Children grow quickly and the stages of development replace each other with incredible speed. You don’t even know when the time has passed and the baby has started to roll from side to side, crawl, walk, take two or three steps while holding on to the furniture, and finally walk standing. These are simple gestures, but full of meaning for the development of babies. One such gesture is a baby’s tiptoeing, a behavior that can intrigue and worry parents. Is this normal for children or could this be a sign that something is wrong?

Walking on tiptoes is quite common among toddlers, but most will give it up. Until the age of 3, as long as the child grows and develops normally, walking on tiptoes does not cause concern, and if he still sometimes practices it, then he does it out of habit. However, after 3 years, this is no longer normal and should be investigated.

Risk of injury and joint discomfort

When a child walks on their tiptoes for long periods of time, the bones and ligaments in the knees, hips, and lower back are put under unnatural stress, which can lead to improper bone development and/or overstretching of ligaments, exposing it. risk of injury and joint discomfort as it grows.

Nicole Kaiser, MD, a pediatrician at Rainbow University Hospitals Children’s Medical Group, says keeping a close eye on your baby not only keeps her safe, but also provides important clues about her development.

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When a child reaches 3 years of age and continues to walk on tiptoes, parental concern is natural and justified, and a pediatrician should be consulted to evaluate this aspect. The pediatrician will perform a clinical examination and, depending on the results, perform or recommend a neurological examination to identify a disorder that affects his coordination abilities.

Although tiptoeing is a habit, it can be caused by a neuromuscular disorder, leg length discrepancy, or hip dysplasia. The latter can be especially to blame in a situation where the child walks on tiptoes with only one leg. Other causes may be spinal abnormalities or tendon contractures in the heel, as well as a too short Achilles tendon, heel pain, or autism spectrum disorders. Regarding the fact that walking on tiptoes can indicate an autism spectrum disorder, it should be emphasized that walking on tiptoes without other signs does NOT mean that the child has autism!

Long-term negative consequences

If the child’s tiptoeing does not have the reasons listed above, but is simply a persistent habit, it must be corrected. And this is because over time it leads to problems such as muscle and tendon strains, problems wearing shoes or even difficulty standing. Children with mild contractures may need stretching or physical therapy. Persistent or more severe contractures may require surgery.

Therapy and surgery

Depending on why your child is tiptoeing, the doctor may recommend one of the following treatments:

physiotherapy

Walking exercises stretch the muscles and improve the range of motion. Children can also do these exercises at home.

Wearing a tendon stretching device

In some cases, it may be recommended to install a device that stretches the leg and helps the child put it on the ground.

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The doctor may place short plaster casts on the child’s legs to stretch the muscles and improve the position of the foot on the floor. Some children also receive Botox injections to relax the muscles. In situations where these treatments fail, surgical options are available. For example, if walking on tiptoes is caused by an Achilles tendon that is too short, this aspect can be corrected surgically by lengthening it (interventional tendon lengthening), but surgery can be performed after 5 years.

Aprons, the “enemy” for the child’s legs

Even if walkers were initially considered an aid to stimulate walking in children, their use revealed negative aspects. Conclusions made over time by orthopedists and physiotherapists have led to the conclusion that the use of walkers harms the child.

First of all, a child who cannot walk forward will not be in a natural position, but one that will put stress on the joints and supporting structures of the legs, which will have consequences. Then walking will emphasize the “hunched” position of the legs, which would otherwise begin to bend naturally. Then, without relying entirely on the sole, the child will walk on tiptoes and will maintain this style of walking even after the walker is no longer used. The hip joints are also affected, which are also overloaded, and if the baby also has hip dysplasia, it is aggravated when walking.

Tiptoeing may persist despite treatment

In a study in which 60 children aged 1 to 15 years who walked or tiptoed as children were evaluated to determine the relationship between range of dorsiflexion (bending the leg forward while walking) and height. The study showed that in the age group of 1-2 years, the back bending was on average 12 degrees, in the age group of 6-15 years it decreased to 4 degrees. Of course, the fact that it has decreased is encouraging, but it has not completely disappeared, so interventions are needed to help.

Another study, conducted on a group of 80 children with idiopathic tiptoe walking, followed and evaluated different treatments (observation, cast/orthosis treatment, or surgical lengthening of the triceps muscle). 32% of them had a family history of idiopathic tiptoe walking, 28% were born prematurely and 16% had psychomotor retardation. The researchers concluded that tiptoe walking can be maintained after all standard treatments.

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