Toe Walking in Children Under 8 (Pediatric Equinus)

Yes, often. Toe walking in children younger than 3 is very common and, in many cases, is simply part of learning to walk — it usually resolves on its own and doesn't require a formal workup. That said, it's still worth having the severity and the ankle's range of motion looked at, even under age 3, so we can tell the difference between a normal developmental pattern and something more likely to persist.

The sooner toe walking is addressed, the easier it generally is to treat. As children get older, the calf muscles and other soft tissues can undergo adaptive changes that become progressively harder — and eventually irreversible — to correct with conservative treatment alone. Early evaluation doesn't necessarily mean early treatment, but it lets us catch and monitor anything that needs attention before it becomes harder to reverse.

Toe walking generally falls into one of two categories. Structural toe walking is related to true tightness (or, less commonly, a variation) in the calf muscles and Achilles tendon. Neurological toe walking is related to an underlying neurological or sensory condition, such as sensory processing differences or cerebral palsy. Identifying which category applies to your child is the first step toward the right treatment plan.

We use a quick, painless exam called the Silfverskiöld test. It checks how far your child's ankle can bend upward with the knee straight and with the knee bent. If the ankle can't reach at least 15 degrees of upward bend past neutral in either position, that suggests a structural cause. The test only takes a few minutes and is done during a routine visit.

These are the two calf muscles that can be involved in structural toe walking. The gastrocnemius crosses both the knee and the ankle, so its tightness improves when the knee is bent. The soleus only crosses the ankle, so its tightness persists even with the knee bent. Knowing which muscle is involved can influence stretching technique, bracing, and — for children who need surgery after age 8 — which procedure is most appropriate.

A night brace holds the ankle in a stretched position while your child sleeps, providing hours of consistent, low-effort stretch that daytime exercises alone can't match. Each leg is stretched independently based on what it needs, and the stretch happens while the body is fully relaxed. Sustained over six to ten hours nightly, this gradually lengthens the tight tissue and helps resolve the underlying calf tightness (equinus).

It varies from child to child, but progress is generally gradual and depends on consistency. We re-evaluate every three months, since structural toe walking in younger children typically shows a measurable change on that timeline. On average, calf tightness (equinus) significantly improves — and often resolves — after around six months of consistent nighttime bracing, and we'll adjust the plan based on how your child is progressing at each check-in.

Both are types of orthotic braces, but they serve different needs. An SMO (supramalleolar orthosis) is a low-profile brace that supports the ankle and arch while leaving the toes free — it's most often used for sensory-related toe walking. An AFO (ankle-foot orthosis) provides more support across the ankle and lower leg and is typically recommended for children with cerebral palsy, spastic equinus, or toe walking that hasn't fully responded to other conservative measures. Our team handles casting, fitting, and follow-up adjustments in-house for both.

Not usually, especially when treatment starts early. Most structural toe walking responds well to conservative care like night bracing, stretching, and orthotics. In some cases — particularly children with cerebral palsy and spastic equinus, which is a constant, progressive condition — surgical lengthening of the Achilles tendon may eventually become necessary even with consistent conservative care. That isn't a sign that treatment failed; it reflects the nature of the underlying condition.

Treatment options can look different once a child reaches age 8. Visit our Toe Walking in Children Over 8 page for details specific to that age group. (Update this link to match the actual URL of your "over 8" page.)

We recommend scheduling a follow-up evaluation if conservative treatment hasn't led to improvement after an adequate trial, if your child had improved but is now relapsing, if you notice worsening rigidity or new changes in how your child walks, or if your child is approaching or has reached age 8.

Yes. Some children, often those with sensory processing differences, toe walk as a response to sensory input rather than muscle tightness. For these children, we often use Sure Step SMO braces, which are worn during the day and provide gentle sensory feedback to encourage a more typical walking pattern. Orthotic management is coordinated with your child's occupational therapist when sensory integration therapy is already part of their care — but not every child in this category needs orthotics; it depends on the exam findings.

Evaluations are gentle, child-friendly, and focused on function rather than just appearance. A visit may include gait and posture analysis, foot alignment evaluation, muscle flexibility and strength testing, and digital X-ray imaging when necessary. You'll leave with an accurate diagnosis (or a list of possible differentials), a clear understanding of that diagnosis, and a full picture of the available treatment options.

For out-of-state families, your child's first consultation with Dr. Jarman is done virtually. Whether follow-up appointments continue virtually or need to be in person depends on the reason for that follow-up - Dr. Jarman and our office staff will let you know the recommended next steps after the initial visit.