A number of children needs to be investigated further as there are a number of treatable problems that might be causing the problem. There are various causes of toe walking with approximately 10% getting classed as idiopathic, which means that the cause is not known. Certain neurological disorders for example cerebral palsy or muscular dystrophy that can cause the calf muscle to be tight can cause the toe walking. Musculoskeletal conditions such as club feet that is a deformity or severs disease that causes heel pain or just very tight calf muscles may also result in toe walking. There is also a group of kids who are able to get their heels to the ground, but merely would rather walk on their toes. This later one could be associated with behavioural conditions or linked to disorders like the autism spectrum disorders or developmental delay. After all these kinds of possible underpinning disorders are ruled out, the diagnosis of idiopathic toe walking can be made in those who continue to walk on the toes.
The management of toe walking is aimed at the root condition that is underlying it. In cases in which idiopathic toe walking has been identified, there are a variety of options such a behavioural treatments, calf muscle stretching, vibration therapies, plaster casting as well as Botox injections. If all that does not work out, a surgical lengthening of the Achilles tendon can be done. Many cases do usually come right over time, so moderate cases could just be monitored to let it resolve or later make the diagnosis of a disorder that is underlying the toe walking. All cases need to be taken seriously and further looked into.