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Toe Walking in Children (Pediatric Equinus)

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

Does your child walk on their tiptoes?

Toe walking is a walking pattern in which the child walks on their toes or the balls of their feet and there’s no contact of the heel to the ground.

Toe walking is very common in young children who are 3 years old and younger, however, in children 3 years and older walking on tiptoes may not be normal and could be associated with a neurological immaturity or medical condition. Fortunately, over 90% of these cases can be treated with conservative treatment options and surgery is not required. In the following video, Dr. Mikkel Jarman discusses toe walking and some conservative treatment options and when or if surgery may be necessary.

Cameron and Sawyer Share Their Experience with Toe Walking

Sawyer began walking on her toes at a young age and never outgrew it. Children would comment on it and it was affecting her dancing which she loved to do. Her and her mom found Pediatric Foot & Ankle researching online and scheduled an appointment with Dr. Mikkel Jarman.

Learn more about Sawyer’s toe walking story in the video above.

Cameron began toe walking at around the age of two. After following the foot physical therapies and exercises recommended by their pediatrician with little to no improvement, she decided something needed to be done.

Watch the rest of Cameron’s story and their experience with Dr. Jarman with Pediatric Foot & Ankle.

Most Children Outgrow Toe Walking

Toe Walking is fairly common in children just learning to walk but is something 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 usually isn’t anything you need to be concerned about as long as your child is developing and growing normally, but toe walking after the age of 3, referred to as Idiopathic Toe Walking, may not be normal and should be looked into.

What is Idiopathic Toe Walking?

Idiopathic Toe Walking (ITW) is when a child, three and older, continues to walk on their toes without showing any signs of a neurological, orthopaedic, or mental illness. The NIH’s National Library of Medicine says ITW effects between 7 and 24 percent of children.

When a child walks on their toes for an extended period of time, the bones and ligaments in the knees, hips, and lower back are placed under unnatural tension. ITW can lead to improper bone growth and/or ligament overstretching, placing youngsters at risk for injury and joint discomfort as they age.

Cerebral palsy, congenital Achilles tendon contracture, and paralytic muscle illnesses like Duchenne Muscular Dystrophy may all induce toe-walking. Toe-walking has been linked to developmental abnormalities including autism and other myopathic or neuropathic conditions.

Physical therapy to stretch the Achilles tendon and calf muscles, splints or leg braces to promote a normal gait, or a series of casts to progressively relocate the toes toward the shin may all be effective treatments if it’s discovered that a physical condition is the cause of the patient’s ITW.

If left alone, the majority of kids will stop toe walking on their own. ITW can be treated with physical therapy, custom orthotics, bracing, and casts, with surgical options available if these treatments fail.

Why Do Children Walk on Their Toes?

When children first learn to walk, it’s very common for them to walk on their toes. Sometimes, though, toe walking indicates one of the following conditions:

  • An Achilles tendon that’s too short
  • Autism spectrum disorders
  • Cerebral palsy
  • Heel pain, particularly from Sever’s disease
  • Muscular dystrophy, although this diagnosis typically occurs before the child reaches walking age

The Toe Walking Brace By Pediatric Orthotics in Chandler, AZ

The Toe Walking Brace (aka Toe Walking Boot) by Pediatric Orthotics is an orthotic device designed specifically to address and resolve toe walking in children. The brace is worn at nighttime while the child sleeps. It provides gentle yet effective support to the foot and ankle to promote proper alignment and natural gait development.

The brace helps target underlying causes of toe walking like muscle tightness and imbalances.
Consistent and proper use of the Toe Walking Brace at night can help retrain the muscles and tendons over time. This leads to improved balance, stability, and functional mobility as the child develops a more natural heel-to-toe walking pattern during the day. The brace is engineered for comfort, comes in 3 different sizes and can be adjusted further to ensure a proper fit. 

Toe Walking Diagnosis

When you take your child to the pediatric podiatrist, the doctor will take your child’s medical history and perform an examination. Be prepared to answer the following questions:

  • How long has your child been walking?
  • When did your child begin toe walking?
  • Is the toe walking a new development?
  • Can your child walk on his or her heels?
  • Is there a family history of toe walking?
  • Does your child have any medical issues?
  • Was your child born prematurely?

In addition to asking these questions, the podiatrist watches your child walk. He or she then performs a physical exam to determine range of motion and gauge muscle tone. They may also conduct an electromyography (EMG) test to measure responses in the affected muscle. Finally, if conditions like autism or cerebral palsy are suspected, your doctor may order neurological testing.

Treating Toe Walking

Children who simply toe walk out of habit do not require treatment. They usually outgrow the habit eventually. However, if your pediatric podiatrist determines a physical issue is causing the toe walking, treatment may include:

  • Physical therapy exercises to strengthen and stretch muscles in the legs and feet
  • Leg braces or a splint to correct gait
  • Custom orthotics
  • Serial below-the-knee casting to properly align the toes to the shin

Young child walking on tiptoe

If conservative treatment fails, your podiatrist may recommend surgery, but only as a last resort. Typically, this only occurs if there is an issue with the Achilles tendon or calf muscles.

In this short video snippet, Dr. Jim Sears discusses toe walking with Sarah, a concerned mother of a 3-year old daughter, who had called into the show because her daughter is walking on her toes. Dr. Sears briefly goes over some stretches, but makes the primary point that it is always a good idea to contact a pediatric podiatrist. A pediatric foot and ankle specialist can run additional tests, and if deemed necessary, prescribe a custom orthotic.

(Full video can be found here: https://www.thedoctorstv.com/videos/toe-walking)

Toe Walking FAQ's

What causes toe walking in kids?

Toe walking can be caused by tight calf muscles, neurological conditions, sensory issues, autism spectrum disorder, or idiopathic factors. Sometimes the cause is unknown.

At what age is toe walking a concern?

Toe walking is common in toddlers under 2 but typically resolves by age 3-4. Persistent toe walking beyond 4-5 years old often requires medical evaluation.

Are there risks to chronic toe walking?

Long-term risks include contractures, muscle imbalances, tripping, fatigue, poor posture, and associated foot problems.social and psychological implications are possible.

How is toe walking evaluated and treated?

Doctors assess medical history, observe gait, and examine flexibility. Treatment may involve stretching, toe walking braces, physical therapy, Botox injections, or surgery in severe cases.

Will my child outgrow toe walking?

Many children outgrow it by age 5, but others require treatment. The longer it persists, the less likely it is to resolve on its own. Early intervention provides the best outcome.

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