Pediatric Orthopedic Surgeons treating a Hammer Toe


Toe walking is quite normal in children beginning to walk and it normally will go away.  However, Toe walking sometimes can result from certain conditions, including cerebral palsy, muscular dystrophy, and an autism spectrum disorder.

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Toe Walking

Toe walking is a pattern of walking in which the toes of the feet are pointed toward the ground as opposed to the heels. This is a common gait pattern for children under the age of 2, but most people eventually adopt a heel-to-toe gait pattern. If your toddler is achieving developmental milestones, tiptoe walking is nothing to worry about. In many cases, it is unclear why your child continues to tiptoe walking past the age of 2. However, the calf muscles can become stiff, making it more difficult for children to learn the heel-to-toe walking pattern as they get older.

Toe walking causes

Doctors often cannot find a reason why a child walks on their toes. They call this idiopathic toe walking. These youngsters can normally walk heel to toe, but they prefer to walk on their toes. However, medical professionals have recognized a few circumstances when a kid could toe walk often.

Health Conditions

Occasionally, chronic toe walking may be an indication of one of the following medical conditions:

  • Cerebral palsy
  • Muscular dystrophy
  • A spinal cord abnormality
  • Neurological conditions

There is no clear connection between autism and toe walking, however children with disorders related to autism toe-walk more frequently than children who are developing normally. Instead, their toe walking may be sensory-related.

Cerebral palsy

This circumstance influences muscle tone, coordination, and posture. People with cerebral palsy may walk clumsily or even on their toes. Their muscles could also be excessively rigid.

Muscular dystrophy

A hereditary disorder called muscular dystrophy results in muscle loss and weakening. Toe walking is one of the possible adverse effects. A possible reason for toe walking in a youngster who has previously walked in a heel-toe pattern is muscular dystrophy.

Spinal cord abnormality

Abnormalities of the spinal cord, such as spinal cord attachments to the spine, or clumps of the spinal cord can cause toe-walking.

Is Toe Walking a symptom of autism? 

Doctors have observed a higher incidence of toe-walking in people with autism spectrum disorders, a group of conditions that affect a person’s communication, social skills, and behavior. But doctors haven’t figured out exactly why people with autism tend to tiptoe.

Autism is not automatically indicated by toe walking

Autism-related sensory issues, where a youngster may not enjoy the way their heels feel when they contact the ground, are some of the suggested causes of toe walking in persons with autism. Concerns about visual and vestibular (balance) function might also be a contributing factor.

Toe walking in adults

Toe walking may afflict adults, despite the fact that doctors typically link the disorder to children. Sometimes an adult may have always tripped over their own feet, making remedial actions useless. Sometimes as an adult, you could begin toe walking. This could be idiopathic or brought on by a number of foot diseases. Examples comprise:

  • calluses
  • corns
  • Peripheral neuropathy, often known as sensory loss in the feet

Consult our doctors to learn more about any potential underlying causes if your child is toe walking.

Diagnosing the cause of toe walking

You should see your doctor who will examine you or your kid and look for any underlying issues if the toe walking persists. Typically, this starts with gathering medical history. A doctor could inquire about things like:

  • If a kid was delivered at full term (37 weeks or more) or whether there were any issues with the mother’s pregnancy
  • Whether there is a family history of toe walking, whether a child’s toe walks on both feet or just one foot when they attain developmental milestones like sitting and walking.
  • When asked whether they have additional foot- or leg-related symptoms, such as discomfort or weakness in the legs, if they can walk heel to toe.

Your doctor will also do a physical examination. This usually involves asking to see you or your child walking. They also check the range of motion and growth of the feet and legs. Other tests may include tests of neurological function and muscle strength. Doctors usually do not recommend imaging or neurofunction tests unless the child’s medical history suggests a cause for the toe-walking. This is because for many people, toe-walking is idiopathic and the cause is unknown.

How to stop toe walking

Toe walking may be problematic because the majority of children with idiopathic toe walking past the age of five, may experience difficulty walking with their heels down later in life. If your child often walks on his or her toes, it may be difficult for you to put their shoes on or have them engage in leisure activities like roller skating that need specific footwear.

Physical Examination

By seeing your child walk, the doctor will often begin the physical examination. This may be done even if your child isn’t aware that they are being watched, to prevent the ‘doctor’s walk’, which occurs when a patient tries to walk correctly when the doctor is looking. The doctor will next want to see your youngster walk both normally and then “best” when on their toes (walking as flat-footed as possible). In addition to seeing the toe walking itself at this time, the doctor will evaluate the walk’s smoothness as part of a neurological assessment. Our Children’s orthopedist specialist will examine your child by:

  • Checking your child’s feet for anomalies, particularly discrepancies between the left foot and right foot.
  • Checking for variations in thigh and calf size as well as leg length.
  • Asking your kid to move their feet and ankles in various ways will help you determine whether one or both of their calf muscles are tight.
  • Checking the range of motion in your child’s hips and knees.
  • Looking closely at the lower extremities and back for any skin or other abnormalities.

Toe Walking Treatment

Physical Therapy

It could be helpful to reduce the amount of toe walking over the course of several sessions to concentrate on stretching the tight muscles. Children should perform stretching activities at home as well.


To encourage a flat foot when walking, certain kids may benefit from an ankle-foot orthotic (AFO). In order to stretch and promote a flat foot position during the day, the AFO is a customized brace. An AFO worn at night might aid in releasing tense muscles as your child sleeps.

Serial Casting

A short leg cast is applied at 1-2 week intervals to gradually stretch tight muscles and improve foot and ankle position. Kids are able to walk in these casts. The addition of Botox injections to stretch the tight muscles in casts may be more effective in some children.

Achilles tendon or Gastrocnemius Lengthening

If physical therapy and continuous casts are ineffective in correcting a tight ankle, surgery may be necessary to achieve a flat foot position while walking. A surgical procedure will increase the range of motion and function of the foot and ankle. The lengthening also makes it easier for the child to tolerate his or her AFO and achieve a flat foot position when walking.

Nonsurgical Treatment

The first course of therapy is always nonsurgical for kids between the ages of 2 and 5 who do not walk flat-footed. The nonsurgical cure may include:

  • Observation. The doctor for your child could advise watching your youngster for a while with routine office visits. If your child is habitually toe walking, they could decide to stop on their own.
  • Serial casting. To gradually stretch and lengthen the muscles and tendons in the calf and break the toe-walking habit, your child’s doctor may use a series of brief leg walking casts. Serial casting often takes place over a few weeks.
  • Bracing. Wearing an ankle foot orthosis (AFO) allows you to stretch and lengthen your child’s muscles and tendons. AFO is a plastic brace that extends behind the lower leg and holds the foot at a 90° angle. Bracing is usually done over a longer period of time (months instead of weeks) than casting.
  • Botox therapy. For certain people (usually those with neurologic abnormalities that cause increased muscle tone), botulinum toxin injections may be given to temporarily relax the calf muscles. This allows muscles to stretch more easily during continuous casting or tensioning.

Surgical Treatment

Children over the age of 5 who walk on their toes can develop too much tension in their calf muscles and Achilles tendon to walk correctly even if they tried. For these patients, doctors may recommend surgery to stretch the Achilles tendon. Stretching the tendons improves the range of motion and improves foot and ankle function. Which part of the tendon is stretched depends on whether the patient’s foot can be laid flat at the ankle with the knee bent. There are different techniques used to stretch different areas of the tendon. Your doctor will tell you which technique is best for your child. Surgery is usually done in an outpatient setting (no overnight stay). After stretching the tendon while your child is still asleep, your doctor will put a short leg cast on your child’s leg. These bandages are typically worn for 4 to 6 weeks.


After both surgical and nonsurgical treatment, physical therapy is typically advised to assist the patient to learn to walk flat-footed more regularly. After surgery, physical rehabilitation normally doesn’t start until the walking casts are taken off.


Most patients experience a gradual improvement and are able to engage in daily activities and sports. Studies suggest that some kids will toe walk even after many castings or surgeries so parents must be patient.  We are experts at toe walking and invite parents to give us a call to schedule an appointment at one of our four convenient offices.

Call 214-556-0590 to make an appointment.

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