Many children when they are learning to walk, walk up on their toes. This is perfectly normal and in most cases is of no significance. By the age of three years, they should be walking comfortably with the whole foot flat on the ground. However a small number don’t and continue to toe walk. These need to be investigated further as there are a number of treatable conditions that could be causing it.

There are several causes of toe walking with about 10% being classed as idiopathic, meaning that the reason is not known. Some neurological conditions such as cerebral palsy or muscular dystrophy which causes the calf muscle to be tight can cause it. Orthopaedic conditions such as club foot which is a deformity or Severs disease that causes heel pain or simply very tight calf muscles can also result in toe walking.  There is also a group of children who can get their heels to the ground, but just prefer to walk on their toes. This later one may be associated with behavioural problems or linked to conditions like the autism spectrum disorders or developmental delay. After all these possible underlying conditions are excluded, the diagnosis of idiopathic toe walking can be made in those who persist to walk on their toes.

The treatment of toe walking is aimed at the underlying condition that is causing it. In cases in which idiopathic toe walking has been diagnosed, there are a number of options such a behavioural interventions, stretching, vibration therapy, plaster casting and Botox injections. If all that fails, a surgical lengthening of the Achilles tendon can be done. Many cases do tend to come right with time, so minor cases could just be monitored to let it resolve or later make the diagnosis of a condition that is underlying it. All cases do need to be taken seriously and further investigated.