Diagnosis

Toe walking can be observed during a physical exam. In some cases, the doctor may do an in-depth gait analysis or an exam known as electromyography (EMG). During an EMG, a thin needle with an electrode is inserted into a muscle in the leg. The electrode measures the electrical activity in the affected nerve or muscle.

If the doctor suspects an underlying condition such as cerebral palsy or autism, he or she may recommend a neurological exam or testing for developmental delays.

Treatment

If your child is toe walking out of habit, treatment isn't needed. He or she is likely to outgrow the habit. Your doctor may simply monitor your child's gait during regular office visits. If a physical problem is contributing to toe walking, treatment options may include:

  • Physical therapy. Gentle stretching of the leg and foot muscles may improve your child's gait.
  • Leg braces or splints. Sometimes leg braces or splints help promote a normal gait.
  • Serial casting. If physical therapy or leg braces aren't helpful, your doctor may suggest trying a series of below-the-knee casts to progressively improve the ability to bring the toes toward the shin.
  • Surgery. If conservative treatments fail, the doctor may recommend surgery to lengthen the muscles or tendons at the back of the lower leg.

If the toe walking is associated with cerebral palsy, autism or other problems, treatment focuses on the underlying condition.

Preparing for your appointment

You'll probably first bring your concerns to the attention of your family doctor or pediatrician. He or she may refer you to a doctor specializing in nerve function (neurologist) or orthopedic surgery.

What you can do

Before your appointment, you may want to write a list of questions for the doctor, including:

  • What could be causing toe walking in my child?
  • Are any tests needed? If so, what are they?
  • What treatments are recommended for this problem?

What to expect from your doctor

Your doctor may ask some of the following questions:

  • Does your child have any other medical problems?
  • Do you have a family history of muscular dystrophy or autism?
  • Was your child born prematurely?
  • Did your child previously walk flat-footed and only recently begin to toe walk?
  • Can your child walk on his or her heels if you ask?
  • Does your child avoid eye contact or exhibit repetitive behaviors such as rocking or spinning?
March 26, 2015
References
  1. Oetgen ME, et al. Idiopathic toe walking. Journal of the American Academy of Orthopedic Surgeons. 2012;20:292.
  2. Engstrom P, et al. The prevalence and course of idiopathic toe-walking in 5-year-old children. Pediatrics. 2012;130:279.
  3. Williams CM, et al. The toe walking tool: A novel method for assessing idiopathic toe walking children. Gait & Posture. 2010;32:508.
  4. Cerebral palsy: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm. Accessed March 2, 2015.
  5. Muscular dystrophy: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/md/detail_md.htm. Accessed March 2, 2015.
  6. Autism fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/autism/detail_autism.htm. Accessed March 2, 2015.
  7. Neurological diagnostic tests and procedures. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/misc/diagnostic_tests.htm. Accessed March 2, 2015.