Toe Walking

Children typically learn to walk between 9 and 18 months of age. During this time, they try different foot positions, including walking on their tiptoes.

Causes

Children who toe walk are often able to stand and walk normally when asked to do so, but they prefer to walk on their toes or the balls of the feet.

Symptoms

If toe walking continues, it can cause problems, such as:

• Muscle tightness
• Tight or short Achilles tendon
• Calluses
• Difficulty wearing shoes
• Difficulty standing, maintaining balance or hopping on one foot

Diagnosis

A doctor will conduct a thorough history and physical exam, evaluating your child to rule out any neuromuscular or orthopaedic problems such as cerebral palsy, muscular dystrophy or tight heel cords. Sometimes children with toe walking have other problems like autism, asthma, and speech and language or developmental delays, so the doctor will check for these things, too.

Treatment

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 first.

If toe walking still exists when your child is around 4-5, your doctor may recommend one of the following non-surgical treatments:

• Physical Therapy/Exercises: These will include Achilles heel stretching exercises to help improve the flexibility of the ankle.
• Serial Casting: Short leg casts, that fit just below the knee down to the toes, may be used to help stretch the Achilles tendon. Casts will be changed every 2 weeks, stretching the heel cord to improve the motion of the ankle up and down.
• Bracing or Splinting: Used to help stretch the Achilles tendon and achieve a more normal gait. Typically, this is done after casting or physical therapy.

If these non-surgical treatments are not effective, surgery may be used to lengthen the Achilles tendon.