0203 693 2120 roche@fortiusclinic.com
Mr Andy Roche MSc FRCS (Tr & Orth) Consultant Orthopaedic and Trauma Surgeon specialising
in Foot and Ankle Surgery and Reconstruction
Childrens Foot And Ankle

Toe Walking in Children

What is tip-toe walking?

This is a condition where a child walks up on the balls of the feet with their heels off the ground. While doing this children do not instinctively place the feet flat onto the ground when they walk.

Toe Walking Children

Is it normal?

In a child who is learning to walk and developing their walking pattern it is actually quite a common phenomenon. The majority of children outgrow this toe-walking pattern. Even after the “toddler” years and a child is walking well, if they continue to toe-walk it is unlikely to be a problem if the child is otherwise developing normally in other areas and no other limb problems are noticed.

What causes children to toe-walk?

A number of conditions can be associated with a child toe-walking. It can be a worrying list to read through but ultimately the child may simply be toe walking out of habit i.e. for no real physical reason, which is not uncommon. Causes can include:

  • Habitual toe walking (Functional toe walking)
  • Neuromuscular disorder such as Cerebral Palsy or Muscular dystrophy
  • Idiopathic toe-walking due to a shortening of calf muscles for unknown reasons
  • Polio
  • Autism

What are the symptoms?

  • Visually walking up on the toes
  • Excessive shoe wear at the front of the shoes
  • Can sometimes walk with feet flat on the ground

What should I do as a parent?

You will clearly be concerned with the way your child walks. It is best to get your child assessed by an Orthopaedic Surgeon for reassurance. They can also advise on further therapy if needed.

How do you diagnose the condition?

Clinical examination can determine if the toe-walking is a habitual condition or if there are other features to suggest it is from shortening of the calf muscles or other conditions. If other conditions are suspected then your surgeon will advise on further tests necessary such as special scans like an MRI scan or muscle or nerve testing.

How is it treated?

Functional toe-walking can usually be successfully treated with intermittent bracing of the ankle, physical therapy and advice. In cases of idiopathic toe walking, it can sometimes be necessary to proceed to a small surgical procedure to lengthen the tendon at the back of the heel to correct persisting deformity. The ankle would be protected in a cast following this operation for a short period, and this treatment is quite successful.

When should you have surgery?

Surgery is not routinely advocated as first line treatment. If surgery is performed then it is done after the age of 4 or 5. This can be discussed with your surgeon. 

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