Toe-walking is a behavior frequently displayed by people with autism spectrum disorders (ASD). No definite cause for this behavior has been determined, but several possible explanations have been proposed. Several treatment options have likewise been suggested to address the various theoretical bases for toe-walking.
A popular explanation for toe-walking behavior is that it is a sign of tactile hypersensitivity, which is common in folks with ASD. Finding tactile input to the sole of the foot aversive, the person reacts by trying to avoid contact with the walking surface as much as possible. It should be noted that toe-walking is more often observed when the person is barefoot. Treatment based on this theory is aimed at reducing the sensory hypersensitivity, usually by therapeutic brushing and graded desensitization to tactile input.
A second theory is that toe-walking is an attempt to self-provide proprioceptive input. Proprioception is the unconscious awareness of body position in space, provided by receptors in muscles, tendons, and connective tissue when they are compressed or distracted. Since persons with ASD often have poor awareness of where their body is in space, the theory is that, by contracting the muscles and changing the position of the foot, the body receives extra proprioceptive input. In sensory integration theory, proprioception is also credited with being modulating, calming input, so people who toe-walk when excited may be attempting on an unconscious level to calm themselves. Treatment based on this theory would concentrate on providing the individual with proprioceptive input in other ways, such as jumping on a trampoline, stomping feet, walking in sand, providing traction, and other activities involving compression and traction.
Yet another theory, proposed by therapeutic optometrists, is that toe-walking is a response to a disordered vestibulo-visual system. It is reported that people with ASD often have adequate focal vision, but very poorly developed ambient vision. (Kaplan, 2006). Ambient vision, which is interrelated with other sensory systems, allows us to see in three dimensions and to correctly perceive movement and distance. Kaplan explains that people with ASD often have either tunnel vision, in which they see only a small arc of visual field, or alternating vision, in which each eye is seeing a separate image. He feels that toe-walking can be explained by tunnel vision, with which persons with ASD “view the world in two dimensions, and cannot accurately judge distance or motion.” Dr. Kaplan reports great success in eliminating toe-walking using prism lenses and a program of vision training.
The creator of the website “Autism and Its World,” who is a woman with high functioning autism, addressed the issue of toe-walking. She explained it this way: “When autistic people walk on their toes, it is because it provides a greater sense of ‘feeling your body and know where it is in space’ and helps balance and feeling like you’re not going to tip over.” Her explanation seems to support both the proprioceptive theory and the vestibulo-visual theory.
Of course, it’s always important to remember that people who have Autistic Spectrum Disorder are all individuals, so it is most likely that there are many explanations for any behavior that is associated with ASD.
Kaplan OD, Melvin. Visual Management: A Physiological Approach to Rehabilitating Autism Spectrum Disorders. http://www.autism.com/ari/editorials/ed_visualmanage.htm
Autism and tip-toeing…why? http://chat1autism.wetpaint.com/page/Autism+and+tip-toeing…why%3F