Foot

TIPTOE WALKING

Prepared by: Dr. Serkan Erkuş

Tiptoe walking refers to walking on the toes without the heels touching the ground. It is common to see tiptoe walking in children during the first two years of life as they are learning to walk. As children's motor skills develop and they grow older, this condition often resolves on its own. However, in some cases, tiptoe walking may persist beyond the age of two. In most instances, when observed after two years of age, the cause is idiopathic, meaning the exact reason is unknown. Children in this group have normal medical examinations, and no underlying disease is found. These children are often able to walk with a heel strike when prompted.

The two main muscles in the calf (gastrocnemius and soleus muscles) join at the base of the calf to form the Achilles tendon, which attaches to the heel bone (calcaneus). In children who are unable to strike with their heels and walk on their toes, these muscle groups may be shorter than normal. Persistent tiptoe walking is usually due to the habit of walking on the toes, which over time can lead to tightening of the calf muscles.

Tiptoe walking can sometimes indicate an underlying medical condition, although this is less common. Conditions such as cerebral palsy, muscular disorders, spinal cord abnormalities, and other neurological diseases can contribute to tiptoe walking. Sensory issues linked to psychiatric disorders like autism spectrum disorders may also cause tiptoe walking. Additionally, it can be observed in cases of leg length discrepancies, scoliosis, or other musculoskeletal abnormalities.

The treatment for tiptoe walking depends on the underlying cause, the child's age, and the severity of the condition. In younger children, non-surgical treatments typically result in successful outcomes. For older children or those with restricted ankle movement, more invasive treatments may be necessary. Non-surgical treatments include observation, stretching exercises, casting, the use of orthotic devices, and botulinum toxin type A injections into the muscles. In more severe or persistent cases, surgical interventions may be considered, including procedures to lengthen or release the calf muscles or Achilles tendon.