Toe Walking (Pediatric Equinus)

Causes, Symptoms, and Treatment for Toe Walking (Pediatric Equinus)

Does your child walk on their tiptoes?

Toe walking is very common in young children, who are 3 years old and younger. However, in children 5 years old and older, walking on tiptoes is not normal and could be associated with some type of neurological immaturity or medical condition. Some medical professionals and many parents are not aware of all of the different conservative interventions that a podiatrist uses for treating toe walking. Read about the Symptoms, Causes, and Various Treatment options offered by Pediatric Podiatrists (Children’s Foot Specialist and Doctor).

Walking on the ball of the foot or toes, which is also referred to as toe walking, is something that is fairly common in children just learning to walk. This is something that most children outgrow. Children who continue to walk on their tiptoes or ball of their feet past their toddler years frequently do it simply out of habit. This by itself, as long as your child is developing and growing normally, usually isn’t anything you need to be concerned about.

Child on tiptoes Toe Walking Pediatric Equinus

Causes of Toe Walking (Pediatric Equinus)

A child walking on their toes is typically just a habit that develops as a child is learning to walk, that they outgrow.

A child who has started “walking on his toes” with his first steps is less worrisome then a child who has been walking normal and now has started “toe walking”.

The causes of toe walking vary with age and careful consideration. Has the deformity has been present since birth, does it occur in one or both legs and is the child able to put his heels down when asked.

Complications, Risk Factors and More

Some possible causes of toe walking include: cerebral palsy, muscular dystrophies, spinal cord pathologies, autism, peripheral neuropathy, acquired contractures or idiopathic toe walking. Children who have any of the above might walk on the balls of their feet or toes, however many do not. Persistent walking on tiptoes might increase the risk that the child will lose their balance or fall. A social stigma can result if other kids perceive a child to be “different” which could result in some form of bullying or made fun of by their peers. In addition, walking on tiptoes from habit (idiopathic toe walking) runs in families at times.

Symptoms of Toe Walking – When you should see a Pediatric Podiatrist

If your child is still walking on tiptoes after the age of two (2), discuss it with your doctor. If walking on tiptoes is also accompanied by lack of muscle coordination, stiffness in the Achilles tendon of the ankle or tight leg muscles, then make an appointment even sooner.

Why You Should Seek Treatment and Advice from a Pediatric Podiatrist

One very important thing for you to keep in mind is that a Pediatric Podiatrist is a type of specialist (Foot Doctor) that regularly treats children. Because it is their specialty, they know a lot more about the lower leg, ankles, and feet than pediatricians and general practitioners do. They spend years studying the one area of the body (beneath the knees), which can greatly benefit you. Your best option is to see someone who specializes in Pediatric Foot care for advice and treatment if necessary.

What to Do Prior To Seeing the Doctor

It might be a good idea for you to prepare a list of questions to ask the doctor, including:

  • What may be causing my child to toe walk.
  • Are any tests necessary? If so, which ones?
  • What specific treatments are recommended for the problem?

Questions You Can Expect When Seeing the Doctor

Your doctor might ask some of these questions:

  1. Is your child suffering from any other kinds of medical problems?
  2. Does your family have a history of toe walking?
  3. Was your child born premature?
  4. Did your child walk flat-footed previously and only start to toe walk recently?
  5. Is your child able to walk on her/his heels?
  6. Does your child avoid exhibiting repetitive behavior like spinning or rock or avoid eye contact?

Doctor Diagnosis, Tests, Examination for Toe Walking

At our office, we make sure we take the time necessary to listen to you, to come up with answers, and to provide the best care for you.

The doctor will preform a thorough physical examination with emphasis on ranges of motion, neurological findings and muscle tone. In the office an in-depth gait analysis is preformed to help isolate the deformity.

The doctor in some cases might order an exam called electromyography (EMG) or nerve conduction velocity test (NCV).

Two children holding hands

Options for Treatment of Toe Walking (Pediatric Equinus)

Conservative Treatment is Always our First Option!

If walking on tiptoes is something your child is doing out of habit, it isn’t necessary for there is to be any treatment. Most likely, she or she will outgrow this habit. Your doctor might simply monitor your child’s gait during regular visits to the office. If there is a physical issue contributing to or causing toe walking, options for treatment might include:

  • Physical Therapy – Your child’s gait may improve by gentle stretching of the foot and leg muscles.
  • Pediatric Prefab Foot Orthotic – Idiopathic toe walking may simply improve with the use of a prefab orthotic as sensory pressure is apply to the heel, the child may not feel the need to toe walk.
  • Nighttime Splints – At times a simple nighttime splint will help to stretch the Achilles tendon and muscle to help with promoting a regular gait.
  • A Series of Casts (serial casting). If nighttime splinting or physical therapy isn’t helping, then your doctor might suggest that you try a series of casts below the knee to improve the ability of bringing the toes towards the shins progressively.
  • Leg Braces AFO – An ankle foot orthosis (AFO) may be required to maintain the position and prevent worsening. An AFO may be the only treatment option short of surgery.
Children's Feet Problems Treatment

Surgery (last resort). If conservative treatments do not work, your doctor might recommend surgery for lengthening the Achilles tendons or muscle at the back part of the lower leg. However, this is only as a last resort, and NEVER as the first.

Your child’s feet are designed for life

Make an appointment today if your child has Pediatric Ingrown Toenails.