Video Explanation: Toe Walking – What Parents Need to Know

Toe walking (tip toe walking) is a walking pattern where the child only contacts the forefoot, without bringing the heel down. It's common in children between 2 and 3 years who are perfecting their gait, but when it persists beyond this age it requires attention. **Idiopathic toe walking:** This is the most common form (over 50% of cases). The child walks on tiptoes out of "habit," without an identifiable neurological or muscular cause. It's often intermittent: the child walks normally when reminded or runs barefoot. **Causes to rule out:** - **Achilles tendon shortness:** The calf is shortened and the child physically cannot bring the heel down. - **Neuromuscular disorders:** Cerebral palsy, muscular dystrophies. These children often have other neurological signs. - **Autism spectrum disorders:** Toe walking is more frequent in children with ASD, although not all toe-walking children have ASD. **Clinical examination:** The orthopaedist evaluates ankle mobility (dorsiflexion), basic neurological examination, muscle strength, and observes the gait. If the child can bring the heel down and has a normal neurological exam, the prognosis is generally good. **Treatment:** For the idiopathic form, calf stretching, observation, and reassurance are often sufficient. In persistent cases with tendon shortness, night splints, serial casting, or rarely surgical lengthening may be helpful.