habitual toe-walking is common in young children up to 3 years (1)
in physiological/idiopathic toe walking
there is generally intermittent periods of toe walking - this may be followed by a period of flat foot strike
eventually normal heel-strike walking occurs
in some cases a child may undertake toe walking (walking on tiptoes) because s/he perceives this as an achievement and pleases his/her parents. In this circumstance the child will walk with a normal heel-strike walk if s/he is not observed
idiopathic toe walking is a diagnosis of exclusion
if a child is toe walking also has abnormal feet and gait then check for undiagnosed spina bifida
if an older child develops toe walking after initially walking with a normal heel-strike have a pathological cause for his/her presentation and requires urgent referral for assessment and management
pathological causes of toe walking include diplegic cerebral palsy, neuropathy (hereditary, sensory motor), spinal dyspraphism, Duchenne muscular dystrophy
if a child presents with unilateral toe walking then the cause is almost always pathological
if persistent toe walking occurs then rarely surgical lengthening of the Achilles tendon may be considered. However note that physiological toe walking may self correct up to the age of 10 years old (2)
Reference:
(1) ARC (2008). Reports on the Rheumatic Diseases Series 5 : Hands On.
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