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Johns Hopkins Pediatric Orthopaedics Patient Guide to Toe-Walking
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Our Pediatric Orthopaedic Physicians
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What is "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 problem.
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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.
Toe-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.
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Surgery 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.
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