Common Developmental Concerns

Toe-walking... "My daughter is a natural ballerina!" A dance school's best recruit is a child with a condition known as toe-walking. Actually, it is not uncommon for early walkers to walk on their toes as their muscles learn the correct way to balance the body. Equinus is the medical term for toe-walking and is defined as a foot that does not have enough dorsiflexion (i.e., flexion at the ankle joint bringing the foot toward the front of the leg). Occasional toe-walking is not a concern, especially if the child can voluntarily bring the heel to the ground. However, the child should be evaluated anyhow to rule out any neurological causes if the condition, especially if it becomes persistent.

There are three main reasons why a child may toe-walk. First, and most importantly, it may be caused by a spasticity of the calf muscles (gastrocnemius and soleus). This is due to a neurological problem such as cerebral palsy, the most serious concern for toe-walking. The second most common reason for toe-walking is due to a tight heel cord (Achilles tendon). This can be treated with stretching, bracing, casting and sometimes surgery if indicated. The third reason is habitual toe-walking. For some reason the child just walks on their toes. They can walk on their heels when asked, but prefer to toe-walk. This is best treated with clever parenting and encouragement of heel walking.