What is the relationship between Autism Spectrum Disorder and Toe walking?

Toe walking is when children favour walking on the ball of their foot, with little to no contact of the heels to the ground. Toe Walking can be quite common in toddlers, children from 3 and under and it can be seen as a normal milestone for some. Once a child is 5 years old, if they are still continuing to walk on their toes, it is time to get them assessed to work out why.

Toe walking comes about due to a number of reasons, toe walking can often be a habit some children develop and will grow out of, sometimes there is an underlying neurological cause, or can be due to developmental delay. This is where Autism comes in as a potential factor, it has been shown that a small percentage of children diagnosed with Autism can develop toe walking.

From research, there is not a lot of evidence available to understand confidently why ASD and toe walking are so closely linked. However, there are some theories that may help explain why toe walking and ASD are related;

Sensory Integration

Sensory experiences include touch, movement, body awareness, sight, sound, smell, taste and the pull of gravity. The process of the brain organising and interpreting this information is called Sensory Integration. Sensory Integration provides a crucial foundation for later, more complex learning and behaviour.

Sensory Integration can be broken up into 3 parts, Tactile System, Proprioception System and Vestibular system. All 3 areas in some way play a part in toe walking.

In children with Autism, the vestibular system (which helps to control balance and body position) is under developed or dysfunctional. Toe walking can often then develop. Exercises targeting vestibular stimulation can assist in reducing toe walking.

Low muscle tone

Often children with ASD exhibit low muscle tone. If a child’s abdominal muscles are weak, they will depend on toe walking to fee

l stable when moving.

What to do if your child is toe walking?

Speaking with your family doctor or Paediatrician is always a good place to start in order to have your child fully assessed.

Podiatry can be of benefit when trying to identify causes for toe walking and treatment.

There are various treatments that can be used to help your child and their toe walking.

Some treatments just to name a few may be:

  • Stretching
  • Exercises for strengthening
  • Education and trialling different shoes types
  • Verbal reminders
  • Orthotic devices or shoe inserts to discourage flexion at the toes

Treatment can be different for each individual, and what may work for one child may not work for another. As a parent it is good to keep an open mind and to be realistic in the goals we set for our children as toe walking can be difficult to manage.

We would also seek to collaborate with other health professionals who may specialise in Sensory Integration. This may be with specialised Physiotherapists, Exercise Physiologists and Occupational Therapists who can work with us to achieve the best outcome.

If you have concerns about your child’s feet, give us a call.


0800 474 776

(09) 212 9612

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