While toe walking can be a normal part of a child’s development, if a child continues to toe-walk past the age of three it is generally considered appropriate to have an evaluation for underlying neurological issues or physical problems (such as a short achilles tendon) or a condition such as cerebral palsy.
However, when a specific cause such as cerebral palsy is ruled out, further investigation may be warranted.
Many children on the autism spectrum toe-walk. It is still unknown how toe-walking is related to the other medical symptoms or underlying pathophysiology of autism, but there is some speculation that toe-walking may be in some way related to mitochondrial dysfunction. Many motor delays in children both on and off the autism spectrum are related to mitochondrial dysfunction, therefore, it is hypothesized that toe-walking may be yet another physical manifestation of muscle groups affected by mitochondrial dysfunction.