refers to a normal child who walks on their tiptoes for no known reason.
The child can usually stand and walk with their heels down if prompted, but they habitually walk and run on their toes
There may be some tightness in the calf muscle, which may contribute to your child preferring to walk on their toes
Causes
Usually idiopathic, Family history of toe walking
spinal dysraphism
muscular dystrophy
cerebral palsy
Physical examination
gait assessment
inspect spine
functional tests – check if able to stand with heels down with trunk straight and able to walk on heels
calf length, size
neurological assessment
Investigations
If suspicious: spinal X-ray
Creatine phosphokinase (for MD)
GP management
The natural history of this condition is that children eventually ‘come down’ onto their heels with age and weight
management of idiopathic toe walkers is controversial, but options may include inserts in shoes, serial casting, splints, Botox injections, stretches or watch, wait and see
Some activities to encourage your child to walk with their heels down include:
balancing on one leg
walk on heels
walk heel-toe forward or backward along a line.
Calf stretching
Indications for specialist referral
inability to dorsiflex foot beyond neutral, stand with heels down or walk on heels
signs of cerebral palsy with hypertonia, hyperreflexia or ataxia
