Toe walking is when a child walks on the balls of their feet rather than in
a heel to toe pattern. Many children outgrow this and yes it should happen fairly quickly (by age two). However if a child is toe walking most of the time they should be assessed as the heel cords could tighten to a point where it becomes very hard to stretch them out.
It is common for a baby to be up on the toes initially after starting to walk. The plantar reflex could be the cause as it may be still integrating. As a child spends more time on their feet this should disappear and the heels should come down.
There are some conditions that could be a cause of toe walking (cerebral palsy, muscular dystrophy and spinal cord abnormalities) but most of the time there is no known cause. This is called idiopathic toe walking.
Research does show a higher incidence of toe walking in those with autism. However the reason remains unclear. It has been proposed that it is related to the sensory system and more specifically the vestibular system.
The main concern with toe waking is tightening of the heel cords. Active stretching is the best method for stretching out the back of the legs/heels. There are many great exercises that are also fun for children to do. Try getting children to walk up ramps and hills as this is a great way to actively stretch those muscles. If the sensory system is involved there are some great methods for de-sensitizing the bottoms of the feet.
If you have any concerns or questions please don't hesitate to contact me directly. Contact me at hgibsonpediatricphysio@gmail.com