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Toe Walking

Children learn to walk any itme between 9 and 18 months of age.  As they practice, they try different foot positions such as walking on their tiptoes.  Usually by age 2, children will have learned to walk steadily with feet flat on the ground.  Persistent toe walking after 2 years old should be evaluated. 

What causes Idiopathic Toe Walking?

Idiopathic toe walking or habitual toe walking typically means children tend to walk on their toes for an unknown reason or cause. Children who demonstrate idiopathic toe walking are often able to stand or walk with feet at when asked, but prefer to walk on their toes or the balls of the feet. 

How is it diagnosed?

 

If your child has persistent toe walking, he/she should be evaluated by an orthopedic specialist. A diagnosis of idiopathic toe walking is made after a thorough history and clinical exam, evaluating the child to rule out any neuromuscular or orthopedic causes such as cerebral palsy, muscular dystrophy or tight heel cords. Toe walking may also be seen in children with autism, asthma, and speech and language or developmental delays. 

Can toe walking cause problems with my child?

Persistent toe walking can lead to muscle tightness or can be associated with a tight or short Achilles tendon that can make it hard to wear shoes, stand with a at foot, maintain balance, or hop on one foot. With continued toe walking, callus may form on the balls of the feet due to unbalanced distribution of weight on the feet. 

What are treatment options?

Typically, your child will be monitored and observed. If toe walking is related to other disorders, such as cerebral palsy or autism, the underlying condition will need to be addressed rst. If idiopathic toe walking persists after the age of 4 or 5 years of age, there are several treatment options. The most common include:

Physical Therapy/ Exercises - This includes Achilles stretching exercises to help improve the dorsi exion or exibility of the ankle to move up and down.

Serial Casting - Your child can be placed into short leg casts, just below the knee down to the toes to help stretch the Achilles tendon. Casts will be changed every two weeks, stretching the heel cord to improve the motion of the ankle up and down. This is more of a continued stretching over a two week period rather than an intermittent stretching with physi- cal therapy and exercises.

Bracing or Splinting - This is another option to help stretch the Achilles tendon and achieve a more normal gait. Typically this is done after casting or physical therapy has stretched Achilles enough to allow for walking with heels down.

Surgery - To lengthen the Achilles tendon is only required when conservative measures fail