Toe walking, as the name implies, describes a pattern of gait where the child walks on his or her toes. The child steps on the front part of his or her foot, and the heels do not hit the ground. Toe walking is considered normal up to age 2. Intermittent toe walking after that can be normal, but persistent toe walking may merit further evaluation.
In this week’s On Call for All Kids, Paul Benfanti, M.D., a pediatric orthopaedic surgeon at Johns Hopkins All Children’s Hospital, explains toe walking in more detail and helps parents understand if and when they should be concerned about their child who might show signs of toe walking.
What Causes Toe Walking?
Idiopathic toe walking (ITW) implies that children walk on their toes for no identifiable reason. Some common underlying causes include cerebral palsy, autism and muscular dystrophy. The first task for the physician, therefore, is to do a thorough history and physical exam to confirm that there is indeed no underlying cause. The physician will ask questions about the child’s birth history, developmental history and family history (ITW may run in families).
The physician will then watch the child walk and perform a physical and neurological exam. Note that some underlying causes cannot be detected on routine examination. If an underlying cause is identified, the child will be referred for further workup to the appropriate specialty. Treatment for that type of toe walking will be dependent on the cause. Some cases of neurological toe walking require treatment; others do not.
Signs and Symptoms
If an underlying cause is not identified, then treatment may be started based on the child’s age and physical findings. There is no single right way to treat ITW, so there will be some variation depending on the patient, parents’ desires and treating physician’s experience.
There have been many treatment options described in the literature including: observation, physical therapy, stretching, Botox injections, casting, bracing, surgery and combinations of some of the above. The first goal of treatment is to ensure the child has the range of motion necessary to walk with a heel-toe pattern. If the child has static ITW, meaning a fixed tightness of the heel cord, it will need to be corrected before it is possible to walk normally. Each child is different, and your physician will suggest the best treatment option for the child.
On Call for All Kids is a weekly series featuring Johns Hopkins All Children’s Hospital medical experts. Visit HopkinsAllChildrens.org/Stories each Monday for the latest report. Paul Benfanti, M.D., is on the medical staff of Johns Hopkins All Children’s Hospital, Inc. (“JHACH”), but is an independent practitioner who is not an employee or agent of JHACH.