Parents have been stepping up to ask me if they should worry if their toddler tends to do a lot of walking on their toes rather than their feet.

Let me try to toe the line on this interesting topic.

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Important things to know

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– Toe walking is when a young child walks on the balls of their feet with no contact between the heels and the ground.

– Flat-footed walking should be seen by age two and by age three, heel-toe walking should be in place.

– Most toe-walking occurs out of habit as an infant is learning to walk.

– More than half of the children who toe walk will stop doing so on their own by age five.

– If it is a habit, it has been shown to run in families.

If, on the other hand, your child toe walks most of the time, has stiff muscles, is uncoordinated, walks awkwardly and is unable to weight bear on their feet, then medical attention should be sought for a developmental and neurologic assessment to determine for example if the toe walking could be due to a short Achilles tendon, cerebral palsy, muscular dystrophy, or autism.

If your child’s health care professional finds none of these causes for your child’s toe-walking which is commonly the case, and it is an isolated finding, then it may just be what we call “toe walking of no known cause” meaning it’s likely a habit that as I said will go away over time.

Stretching exercises, however, may still be useful while your child demonstrates this behavior to make sure there is no increased stiffness or tightening of their Achilles tendon.

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When to see your health care professional

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– Certainly, you should consult your health care professional if you see toe walking after age two.

– Contact them sooner if the toe walking is accompanied by tight leg muscles, stiffness in the Achilles tendon or you note a lack of muscle coordination in your child.

– If a nerve or muscle problem is found, referral to a pediatric neurologist or orthopedist would be in order for further evaluation and treatment which might include physical therapy, and if a neurologic problem is identified, leg braces, botulinum toxin or Botox, and sometimes surgery might then be recommended to improve motor skills, muscle strength, and prevent further muscle damage.

Hopefully, tips like these will allow you and your child to put your best foot forward when it comes to knowing more about when and when not to worry about your child’s toe walking.

Lewis First, MD, is Chief of Pediatrics at The University of Vermont Children’s Hospital and Chair of the Department of Pediatrics at the University of Vermont’s Larner College of Medicine. You can also catch “First with Kids” weekly on WOKO 98.9FM and NBC5.