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idiopathic toe walking

AUTHOR: Marc Mitnick DPM

REVIEWED BY: Podiatric Medical Review Board

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walking on toes with no associated neurological disease state

WHAT IS TOE WALKING

Idiopathic toe walking is a condition where a person, generally a child, walks on their toes in the absence of any disease state. Most young children begin walking around 12 months of age and it is not uncommon for many of them to walk on their toes during their initial period of learning to walk as they develop their gait pattern. If this pattern of walking persists beyond two years of age, it should be a cause for concern for parents and the condition needs to be investigated.

Conditions such cerebral palsy or autism may be first diagnosed in children who walk on their toes. In very general terms walking on the toes on both feet is seen in kids with muscular dystrophy while toe walking on only one foot in most instances is from trauma to the foot, ankle or leg.

If all possible neurological disease states are eliminated and there is no history of trauma to the foot or leg, then a diagnosis of idiopathic toe walking is made. However, recently the thought process has become one where even in these cases, there may be a neurological component. Preliminary studies have shown a correlation between sensitivity to vibration and hypersensitivity in the feet as a reason for children to toe walk. This is an area that needs further investigation.

TREATMENT FOR TOE WALKING

After ruling out a neurological basis for this condition, idiopathic toe walking can be treated by a number of means and in combination.

Stretching exercises- children who walk on their toes show a tendency to exhibit a tight gastrocnemius and soleus muscles which are the two muscles below the back of the knee that come together and form the Achilles tendon. The younger the child, the more effective stretching exercises become.

Serial casting- is another avenue used to decrease the tightness of the Achilles tendon and associated muscles. A non-removable cast is applied to the foot to just below the knee. Each cast is left on for a period of time, determined by the physician. As a new cast is applied, the foot/feet is further dorsiflexed (bent upwards) in an effort to stretch the Achilles tendon and muscle group. This has to be done in stages as it would be very painful to the child and probably impossible to stretch the muscle group by trying to accomplish all the stretching necessary in the initial casting.

Ankle-foot orthoses- In situations where the plantarflexion (bending down of foot) also known as equinus is not so severe, the doctor may decide to try what is known as an ankle foot orthosis (AFO) . This is a device that attempts to maintain the proper angle of the foot to the leg while allowing the child to walk. Stated the other way, it does not allow the child's foot to plantarflex and thus alleviates toe walking.

Night splint- In conjunction with an ankle foot orthosis, the child may also wear a night splint. This is a removable cast like device that is worn while the child sleeps and just like all the other treatment options attempts to stretch the achilles tendon.

Surgery- In more severe cases surgical lengthening of the Achilles tendon is employed. If the posterior leg muscle group is too tight and has not responded to the previous mentioned conservative options, then actually lengthening the tight heel cord may be the only means to allow the child to walk normally.

Botox- In recent years Botox injections have been employed with a mixed degree of success. Botox or botulinum toxin injections have the ability to relax muscle, so in theory if a child has a tight heel cord, injecting the muscle with Botox should loosen up the muscle. The injection in conjunction with night splints and stretching has had some degree of success.

It is worth noting that even with what may be considered a "successful" treatment, most children will require some kind of orthotic device going forward. In many instances, improvement seen with treatment degrades over time. Continued walking on the toes into adulthood can impact the quality of life as it is an altered gait and opens the adult for a myriad of problems.

REFERENCE

Lower Extremity Review, August 12, 2012, Volume 4, page 39

REFERENCES

Mayo Clinic

OrthoInfo

Cleveland Clinic

ORTHOTICS for multiple types of foot pain best buy in a pre-made orthotic click link below



ORTHOTICS for heel and arch pain for those who must wear dress shoes click link below

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New York

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Memphis, TN

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Scotland

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(location unknown)

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Redondo Beach, CA

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LH

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Dr. Marc, Thank you so much for your reply which seemed to be right on. I have researched many sites but you put me on the right path to the possible answer. My foot pain may not rule the rest of my life after all! I believe I'll make a sign that reads, "THE END IS NEAR!" Thanks Very Much,

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UK

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Mansfield Ctr, CT

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Placentia, California

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Unknown

Unknown location

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Unknown location

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Pacific Grove, CA

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New Zealand

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Arizona

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Florida

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Poland

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M P

South Carolina

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Arlington, VA

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Pam

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Glen

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Bre

location unknown

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Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.

anonymous

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Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!

anonymous

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Poland

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Seattle, WA

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Bill

New Jersey

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Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.

Debbie

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Thanks so much for this website Dr. Marc! It is so nice that you have this ask the doctor feature..I'm sure I'ts been helpful for alot of people. I will try what you suggested and see if it helps...thanks again!

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Evansville, IA

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Dear Marc

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San Diego, CA

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Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

Rivi,

Albany, NY

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Jill S.

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THANK YOU SO VERY MUCH FOR YOUR TIME AND EFFORTS, YOU ARE SO VERY APPRECIATED. THANK YOU FOR ALL YOU DO.

Jackie

Whichita, KS

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Boston, MA

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Colorado

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Colorado

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Wonderful advice

by: Anonymous

This is the best site for foot problem info.

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Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

by: Max

location unknown

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Barb D.

Canada

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Wisconsin

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Thank you for your response. You have provided some great insight (to my question)....

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North Carolina

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Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

KG

location unknown

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Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.

Bessie Mae

Florida

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Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown

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Robert

New Jersey

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Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown

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I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!

Melody

Lenoir, NC

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Thank you so much Doc for a quick and thorough response!

Rustam

Bellevue, WA

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I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!

Jodi

location unknown

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