Idiopathic Toe Walking

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Toe walking is a toe-to-toe or forefoot-to-forefoot gait that lacks initial heel strike (figures 1 and 2.) In typical early child development, nearly all children toe walk to some degree. If a child persistently toe walks between ages 2 to 3 years, then further evaluation is needed. There are several reasons for toe walking, including diseases such as cerebral palsy, muscular dystrophy, myopathy and neuropathy, which may cause muscle imbalances due to spasticity or weakness. It has also been reported that 68 percent of children with autism spectrum disorder exhibit toe walking or other types of gait abnormality.7 If a specific disease process is not identified after a thorough neurologic and musculoskeletal exam, then the toe walking is considered idiopathic. There are several theories for idiopathic toe walking (ITW) including increasing sensory stimulation, increasing proprioception and balance for the lower limbs, shortened Achilles tendons, increased Type I muscle fibers, and possibly genetic contributions as it seems to be hereditary.