toe walking

Last reviewed 01/2018

• normal part of development in many children
  • habitual toe-walking is common in young children up to 3 years (1)
• in physiological/idiopathic toe walking
  • there is generally intermittent periods of toe walking - this may be followed by a period of flat foot strike
  • eventually normal heel-strike walking occurs
  • in some cases a child may undertake toe walking (walking on tiptoes) because s/he perceives this as an achievement and pleases his/her parents. In this circumstance the child will walk with a normal heel-strike walk if s/he is not observed
  • idiopathic toe walking is a diagnosis of exclusion
    • if a child is toe walking also has abnormal feet and gait then check for undiagnosed spina bifida
    • if an older child develops toe walking after initially walking with a normal heel-strike have a pathological cause for his/her presentation and requires urgent referral for assessment and management
      • pathological causes of toe walking include diplegic cerebral palsy, neuropathy (hereditary, sensory motor), spinal dyspraphism, Duchenne muscular dystrophy
      • if a child presents with unilateral toe walking then the cause is almost always pathological
• if persistent toe walking occurs then rarely surgical lengthening of the Achilles tendon may be considered. However note that physiological toe walking may self correct up to the age of 10 years old (2)

Reference:

• (1) ARC (2008). Reports on the Rheumatic Diseases Series 5 : Hands On.
• (2) GP (April 15th 2005), 68.