Introduction

A baby can begin taking their first steps anywhere between 10 months and 17 months of age. Toe walking can be common in the early stages of walking as children adapt to being on two feet and start to reach for the objects around them. As a child masters being on their feet (approximately 6 months after the onset of walking) they should begin to demonstrate more typical walking pattern.

Persistent toe walking along with several other features may be indicative of more serious conditions that require review from a Paediatric Physiotherapist or Medical professional. These include:

Ortopaedic

This is caused by an issue with the bony structures in the body such as the development of the hips or a difference in leg length.

Common symptoms include:

• Toe walking on one leg
• Measure leg length discrepancy
• Decreased hip range of motion (ROM)

Behavioural

Toe walking has been linked with behavioural conditions such as Autism, Asperger Syndrome and Sensory Disassociation.

Common signs can include:

• Delayed Gross motor milestones
• Poor communcation skills
• Later onset of toe walking

Neurological

Toe walking can be a symptom associated with damage to the nervous system. This can be occur in conditions present during birth such as Cerebral Palsy or later in childhood such as Muscular Dystrophy.

Signs and symptoms associated with a neurological disorder consist of:

• Delayed gross motor milestones
• Premature birth
• Seizures
• Scoliosis
• Increased muscle tone
• Decreased calf ROM

Idiopathic

Idiopathic toe walking occurs in approximately 5-12% of healthy children and has known cause. It is considered the diagnosis when all the above conditions have been excluded.

Children who are Idiopathic toe walkers may present with the following:

• Reduced calf length (difficulty squatting with heels on the ground)
• Age appropriate gross motor skills
• No leg length difference
• Normal hip ROM

How can Physio Help?

A physiotherapist will screen your child to exclude any serious conditions that may be causing you child to walk on their toes. typical assessment will involve:

• Observing for signs of scoliosis
• Measuring calf length
• Assessing hip ROM
• Examining age appropriate gross motor skills
• Referral for further investigations if required

Treatment may consist of soft tissue massage, manual therapy, stretching, strength exercises, night splints and casting. The type of treatment your child will receive will depend on the degree of movement restriction evident on assessment and the reason for their toe walking.

References

Eastwood, D., Menelaus, M., Dickens, D., Broughton, N., & Cole, W. (2000). Idiopathic toe walking: Does treatment alter the natural history. Journal Pediatric Orthopaedics, 9(1), 47-49.

Engelbert, R., Gorter, J., Uiterwaal, C., van de Putte, E., & Helders, P. (2011). Idiopathic toe walking in children, adolescents and young adults: A matter of local or generalised stiffness? Musculoskeletal Disorders, 12(1), 61-69.

Le Cras, S., Bouck, J., Brausch, S., & Taylor- Haas, A. (2011). Cincinnati Children’s Hospital Medical Centre: Evidence-based clinical care guideline for management of idiopathic toe walking. Retrieved from: http://www.cincinnatichildrens.org/service/j/anderson-centre/evidence-based-care/occupational-therapy-physical-therapy

Williams, C. (2010). Idiopathic toe walking and sensory processing dysfunction. Journal of Foot and Ankle Research, 3(16), 1-6.

Zimbler, S. (2007). Idiopathic toe walking: Current evaluation and management. Retrieved from: http://www.orthojournalhms.org/volume9/manuscripts/ms10.pdf