Toe Walking in Autism

SEED Early Childhood Educational Blog

DISCLAIMER

This post delves into the complex links between toe walking and autism. Exploring current knowledge on the symptoms and treatment options using current evidence-based knowledge.

Keywords: Autism tip toes toe walking autism spectrum disorder persistent toe walking PTW

Author SEED Early Childhood

Edited by Henry Hackbridge

14 February 2026

Thumbnail Toe Walking in Autism SEED Early Childhood Specialist SEN Education Early Development Blog

Many children may toe walk as part of normal development, but continued toe walking can often be linked to other conditions such as, language problems, physical development delay and Autism Spectrum Disorder (ASD). [4]

Autism is a neurodevelopmental condition that causes difficulties in social skills, communication and behaviour. Autism is described as a spectrum disorder as symptoms can be mild or severe. [13]

A gait pattern is the way you walk.

What is toe walking?

Toe walking is a common gait pattern where the heal of the foot does not touch the ground. Toe walking is common in children three and under, continued toe walking in children 5 old years and over is categorised as Persistent Toe Walking (PTW). Persistent toe walking is often associated with autism and other developmental disorders like Spinal dysraphism and Myopathy. Toe walking alone is not an autism indicator. In autism the gait refers to the specific walking patterns and movements frequently observed in children with autism. In research about toe walking there is some debate about children with autism being classified as having Toe Walking Behaviour (TWB) or if their experience of toe walking should be understood in relation to their condition and categorised differently. [4][12][1][3][6]

Do autistic children toe walk more than neurotypical children?

A study [3] found that toe walking was in 1.5% of children without autism and 6.3% of children with autism with earlier studies finding higher numbers in children with neurodevelopmental disorders.

Toe walking and Autism

In research there are mixed views on whether when seen in autism toe walking should be recognised as part of the autistic profile or as an independent issue. Research around this subject is complex. Newer research discusses viewing toe walking in autism as part of a broad neurodevelopmental profile. A study [7] found consistently that the presence of autistic toe walking was connected with links to the severity of neurodevelopment, disordered sleep and digestive disfunction, these findings support the idea that these areas may share the same neurobiological mechanism. Toe walking has also been linked to cognitive, language and motor dysfunction. [9][5][4][8]

What causes toe walking

A child with autism may toe walk for different reasons but it is often involuntary. To properly address underlying issues a child with autism needs an official diagnosis. Toe walking can also be a result of cerebral palsy but a significant number of children with toe walking have autism. Toe walking can be caused by a dysfunctional vestibular system a common problem in autism effecting coordination and motion. It could also be linked to archaic reflexes. Young children with autism tend to arch when picked up or cuddled like labyrinthine reflex in supine. Children may be doing this to decrease the foot surface area an so reduce stimulation. [9][10][4][5][8][5].

Toe walking and ADHD

In ADHD this can be a sign of motor coordination problems more than developmental. [4]

What are the physical effects of toe walking?

Persistent toe walking can have serious effects of a child’s physical development:

• Tight Achilles

• Tight calf muscles

• Tight heal cords

• Equinus deformity

• Midfoot deformity

• Restricted motion

• Flatfoot

• Metatarsalgia [4][5][6][9]

This can affect a child’s stability and ability to balance. This can also impact their social and emotional development as they may be limited in their ability to take part in certain activities, and they may be self-conscious of their difference.

What are the treatments for toe walking?

Again, it seems that the gait pattern of children with autism is frequently misunderstood. Some researchers believe toe walking in autism must be treated as a distinct condition because of the neurodevelopmental diagnosis and the higher rates of persistent toe walking and treatment recurrence in children with autism. [2][4]

Early intervention can help prevent long-term complications and surgery. Therapeutic interventions for toe walking in children with autism may include:

• Behaviour treatments

• Occupational therapy

• Physical therapy.

• Cast and Go Protocol

• Prism Lenses

• Therapeutic vestibular stimulation

• Serial casting

• Bracing

• Surgery

• Botox

• Physiotherapy [4][11][6][5]

Evidence Based Techniques:

• Vestibular stimulation

  It might be possible to reduce or eliminate toe walking by providing the child with therapeutic vestibular stimulation (e.g., being swung on a glider swing).

• Reflex integration and tactile stimulation

  Targeting the feet, specific exercises promoting heel-to-toe walking.

• Physical therapy

  Vital for treating toe walking, particularly in children with autism.

• Prism lenses

  Research [1] found that in each case the child’s toe walking was ‘eliminated’ moments after the child wore the prism lenses. [11][4]

References

1 Stephen, M. Edelson Toe Walking and ASD https://autism.org/toe-walking-and-asd/

2 Valagussa, G., Piscitelli, D., Baruffini, S. et al. (2024) Little Evidence for Conservative Toe Walking Interventions in Autism Spectrum Disorders: a Systematic Review. https://doi.org/10.1007/s40489-022-00329-3

3 Michael Chapek, Jeffrey Kessler (2025) The Prevalence of Persistent Toe Walking in Children With and Without Autism Spectrum Disorder and the Odds of Subsequent Surgery https://doi.org/10.1053/j.jfas.2024.08.005

4 Step Ahead ABA (2025) Autism Toe Walking Understanding the Unique Walking Pattern in Autism https://www.stepaheadaba.com/blog/autism-toe-walking

5 Michela Camia , Roberto Sacco, Maria Boncoddo, Fabiana Bellomo, Francesca Cucinotta , Arianna Ricciardello, Laura Turriziani, Pasquale Tomaiuolo, Riccardo Cuoghi Costantini, Roberto D'Amico, Antonio M. Persico (2024) Toe walking in children and adolescents with Autism Spectrum Disorder: Relationship with sensory and motor functions,language, cognition, and autism severity https://doi.org/10.1016/j.rasd.2024.102457

6 De Angeli, L. R. A., Serafim, B. L. C., & Masquijo, J. J. (2025). The Autistic Toe Walking: A Narrative Review for Interventions and Comparison with Idiopathic Toe Walking. https://doi.org/10.3390/children12091198

7 Costanza, C., Gallai, B., Sorrentino, M., Gnazzo, M., Pisanò, G., Parisi, L., Germanò, E., Maltese, A., Esposito, M., Roccella, M., & Carotenuto, M. (2025). The Prevalence and Clinical Significance of Toe Walking in Autism Spectrum Disorder: A Cross-Sectional Study in an Italian Pediatric Sample. https://doi.org/10.3390/medicina61081346

8 Barrow, W. J., Jaworski, M., & Accardo, P. J. (2011). Persistent Toe Walking in Autism https://doi.org/10.1177/0883073810385344

9 My Team ABA (2025) Autism Toe Walking: Signs, Management Strategies, and Dispel Myths https://www.myteamaba.com/resources/autism-toe-walking

10 Cleveland Clinc Toe Walking (2022) https://dev.mycc.clevelandclinic.org/health/diseases/21017-toe-walking

11 ELFT ASD Tip-toeing (2021) https://www.elft.nhs.uk/sites/default/files/2024-09/ELFT ASD Tip-toeing - needs updating the format Dec 21.pdf

12 NeuroLaunch editorial team (2024) Autism Gait: Unraveling the Mystery of Movement in Autism Spectrum Disorder https://neurolaunch.com/autism-gait/

13 SEED Early Childhood (2026) Autsim in Girls https://seedearlychildhood.com/autism-in-girls

Author: SEED Early Childhood

Edited by: Henry Hackbridge

SEED Early Childhood is the Educational blog founded by Samantha Donnelly to bring professionals to you.

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