When is toe walking normal and when is it not?
Toe walking in toddlers can be physiologic and is common until the age of 2 years. However, after 2.5-3 years of age, if contact with the ground still does not occur with heel pressure or if this walking style negatively affects the child’s balance and walking function, an underlying orthopedic or neurological cause should be considered.
Which Conditions Can Cause Toe Walking?
- Shortness of the Achilles tendon (acquired Achilles shortness)
- Central nervous system disorders such as cerebral palsy
- Autism spectrum disorder
- Habitual gait patterns
Especially in cases where the Achilles tendon is short, the ankle range of motion is restricted if the child is unable to press the heel to the ground or if there is sole stepping and walking on tiptoe. This can lead to knee, hip and lower back pathologies in the future.
Treatment Options
Treatment is tailored to the child’s age, associated symptoms and gait analysis findings.
- Physiotherapy may be sufficient in mild cases
- In moderate shortness, night splints and insoles can be added to treatment
- If necessary, the Achilles muscle can be temporarily relaxed with botulinum toxin (Botox) injections
- In advanced cases, tendon release surgeries can be planned
As a pediatric orthopedist, I can say that the correct evaluation and family information in the early period directly affect the success of the treatment process.
