Toe Walking

Question 1

Toe Stepping

Answer 1

normal variant 
occurs in children under 2.5 
able to walk with flat feet 
able to walk on heels 
bilateral 
occurs when pull to stand or when change surface

Question 2

Toe Walking

Answer 2

atypical
walk on their toes majority of the time
can’t/rarely walk on flat feet

Question 3

Differential Diagnosis - Bilateral VS Unilateral

Answer 3

need to rule out a differential diagnosis 
BILATERAL need to consider 
- cerebral palsy 
- Duchenne Muscular Dystrophy 
- Spinal issues 
- Charcot Marie Tooth Disease 

UNILATERAL need to consider

• cerebral palsy
• DDH
• leg length discrepancy
• nerve idiopathic if unilateral

Question 4

Subjective Ax.

Answer 4

Onset
- idiopathic if onset with or within 6 mths after onset of walking 
Change?
can they stand on flat feet with prompting 
Percentage of time spent on their toes 
general development history 
family history 
pain, weakness, tightness?
impact on function

Question 5

Objective Ax.

Answer 5

no standardised assessment 
Gait analysis 
- walking over 10m 
- measure cadence - toe walkers will have high cadence 
- percentage of time on toes 

Leg length discrepancy

Strength

• full squat without holding on
• how they get off the floor
• hopping
• SL heel raise

Neuro screening - tone
AROM/PROM
gross motor skills

Check sensation and cognition

Question 6

Treatment/Management

Answer 6

Conservative

• monitoring purposeful play
• gastroc and soleus stretches
• tib ant strengthening
• gait re-education
• orthotics

Surgery
- tendon lengthening