Most tots will walk using their whole foot by the age of three—but some are physically unable, and need professional analysis.
The causes of toe walking can be divided into four groups. The first is neurological disorders, such as cerebral palsy or muscular dystrophy, which affect the structure and mechanics of the calf muscle.
Then there are orthopaedic conditions; namely club foot, and calcaneal apophysitis (inflammation of the growth plate in the heel).
Some children exhibit no muscular pathology, but simply prefer to walk on their toes. They will have certain behavioural markers, such as developmental delays or ritualistic behaviours that put them on the autism spectrum.
Finally, there are children with no medical conditions who continue to toe walk. Experts refer to this as idiopathic toe walking.
Idiopathic toe walking presents in between 5 percent and 12 percent of healthy children, and researchers do not yet know the causes—except that there may be a genetic link.
However, idiopathic toe walkers tend to have tight calf muscles—either as a potential cause, or effect; the likes of which only exacerbate the habit as it makes getting the heel to the ground difficult and painful.
Treatment for idiopathic toe walking is either conservative—including verbal reminders, stretching, heavy footwear, orthotics, whole-body vibration, vinyl, carpet or gravel flooring, plaster casts to stretch the calf muscles, and Botox injections into the calf muscles.
Surgical intervention aims to lengthen the Achilles’ tendon, but ultimately, no single form of treatment, even surgical, has been shown to cure the idiosyncrasy.
One consolation is that time itself seems to be the best fixer—when a child grows heavier, toe-walking becomes harder to accommodate.