Toe Walking


What is Toe Walking?

Tip toe walking is a condition where children walk on their toes instead of using a typical gait with the whole foot on the sole.

Walking on toes is fairly common in children in the first 2-3 years of life.


What causes Toe Walking?

In most cases Toe Walking is just a child’s strategy that allows him/her to move the center of gravity forward and then use less energy to make the first steps.

Most children outgrow toe walking but sometimes it can become an habit that needs to be broken by parents.

As long as a child grows and develops normally, toe walking on its own is unlikely to be a cause for concern.

An orthopedic evaluation will be required if the baby keeps toe-walking.

In a few cases, toe walking is caused by an underlying condition, such as:

  • A short Achilles tendon
  • Lumbar spine malformation
  • Neurological disorders
  • Severe developmental disorders that are almost always associated with a neuromotor delay, which is the first clinical sign to be noted. These disorders may include: Cerebral palsy, Muscular dystrophy, Autism.


How is Toe Walking diagnosed?

To determine if the child has just an idiopathic toe walking it is important to exclude all the other related conditions.

This is why the physical examination will try to check.

  • any pregnancy complication
  • when toe walking started
  • family history
  • other feet abnormalities
  • difference in leg length
  • flexibility of the foot in dorsiflexion with an Achilles tendon of normal length

All the possible causes previously described require an orthopedic and neurological evaluation and thorough investigations such as X-ray or, where necessary, a magnetic resonance imaging (MRI) of the spine.


Toe walking treatment

Observation is the first step. If toe walking it is just a habit and the child is also able to walk flat-footed the doctor may decide just to monitor child’s gait.

If toe walking is associated to other physical problems treatment may include the following nonsurgical treatments:

  • Physical therapy
  • Casting or Braces
  • Botox therapy


Surgery for toe walking

Surgery procedure may be recommended if the calf muscle and Achilles tendons are too tight that the child can’t walk flat-footed.

Surgery may be needed also if toe walking is associated with other neurological disorders such as cerebral palsy.


Why choose Prof. Portinaro

Prof. Portinaro is one of the most qualified pediatric orthopedic surgeons in the world for foot diseases and treatments.

In his long-running career he has been treating both idiopathic toe walking and non.

Prof. Portinaro has indeed a huge experience in treating neurological diseases that may develop toe walking as possible consequence.

He examines hundreds of patients each year and performed more than 7,000 surgeries to the Achilles tendon with different techniques according to the needs of the patient and the underlying pathology.


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