Toe walking is quite common in children with autism. Although the exact cause is unknown, there is a relationship between autism and toe walking. Although it is not a condition used to diagnose autism spectrum disorder, it is a sufficient indication for parents to take their child to a specialist.
No child born into the world learns to walk in the womb. After all, individuals have sufficient muscle development, they take their first steps with the support and supervision of their primary caregivers. However, some special children start to tiptoe even before they take their first steps. And in these special children with autism, this habit does not disappear over time and even turns into toe walking.
When describing autism symptoms, the focus is more on social interaction symptoms. But it does not change the fact that physical symptoms exist. Toe walking is one of these physical symptoms. We can list some of the main distinguishing features of children with toe walking as follows:
- These children keep their heels up. They put their weight on their toes not only when walking but also when standing.
- These children insist on toe walking. After learning to walk in this way, they always continue to walk like this for at least 3 months, but they do it often afterward.
- These children’s tight heel cords are very developed. In normal circumstances, foot positions make the tendons and ligaments flex and stretch. However, when children walk on their heels, they do not develop normally which makes walking harder to correct.
While neurotypical children take their first steps on their toes, they usually start walking normally when they reach the age of 3, but the situation continues for children with autism. So if your child is just learning to walk, there is no need to worry about tiptoe walking. However, if this situation does not pass over the years and continues, it will be beneficial to take your child to a specialist for a definitive and accurate diagnosis.
Can Toe Walking Help Diagnose Autism?
It is a well-known fact that many children with autism walk on tiptoe. According to the results of the research, the rates are quite high. But doctors always emphasize that toe walking is not enough to diagnose autism. They try to explain this carefully to families.
To diagnose autism, there must be some symptoms that can be observed in early childhood in addition to walking on tiptoe. We can list these symptoms as follows:
- Not speaking at all or speaking a word or two.
- Insensitivity to name. Not answering when called.
- Lack of interest.
- Don’t babble.
As a parent, you may start to worry if toe walking begins to be observed along with language delays. Experts recommend seeing a professional exactly at this point. But you should always keep in mind that your child adopts and maintains this behavior for many different reasons. It can also be caused by a genetic disorder. Or there may be another health problem that you have not completely thought of.
It is a fact that children take their first steps on their toes however they usually start walking normally when they reach the age of 3. But toe walking continues for children with autism. So if your child is just learning how to walk, there is no need to worry about tiptoe walking. However, if this situation does not pass over the years and continues, it will be beneficial to take your child to a specialist for a definitive and accurate diagnosis.
Let’s say you took your child to a specialist and autism was suspected. The next step is behavioral screening. Tests such as blood tests, X-rays, or brain scans are not helpful in diagnosing autism, other than behavioral screening. That’s why doctors talk to parents about these children’s development, ask parents to complete behavioral questionnaires, and observe the child’s movements and behavior. In light of these data, the child can be diagnosed with autism.
Autism tests require observation as they are behavioral tests. This is why some doctors avoid diagnosing autism until children reach a certain age. They wait for the symptoms to become well visible. Even if you are not comfortable as a parent, it would be beneficial to seek a second expert opinion.
Is There Any Treatment for Toe Walking?
If the behavior of toe walking, which is one of the most common behaviors in children with autism, is not controlled at an early age, after a while, the tendons at the back of the leg lose their flexibility, causing pain and discomfort when the child presses on the ground flat, so that the toe walking behavior will become a necessity for the child. At this point, some interventions and treatments should be followed in order to change this behavior.
Although there is no definite cure for this condition, it is certain that children who walk on their toes need help and support in order to stop this behavior. The tendons of children who continue toe walking cause pain and change in their walking patterns in the long run. After reaching a certain age, they can learn to walk on flat feet to a certain level thanks to some therapies they receive. There are some aspects that such treatments should include.
- Physical exercises. Of course, it is an indispensable element of such treatments. Passive stretching techniques are used. Efforts should be made to keep their heels on the ground. Although difficult to follow in children with a lack of communication, they are very useful methods.
- Visual interventions. Prism lenses may be effective in some children. They are glasses-like devices. It is used to treat some vision disorders. Visual disorders observed in children with autism are some of them. It is a kind of glass used to retrain the eyes. The daily prescribed exercises are followed. At the end of these treatments, it is observed that these children can continue their daily lives at least without using these types of special glasses.
- Casting. This technique is followed to stretch the tendons. When the child’s foot is in the position that is pushed back at regular intervals, it is cast in plaster and the position of the foot is tried to be corrected. This plaster, which is standing day and night, relaxes the tendons and allows the children to walk with their heels on the ground. These treatments are usually completed in 6-weeks.
- Home brushing. To give different sensory inputs to the child on the autism spectrum by using a special therapy brush. Different textures should be introduced by brushing not only the soles of the feet but also the arms and legs. Massaging the soles of the feet with materials of different textures can also be counted. Children with autism can walk barefoot on different surfaces.
- Weighted vest. In fact, it is generally to dress children with autism, such as vests or bags with weights. The extra weight on them makes it difficult for them to tiptoe and can make them stand flat on the ground.
- Verbal warning. Although individuals with autism are not at a sufficient level in verbal interaction and communication, it may be useful to give verbal warnings such as “put your heel on the ground” when you see your child walking on their toes.
It is very important to know exactly what the cause of toe walking is before choosing the appropriate intervention method. Parents should be very careful about this. There are several points to consider when deciding on the appropriate intervention or treatment. The reliability, effectiveness, and cost of the treatment are some of the points to be considered.
These kinds of interventions listed above are the most followed and preferred interventions. It is possible to observe more benefits in the long run. So, it is important to be patient and keep going. However, curing this toe walking style does not mean curing autism. Individuals with autism benefit from individually structured therapies and treatments throughout their lives. These therapies are usually in the form of ABA therapy. It has also been scientifically proven that they benefit most from ABA therapies.
During ABA therapies, verbal skills are developed in addition to physical skills. Some children may even reach the same school level as neurotypical children. Therefore, such therapies should be given due importance. The younger the child is, the more beneficial the treatment and therapy will be.
Other Causes of Toe Walking
- Achilles tendon shortness: The shortness of this tendon, which is located at the back of the ankle, may prevent the heel from touching the ground during walking. In toddlers, when there is any inconsistency between the bone growth rate and the muscle growth rate, the Achilles tendon may be short when the bones grow fast and the muscles grow slowly. Therefore, the child walks on tiptoe. This is the most common reason for toe walking.
- Cerebral Palsy (CP): It is a disorder that develops during birth due to damage to the part of the brain that controls the muscles due to a lack of oxygen. In this disorder, shortness of the Achilles tendon may also develop.
- Muscular dystrophy: It is a progressive disorder that impairs the function of the muscles. In muscular dystrophy, which is a genetic disorder, everything may be normal at the beginning, and over time it starts with sensitivity in the muscles. In the beginning, walking on the tip of the toe can be observed in a child who walks normally. Since it is a progressive disorder, it shows itself over time. Depending on the degree of the disorder, walking may become completely impossible over time.
- Autism: Toe walking behavior can sometimes be observed in children on the autism spectrum. Although everything related to muscle development is normally developed, toe walking behavior may occur due to behavioral disorders.
The treatment of toe walking is determined by its cause. If your child walks normally but occasionally walks on tiptoe, no treatment is needed. It will be sufficient to follow the behavior at certain intervals. In the case of toe walking due to muscle shortness, it should be followed up with physical therapy. If it is due to muscular dystrophy, the treatment is recommended by a child neurologist, and if it is due to autism, by a child psychiatrist, the treatment is followed. Achilles tendon lengthening surgery is performed with surgical treatment if physical therapy is not beneficial in the toe walking due to muscle shortness.
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