Idiopathic Toe-Walking(ITW)

Dr Vakili DPT
 Idiopathic Toe-Walking
Toe-walking that persists
after the age of 2 years
in the absence of
neurologic or
orthopedic
abnormalities is termed
idiopathic toe walking
.(ITW)
 Main Feature
Initially, children with ITW walk on their toes but
can bear weight with their foot at on request
.and with concentration on their gait
 Over time
Over time, an equinus contracture, defined as a
limitation of at least 10° of passive ankle
dorsiflexion with the knee extended and the
.ankle in neutral position, may develop
If not corrected, the contracture can develop
into acquired flatfoot, metatarsalgia, and
.plantar fasciitis
 Causes
No known cause has been identified for ITW but
a family history is common and a possible
autosomal dominant genetic link has been
.suggested
 Several Possible Causes
Tight muscles in the back of their lower leg (calf
muscles – gastrocnemius, soleus)
Weak muscle in the front of their lower leg
(anterior tibialis helps bring your foot off the
ground)
They may have a sensory concern and do not
like their heels on the ground
Visual problem
 Sensory problem
Children may toe walk to place more pressure
through a smaller surface area of the foot to
gain extra tactile (touch) or proprioceptive
.(movement) sensory input
Conversely, children may toe walk because they
are sensitive to the tactile (touch) feedback of
the ground under their feet and are
.attempting to avoid or minimise this feedback
 Visual problem
Standing on one’s toes changes the angle of
vision and this can provide a better
awareness of surroundings but also be
.indicative of visual motor difficulties
 Note
Children may toe walk when they are
particularly anxious or heightened, in an
attempt to self-regulate or calm themselves
.down
Children who continue to toe walk may do so
due to habit and or because the muscles and
tendons in their legs have tightened over
.time
 Incidence
The incidence of ITW has been reported
as nearly 5%. Generally, it is a diagnosis of
exclusion, ruling out neurologic involvement
(ankylosing spondylitis, cerebral palsy,
Charcot-Marie-Tooth disease, muscular
dystrophy, spina bifida, tethered cord
,syndrome, transient focal dystonia)
 Intervention
A majority of children will stop toe walking on
.their own without intervention
 Intervention
Conservative measures may include
stretching of the plantar flexors including
passive stretching, prolonged ankle foot
orthosis, serial casting, and/or Botox
.injections
 Intervention
Surgical lengthening of the Achilles tendon may
.often be performed in cases that persist
 Intervention
Persistent toe walking can increase a child's risk
.of falling. It can also result in a social stigma
 Intervention
Assist the child to regulate their senses and
emotions well/support the child’s anxiety so
.the child is less likely to toe walk
Prescribe activities and games on an incline (i.e.
walking up a ramp or balance beam) to give the
.lower limb muscles a stretch
 Intervention
Engage the child with tactile (touch-based)
stimulation on the feet (i.e. shaving cream or
.dried beans on the bottom of the feet)
Prescribe jumping, stomping or animal walk
.activities
 Exercises To Decrease Toe Walking 7
:Stretching Exercises
 :Strengthening Exercises

Penguin Walks
 :Strengthening Exercises
Have your child sit on a 
scooter board with their
feet in front of them.
Place heels on the ground
and toes up in the air. Use
their heels to press into
the ground and propel
.themselves forward
 :Strengthening Exercises
Have your child sit on a
child sized chair or stool.
Place your hands above
his/her ankles, providing
moderate and constant
pressure downward to
keep their heels on the
floor. Have your child
practice standing up and
down while keeping their
.heels on the ground
 :Strengthening Exercises
Have your child sit in a
chair or stand. Start with
sitting and as he/she gets
stronger, progress to
standing. Place a bean
bag on top of his/her foot
and have your child
transfer it to a bucket or
 .basket