Normal gait or walking is heel-toe. One lands on the heel followed by transfer of weight to the front of the foot to push off.

A small percentage of toddlers do not bring their heels to the ground but walk on their toes. A child who is learning to walk requires stability so toe walking is never a normal way to walk.

Toe walking can be due to neuromuscular disorders such as cerebral palsy or muscular dystrophy. When neuromuscular disorders have been ruled out, toe walking is labelled “idiopathic.” The term “idiopathic” means that the cause is unknown. We have seen a number of so-called idiopathic toe walkers who have a mechanical issue such as a shortened Achilles tendon so the issue was that the underlying diagnosis was undiscovered instead of just being unknown.

One problem with delaying treatment for toe walkers is that it can become habitual so that even when the causes are addressed, the child prefers to toe walk because of doing so for too long. A habit can be outgrown but not a functional or structural problem causing toe walking. Additionally, toe walking places abnormal stress on the forefoot and front of the ankle which can cause pain in those areas.

Toe walking takes a lot of energy so children with this problem may become inactive and chose more sedentary activities. Toe walking can make walking long distances very tiring. Participation in sports may be limited and difficulty in keeping up with friends can effect the child’s self esteem. Additionally, toe walking can affect balance and cause pain and fatigue in the legs and back.

The first step is an examination with a podiatrist with a subspecialty in podopediatrics, the field of diagnosis and treatment of children’s foot problems and gait issues.

A tight or short Achilles tendon can be treated via stretching, manual therapy or an ankle-foot orthotic used during walking. The infant’s tissues are soft and pliable so the earlier the process of lengthening the Achilles tendon is started, the faster the results. Too often, I hear stories of flawed advice, basically taking a wait and see approach. The problem with that approach is that once the tissues have become stiffer with age, it is more likely to require surgical treatment.

A short or contracted Achilles tendon is a frequent cause of toe walking.