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Idiopathic toe walking, ITW, is an abnormality of gait which is typically characterized by an absence of a normal pattern of heel-to-floor contact by both feet. In ITW, the forefoot is involved in the majority of contact with the floor during the gait cycle. While walking on the balls of their feet, or toes, is quite common in children just beginning to walk, most will outgrow this type of gait.
Idiopathic Toe Walking Evaluation
The cause of toe walking may involve multiple etiologies, including neuromuscular disease, however the most commonly seen type is ITW, or idiopathic toe walking. Management of toe walking begins with an accurate determination of its cause. Therefore, a comprehensive evaluation by a pediatric orthopaedic specialist is paramount to determine if the gait abnormality is idiopathic, or out of habit, of neurologic origin, or due to a muscular disease.
Toe Walking Signs and Symptoms
Toe walking is a common early pattern of gait development in children who are learning to walk. In most instances, a consistent heel-to-toe pattern of walking will develop by the time a child is two-years old. If toe walking continues to be observed beyond two-years, an evaluation is often recommended. It may be the simple case that a toddler continues to toe walk out of habit, and if no other issues with growth and development are noted, toe walking may not become cause for concern.
Idiopathic Toe Walking and Underlying Conditions
With ITW, the habit of walking on their toes or ball of feet typically develops when a child is learning to walk. Idiopathic toe walking is only diagnosed when no other condition has been discovered that may lead to toe walking. In some cases, toe walking may be brought on by an underlying condition:
- Achilles Tendon that is short may prevent the heel from properly touching the ground during gait
- Cerebral palsy may impact muscle tone, posture, movement patterns due to injury, or abnormal development in parts of the brain that control muscle function
- Muscular dystrophy, a genetic disease, may be an underlying cause of toe walking as muscle fibers are prone to damage and weakening over time
- Autism spectrum disorders have been linked to the display of toe walking
- Spinal conditions, musculoskeletal disorders, or tethered cord syndrome may also present with gait abnormalities in the developing child
The treatment for idiopathic toe walking depends on the child’s age and severity of the abnormal gait pattern. Treatment may be as simple as observation over time, to surgical intervention. Specific treatment options will be discussed with you following a comprehensive pediatric evaluation in order to best meet your child’s individual needs.
The providers at Pediatric Orthopaedic Associates provide a caring, multidisciplinary approach for the expert evaluation, diagnosis, treatment, and management of gait abnormalities. Call the office to help your child put “their best foot forward,” now and into the future. 404-321-9900