- 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
- calf hypertrophy
- asymmetry
- abnormal spine examination
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