Guide to Toe-Walking
" Toe-walking" is just what the name implies. It refers to a child
walking 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 eventually
adopt a normal walking pattern as they grow older. Walking exclusively on the
toes beyond the age of three, however, is suspicious for an underlying neuromuscular
What causes toe-walking?
In most cases, toe-walking is caused by a short Achilles tendon (or "heel
cord") which raises the heel and does not allow the patient to put
it on the ground when walking.
can also be caused by more serious conditions, as mentioned above,
such as various neuromuscular disorders.
Is toe-walking hereditary?
The answer is overwhelmingly "yes." It has been found that up to
70% of patients who toe-walk have at least one member in the family who also
toe-walked at some point in time.
Is there any treatment that is recommended?
This depends upon the severity of the toe-walking. The severity, in turn, is
measured by how far the heel is from the ground when walking. Stretching the
foot at the ankle and casting of the foot with the toes pointed up as far as
they can go has been shown to help. The cast should be changed every week until
the proper range of motion is achieved. You can talk about the desired goal
with your doctor.
is recommended in more severe cases that are not corrected by
the more conservative approaches mentioned above. Surgery should
be delayed for several years to assess the toe walking as the
patient matures. The most common operation is the lengthening
of the Achilles tendon which allows the heel to touch the floor
during walking. Surgery performed too early may result in over-lengthening
of the Achilles by causing a loss in strength.
What is the prognosis for my child who is a toe-walker?
Most children who are toe-walkers will develop normal walking by the age
of 3 years old. Toe-walking beyond this point necessitates a neurological
exam because there might be something more serious going on.
to pediatric orthopaedic common conditions page
to pediatric orthopaedic homepage