Toe walking is walking on the toes or the balls of the feet.

If your child is still toe walking after age 2, talk to your healthcare professional about it. Make an appointment sooner if your child also has tight leg muscles, stiffness in the Achilles tendon or a lack of coordination.

Generally, toe walking is a habit that develops when a child learns to walk. Rarely, toe walking is caused by an underlying condition, such as:

• A short Achilles tendon. This tendon links the lower leg muscles to the back of the heel bone. If it's too short, it can prevent the heel from touching the ground.
• Cerebral palsy. Toe walking can be a symptom. Cerebral palsy is a group of conditions that affect movement and posture. It's caused by damage that occurs to the developing brain, most often before birth.
• Muscular dystrophy. Toe walking sometimes occurs in this genetic disease in which muscle fibers are unusually prone to damage and weaken over time. This diagnosis might be more likely if your child initially walked as expected before starting to toe walk.
• Autism spectrum disorder. Toe walking has been linked to autism spectrum disorder, which affects a child's ability to communicate and interact with others.

Toe walking out of habit, also known as idiopathic toe walking, sometimes runs in families.

Constant toe walking can cause lasting changes to the structure of the foot and increase a child's risk of falling. It also can result in a social stigma.

Toe walking can be observed during a physical exam. Sometimes, the healthcare professional may do a gait analysis or an exam known as electromyography (EMG).

During an EMG, a thin needle with an electrode is inserted into a muscle in the leg. The electrode measures the electrical activity in the affected nerve or muscle.

If the healthcare professional suspects a condition such as cerebral palsy or autism spectrum disorder, the next step may be to have a neurological exam or testing for developmental delays.

If your child is toe walking out of habit, treatment isn't needed. Your child is likely to outgrow the habit. Your healthcare team might simply monitor your child's gait during office visits.

If a physical problem is contributing to toe walking, treatment options might include:

• Physical therapy. Gentle stretching of the leg and foot muscles might improve the child's gait.
• Leg braces or splints. Sometimes these devices help promote a regular gait.
• Serial casting. If physical therapy or leg braces aren't helpful, your healthcare team might suggest trying a series of below-the-knee casts to progressively improve the ability to bring the toes toward the shin.
• OnabotulinumtoxinA (Botox). Injections into the calf muscles are sometimes used to help promote a regular gait.
• Surgery. If conservative treatments fail, surgery to lengthen the muscles or tendons at the back of the lower leg might be recommended.

If the toe walking is related to cerebral palsy, autism spectrum disorder or other problems, treatment also will include addressing the underlying condition.

You'll probably first bring your concerns to the attention of your primary healthcare professional — a family doctor, nurse practitioner, physician assistant or pediatrician. The health professional might refer you to a doctor specializing in nerve function, called a neurologist, or to orthopedic surgery.

What you can do

Before your appointment, you might want to write a list of questions, including:

• What could be causing toe walking in my child?
• What tests are needed, if any?
• What treatments do you recommend?

What to expect from your doctor

Your healthcare professional is likely to ask some of the following questions:

• Does your child have other medical problems?
• Do you have a family history of muscular dystrophy or autism spectrum disorder?
• Was your child born prematurely?
• Were there complications with the child's birth or during the hospital nursery stay?
• Did your child first walk flat-footed, then start toe walking?
• Can your child walk on his or her heels if you ask?
• Does your child avoid eye contact or exhibit repetitive behaviors such as rocking or spinning?