There are 4 main reasons for still walking on tiptoe after the age of 3. First, some neurological problems, such as cerebral palsy and muscular dystrophy, can cause tightening of the calf muscles or cause a change in the way they walk. In this case, it is difficult, if not impossible, for the child to land on his or her heels, let alone walk on all feet. Second, orthopedic problems such as congenital clubfoot (deformed foot) can also cause tiptoeing. Changes in the anatomy of the foot or leg can result in the inability to touch the heel to the ground, or pain when touching the ground. Third, on the autism spectrum, some children can land on their heels but just insist on walking on tiptoe. They may also have the following behavioral characteristics: repeatedly missing “developmental milestones” and reaching an age where they are the only child who does not know the skills that other children have mastered. At this point, tiptoeing may indicate autism spectrum or behavioral delays. Fourth, 5-12% of healthy children have no head-to-toe problems, but prefer to tiptoe. This may be idiopathic tiptoeing, which is a habitual gait of the child that stems from bad habits developed as a toddler. It is also known as “familial tiptoe”. This is because studies have shown that idiopathic tiptoe is “hereditary” and is often a trait shared by several close family members. Idiopathic tiptoe is also associated with specific behavioral developmental characteristics. Some small observational studies have shown that delayed language development and limited control and perceptual development such as balance and finding movements are common in children with idiopathic tiptoe.