Idiopathic Toe Walking (ITW) is when a child has a consistent toe-walking gait. It is considered idiopathic because the cause is unknown, meaning that other factors are excluded such as comorbidities, and their muscle tone and reflexes are typical.

Toe walking has been associated with a variety of different conditions including autism spectrum disorder (ASD), developmental delays, cerebral palsy, neuromuscular disorders, and myopathic disorders.^1,2,3

Toe walking can be normal up to the age of 3, after that it is considered abnormal and should be treated otherwise it can have serious effects on the body. Toe walking can cause pain in the foot and leg which increases as a child ages. The muscles tighten, especially the gastrocnemius, soleus, and Achilles tendon, causing a loss in the range of motion. This again becomes more prominent in older children, becoming more difficult to treat. Posture is offset impacting hip and core strength, thus affecting other movements such as squatting or climbing stairs. There is also a loss of balance and ankle stability, making the child more prone to falls and ankle injuries.

The severity of the toe walking gait will determine the intensity of treatments. Most toe walking in younger children can be addressed with less invasive methods. The most common treatments^1,4 listed across the literature include:

• Stretching of the ankle plantar flexors

• Strengthening the anterior tibialis

• Gait training

• Home exercise programs

• Night splinting

• Orthotics

• Casting

• Botox injections

• Surgery

Children with ITW have similar characteristics to that of children with CP, particularly affected muscle tone, strength, and tendon reflexes, particularly in the plantar flexor muscles which contract over time.⁵ An effective intervention is to include plantar flexor muscle strengthening on top of stretching it, as well as the typical interventions of strengthening the triceps surae (TS) and anterior tibial (AT) muscles, gait training, and motor control training.⁶