Toe walking refers to a condition where a person walks on his or her toe

Toe

Toes are the digits of the foot of a tetrapod. Animal species such as cats that walk on their toes are described as being digitigrade. Humans, and other animals that walk on the soles of their feet, are described as being plantigrade; unguligrade animals are those that walk on hooves at the tips of...

s without putting much weight on the heel

Heel

In human anatomy, the heel is the prominence at the posterior end of the foot. It is based on the projection of one bone, the calcaneus or heel bone, behind the articulation of the bones of the lower leg.- Human anatomy :...

 or any other part of the foot. Toe-walking in toddlers is common. These children usually adopt a normal walking pattern as they grow older. If a child continues to walk on his or her toes past the age of three, he or she should be evaluated by a doctor.

Toe walking can be caused by different factors. One type of toe walking is also called "habitual" or "idiopathic" toe walking, where the cause is unknown. Other causes include a congenital short Achilles tendon

Achilles tendon

The Achilles tendon , also known as the calcaneal tendon or the tendo calcaneus, is a tendon of the posterior leg. It serves to attach the plantaris, gastrocnemius and soleus muscles to the calcaneus bone.- Anatomy :The Achilles is the tendonous extension of 3 muscles in the lower leg:...

, muscle spasticity (especially as associated with cerebral palsy

Cerebral palsy

Cerebral palsy is an umbrella term encompassing a group of non-progressive, non-contagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement....

) and paralytic muscle disease such as Duchenne muscular dystrophy

Duchenne muscular dystrophy

Duchenne muscular dystrophy is a recessive X-linked form of muscular dystrophy, which results in muscle degeneration, difficulty walking, breathing, and death. The incidence is 1 in 3,000 boys. Females and males are affected, though females are rarely affected and are more often carriers...

. It may also be one way of accommodating a separate condition, foot drop

Foot drop

Foot drop is the dropping of the forefoot due to weakness, damage to the peroneal nerve or paralysis of the muscles in the anterior portion of the lower leg. It is usually a symptom of a greater problem, not a disease in itself. It is characterized by the inability or difficulty in moving the ankle...

. Persistent toe walking in children has been identified as a potential early sign of the neurodevelopmental disorder autism

Autism

Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism affects information processing in the brain by altering how nerve cells and their...

.

Diagnosis

A doctor will typically evaluate whether there is bilateral (both legs) toe walking, what the child's range of motion is (how far he or she can flex his or her feet) and perform a basic neurological exam. Treatment will depend on the cause of the condition.

Treatment

For idiopathic toe walking in young children, doctors may prefer to watch and wait

Watchful waiting

Watchful waiting is an approach to a medical problem in which time is allowed to pass before medical intervention or therapy is used. During this time, repeated testing may be performed....

: the child may "outgrow" the condition. If there is a reduction in the child's range of motion, there are several options.

• Wearing a brace or splint either during the day, night or both which limits the ability of the child to walk on his or her toes and stretches the Achilles tendon. One type of brace used is an AFO (ankle-foot orthosis).
• Serial casting where the foot is cast with the tendon stretched, and the cast is changed weekly with progressive stretching.
• Botox therapy
  Botulinum toxin
  Botulinum toxin is a protein produced by the bacterium Clostridium botulinum, and is considered the most powerful neurotoxin ever discovered. Botulinum toxin causes Botulism poisoning, a serious and life-threatening illness in humans and animals...
  
   is used to paralyze the calf muscles to reduce the opposition of the muscles to stretching the Achilles stretching, usually together with serial casting or splinting.
• If conservative measures fail to correct the toe walking after about 12–24 months, surgical lengthening of the tendon is an option. The surgery is typically done under full anesthesia
  Anesthesia
  Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
  
  but if there are no issues, the child is released the same day. After the surgery, a below-the-knee walking cast is worn for six weeks and then an AFO is worn to protect the tendon for several months.

For toe walking which results from more serious neuro-muscular conditions, additional specialists may need to be consulted.