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What is Idiopathic Toe Walking (ITW)?

What is it?

A child over the age of two years who walks with consistent toe-toe pattern without any known reason or other medical diagnosis


Why does it happen?

The name says it all: Idiopathic meaning arising spontaneously or for which the cause is unknown. To arrive at this diagnosis, your child may need to visit with a variety of specialists such as an orthopedists or neurologist to rule out other causes.


Why treat it?

The young foot is very moldable and if left untreated, toe walking can cause spreading of the forefoot, a smaller heel bone and weakness of the muscles within the feet. Other changes within the body can also happen like:

  • Knee instability due to increased back bend of the knee

  • Increased frequency of injury and falls

  • Joint pains in the legs and back

  • Footwear challenges with wider forefoot

  • Decreased endurance from high energy demand of ITW leading to less participation in activity

  • Possible negative social effects

Timing is key with toe walking. Once a young infant begins to walk regularly, their walking pattern begins to become a habit after 3 to 6 months. If toe walking is your child’s consistent, persistent walking pattern above the age of two, treatment should be initiated.


What do treatment options look like?

Whether noticed by a parent or picked up on a well check visit, pediatricians usually refer to an Orthopedist who begins a conservative care treatment program.


Serial Casting – If the ankles are very stiff, serial casting is a rapid way to improve flexibility of the foot. This is a series of casts changed each week over 3-6 weeks to increase the stretch on the calves and improve toes back motion.


Physical Therapy – A physical therapy evaluation followed by treatments that wean over time are key for treating more mild stiffness, as well as any sensory issues associated with toe walking. The physical therapist will teach the parents stretching techniques as well as positioning, proper shoe wear, walking strategies and play activities to encourage and train heel first contact when walking.


Orthosis - Worn for a fairly short period of time (4-6 months), this option uses hard plastic braces that block the child’s ability to rise up onto their toes. Repetitive heel-toe walking pattern in braces creates a new habit within the brain that over time can defeat toe walking.


Surgery – If conservative treatment (casting, bracing, and physical therapy) do not show progress, the next step is surgery to physically lengthen the short achilles tendon to get the child down on their heels.

If you have concerns of your child’s tendency to walk on their toes, talk to your pediatrician who will be able to refer to physical therapy, orthopedics or neurology as indicated. Central Texas Pediatric Orthopedics offers orthopedist visits as well as physical therapy and can be reached at 512-478-8116.

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