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Why you Need to be Cautious of toe Walking

Kristie Rivers, MD, FAAP, Board Certified Pediatrician
January 3, 2019 . 2 min read

It\’s common for children to walk on the balls of their feet when they are first learning to walk. While most children outgrow this “toe walking,” children who continue to walk on their toes beyond the toddler years should be evaluated for an underlying problem.

There are several medical problems that could cause a child to toe walk beyond age 2. These problems include a congenitally short Achilles tendon, Cerebral palsy, muscular dystrophy, or another neuromuscular disorder. Children with autism may also toe walk. Your child’s pediatrician will be able to examine your child and refer him or her to a specialist such as an orthopedic surgeon or a neurologist if an underlying cause is suspected.

If there is no serious underlying problem detected, the toe walking is termed “idiopathic.” For these children, the toe walking that began as they learned to walk has become a habit. They are physically able to fully plant their foot on the floor and walk in a heel to toe motion when asked, but revert to a toe-walking pattern as soon as they resume their regular gait. These children otherwise have normal development and a normal physical exam. Sometimes there is a history of idiopathic toe walking in the family.

Often, only reassurance is provided, as idiopathic toe walking will likely resolve over time. The pediatrician or specialist may simply assess the child’s gait every few months to look for worrisome signs that may indicate a further problem. Other interventions may include:

Stretching exercises to lengthen the Achilles tendon

Serial casting or bracing

Botulinum toxin injections

Despite the variety of treatments that are often attempted for idiopathic toe walking, it is thought that these treatments do not significantly alter the natural course of the disorder. In other words, even though many doctors will try these methods, there is no good evidence that most of these treatments help any more than watchful waiting.

As a last resort, some orthopedic surgeons will perform surgery to lengthen the muscle and Achilles tendons of affected patients, after conservative measures have failed. As toe walking can have negative social effects on school-aged children (such as teasing or bullying), this option is often reserved for severe cases or for those who are feeling the negative effects from peers.

Sources:

  • Journal of Pediatric Orthopedics
  • Idiopathic toe-walking: does treatment alter the natural history?
    Pediatric News
  • Toe-Walking Requires Extensive Evaluation Only After 2 Years of Age.
    Pediatrics
  • The Prevalence and Course of Idiopathic Toe-Walking in 5-Yeah-Old Children.

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