Idiopathic Toe-walking refers to children who habitually walk on their toes rather than using a typical gait and for whom no specific cause has been found. It has been a traditional red flag to clinicians and parents alike for developmental problems including autism. There is little systematic study, however, of the phenomenon and its predictive associations with neurodevelopmental disorders. 
A new study from Sweden examined a group of 1436 children presenting for their health check at around age 5 and a half. A history of past and present toe-walking was obtained and data was also collected among those who were receiving services for special needs (n=35).
The rate of current toe-walking was 2.0% with males to females at a two to one ratio. An additional 2.8% previously walked on their toes but no longer did. Among children with developmental or psychiatric problems, the rate of lifetime toe-walking was 41.2%. A family history of toe-walking was common.
The authors concluded that idiopathic toe-walking is relatively common and spontaneously remits in most children by age 6. It is more common among children with neurodevelopmental problems.
Strangely, the authors do not frame their data in a way that might be most useful for clinicians who see children with toe-walking and are trying to predict neurodevelopmental problems. Doing the math, it appears that (7/70) or 10% of toe-walking children had a neurodevelopmental disorder such as autism or ADHD. Thus, toe walking was not a particularly strong test for conditions such as autism in this study.
Reference
Engstrom P, Tedroff K. The prevalence and course of idiopathic toe-walking in 5 year old children. Pediatrics 2012; 130(2):279-284
Tags: autism, toe-walking