Do you have a little ballerina in the house? When she is barefooted, does looks like she is walking like she has high heels on?

Toe walking in young school-age children can have a variety of causes. If passive dorsiflexion of the foot results in ankle clonus (rapid, rhythmic contractions of the calf muscles), spasticity is present, and it is likely that the child has a form of cerebral palsy. There is no spasticity present with idiopathic toe walking.

In children without spasticity, some toe walking is normal up to 3 years of age. If it continues past that age, it usually resolves by age 6 or 7. In approximately 50 percent of idiopathic toe walkers, the condition is hereditary (more likely in males than females) and is not associated with any other problems. Most of these children outgrow their toe walking, although, because it is habitual, some may not. (In cases where idiopathic toe walking leads to detrimental muscle contractures and inflexibility, the child may benefit from the use of orthoses, possibly coupled with Botox® injections to relax the muscles and inhibit toe walking.)

In the other 50 percent of idiopathic toe walkers, the condition is associated with attention deficit disorder, developmental disability, learning disabilities such as dyslexia, or a form of autism. In some cases, these underlying difficulties may be obvious. In other children, however, they may have gone undiagnosed. When toe walking is present in a child who also exhibits difficulties with attention, behavior or cognition, a developmental assessment and an assessment for learning difficulties are indicated. Early intervention can help improve overall outcomes for the child.