Tip toe walking

What is tip toe walking?

Tip toe walking is walking on the balls of the feet without the heels making normal contact with the ground. It is common and often completely normal in toddlers who are learning to walk. When it persists beyond around the age of three, or when a child always walks this way, it sometimes needs assessment to look for an underlying cause such as a tight calf (Achilles) tendon or a neurological condition.

Signs and symptoms

• Persistent walking on the toes

• Difficulty placing the heels flat on the ground

• Tightness in the calf

• In some children, no other symptoms at all

How is it diagnosed?

A careful history and examination are the most important steps, including assessment of muscle tone, the tightness of the calf tendon, and the child’s general development. Most children with idiopathic toe walking (where no underlying cause is found) are otherwise developing normally. Where there are other concerns, further assessment may be arranged.

Treatment options

Many children grow out of toe walking. Where treatment is helpful, options include physiotherapy and stretching, a period of casting to gradually lengthen a tight tendon, and, for a persistently tight tendon that does not respond to other measures, a surgical lengthening procedure.

Outlook

The outlook is very good, particularly for idiopathic toe walking, which usually resolves with simple measures.

When to seek advice

If your child toe walks all the time, cannot bring their heels to the floor, or if you have any concern about how they are developing.

This information is for general guidance only and is not a substitute for a consultation with Mr Wadia. If you are worried about your child, please seek medical advice.