Children should be walking normally with the full foot flat on the ground. However a small number do not and persist with the toe walk. These have to be looked into further because there are a number of serious issues that could possibly be underlying it. There are various causes of toe walking with approximately 10% being classed as idiopathic, meaning that the reason is not known. Several neurological problems such as cerebral palsy or muscular dystrophy that causes the calf muscles to be limited could cause it. Orthopaedic disorders for example club foot which is a deformity or severs disease that causes heel pain or simply really tight calf muscles may also result in toe walking.
There is also a group of children who are able to get their heels down, but just prefer to walk on their toes. This later one might be associated with behavioural conditions or connected to disorders like the autism spectrum disorders or developmental delay. After all these kinds of possible underlying conditions are excluded, the diagnosis of idiopathic toe walking can be made in those who persist to walk on the toes.
The management of Toe walking targets the underlying disorder that is underlying it. In cases in which idiopathic toe walking has been diagnosed, there are a number of treatments such a behavioural interventions, stretching, vibration treatment, plaster casting as well as Botox injections. If all that fails, a surgical lengthening of the Achilles tendon can be carried out. Many cases do tend to come right after a while, so mild cases could just be monitored to let it resolve or later result in the diagnosis of a condition that is underlying it. All cases need to be taken seriously and further examined.