Toe walking

This article is about the medical condition in humans. For animals that walk on their toes, see Digitigrade. For the posture where a human consciously lifts his or her heels off the ground, see Tippy toes.

Toe walking refers to a condition where a person walks on his or her toes without putting much weight on the heel or any other part of the foot. Toe-walking in toddlers is common. These children usually adopt a normal walking pattern as they grow older. If a child continues to walk on his or her toes past the age of three, he or she should be evaluated by a doctor.

Toe walking can be caused by different factors. One type of toe walking is also called "habitual" or "idiopathic" toe walking, where the cause is unknown. Other causes include a congenital short Achilles tendon, muscle spasticity (especially as associated with cerebral palsy) and paralytic muscle disease such as Duchenne muscular dystrophy. It may also be one way of accommodating a separate condition, foot drop. Persistent toe walking in children has been identified as a potential early sign of the neurodevelopmental disorder autism.

Diagnosis

A doctor will typically evaluate whether there is bilateral (both legs) toe walking, what the child's range of motion is (how far he or she can flex his or her feet) and perform a basic neurological exam. Treatment will depend on the cause of the condition.

Treatment

For idiopathic toe walking in young children, doctors may prefer to watch and wait: the child may "outgrow" the condition. If there is a reduction in the child's range of motion, there are several options.

• Wearing a brace or splint either during the day, night or both which limits the ability of the child to walk on his or her toes and stretches the Achilles tendon. One type of brace used is an AFO (ankle-foot orthosis).
• Serial casting where the foot is cast with the tendon stretched, and the cast is changed weekly with progressive stretching.
• Botox therapy is used to paralyze the calf muscles to reduce the opposition of the muscles to stretching the Achilles stretching, usually together with serial casting or splinting.
• If conservative measures fail to correct the toe walking after about 12–24 months, surgical lengthening of the tendon is an option. The surgery is typically done under full anesthesia but if there are no issues, the child is released the same day. After the surgery, a below-the-knee walking cast is worn for six weeks and then an AFO is worn to protect the tendon for several months.

For toe walking which results from more serious neuro-muscular conditions, additional specialists may need to be consulted.