' can benefit from additional exercise.
• A toddler may tiptoe when uncomfortable, e.g. B. he is cold.

The above reasons why a one-year-old child tiptoes are quite natural. From the toe position, the child can change at any time and walk on all feet.

According to American pediatricians, a child's toe walking is not a serious problem until the age of 3 (at this age the leg muscles develop unevenly). Gymnastics and general developmental activities will definitely help.

With regular check-ups by the pediatrician and the understanding that the child is developing, there is no cause for alarm if a child at the age of 2 still occasionally tiptoes. The child learns to walk, tries out different paths and experiments.

Reasons for tiptoe walking that is not the norm

Important!!! Constant tiptoe walking should alert you. It is advisable to consult a pediatric neurologist or orthopedist.

We are parents ourselves when we put a child in a height-adjustable device. When the child is too small and cannot reach the floor with its whole foot, it must touch the floor with its toes in order to move. Getting used to this type of locomotion has a detrimental effect on the child's muscular development.

1. If the child tips their toes frequently and extensively, the cause may be excessive nervous excitability. This condition is common in preterm, highly sensitive, and emotional infants.

Constant toe walking contributes to an abnormal distribution of stress on the child's muscles, which can lead to excessive stress and strain on the body. The orthopedist will advise you on a suitable therapy. Some relaxation massages can help improve the situation.

Part of the muscles in the child's legs is hypertonic - overstretched, the other part suffers from hypotonia - low muscle tone. With this diagnosis, the child walks on tiptoe all the time.

1. Pyramidal insufficiency is a nervous system disorder that can cause muscular dystonia. There are a number of causes that can contribute to this condition, such as: B. Fetal lack of oxygen, trauma or the position of the baby after birth.

Why do babies walk on their toes? trigger

• Use of a walker. Often the child stands on tiptoe and consistently continues on tiptoe.
• Hyperactivity, temperamental behavior, stress. Anything that throws the child's nervous system out of balance can be a trigger for toe walking.
• Premature babies often have periventricular leukomalacia, a lesion in the white matter of the cerebral hemispheres that can cause problems with coordination and motor skills, including toe walking.
• Shortening of the Achilles tendon or calf muscles, heel arthrosis and other changes in the foot cause discomfort and make the child tiptoe when walking. Only a doctor can diagnose this disorder and prescribe treatment.
• If a child walks on tiptoe, then parents should exclude neurological disorders: autism, cerebral palsy, since the symptom occurs with these diagnoses. However, doctors who practice evidence-based medicine see pyramidal insufficiency syndrome (a disorder of the nervous system responsible for movement) as a diagnosis for concerned mothers, not a disease that requires treatment.

Doctors estimate that children up to the age of 3 can walk this way and still have no problems due to the heavy strain involved in walking and the strong development of the ankle muscles.

If a child in the west walks on their toes but is otherwise healthy, doctors will not recognize it as an abnormality until they are 6 years old.

But while there's no dangerous reason for a child to keep walking on their toes, it's worth investing time in maintaining proper foot shape from the age of three. After all, such a harmless habit can negatively affect the natural development of a growing child's feet.

What should you do if your child mainly walks on tiptoe? Buy orthopedic mats and place them in the areas your child is most exposed to on a daily basis. Try baths and massages, foot rolling various objects and LFC sets.

If your child walks on their toes: what to do and how to treat it

The first treatment is conservative therapy, which includes the following.

• walking barefoot on uneven ground;
• therapeutic massage;
• swimming with a coach;
• Walking: half squat, goose step, heel walk, walking on the inside or outside of the foot;
• Climb;
• Bicycling (peddling) for older children.

If these activities don't help and the child walks on tiptoe, the doctor will decide what to do next. Depending on the situation, the problem is treated either by a neurologist who selects special drugs and therapy, or by an orthopedist who, in the absence of positive dynamics and taking into account the diagnosis, can recommend surgical intervention.

Finally, a note for those whose child tiptoes. What should I do? At first, until the age of 2-3 years, leave your child alone, do not scold, reduce attention and observe him from the outside, if there are no other health problems.

Has your child started walking spontaneously on tiptoe, is it older than 3 years, does it have other developmental and wealth problems? This is a good reason to immediately consult a specialist.

Keep in mind that 'terrible' diagnoses still have a host of other symptoms besides toe-walking, so you probably can't miss them, and that over-scrutiny and monitoring isn't good for either the child or the mother.

Pediatric orthopedist Kirill Shlykov explains how a child's feet should develop, whether children need orthopedic shoes, and what is appropriate for walking at home.

• Toe movement in children.
• Tiptoe as an adult.
• A person walks on tiptoe.
• The child walks on its toes.
• Tiptoe walking.
• Tiptoe walking.
• Why people tiptoe.
• Why girls tiptoe.