Many toddlers when they are learning to walk, walk up on their toes. This is really normal and often is of no importance. By the age of three years, they should be walking freely with the full foot flat on the floor. However a tiny number do not and persist with the toe walk. These need to be looked at further because there are a number of serious issues that might be underlying the problem.
There are various reasons for toe walking with about 10% being classed as idiopathic, which means that the reason is unknown. Some neurological conditions such as cerebral palsy or muscular dystrophy that causes the calf muscles to be tight can cause it. Musculoskeletal disorders such as club foot which is a deformity or severs disease that causes heel pain or just very tight calf muscles may also result in toe walking. There is another group of children who can get their heels down, but merely prefer to walk on their toes. This later one might be related to behavioural problems or associated with conditions like the autism spectrum disorders or developmental delay. After all these potential underpinning conditions are ruled out, the diagnosis of idiopathic toe walking can be made in those who persist to walk on the toes.
The management of Toe walking targets the underlying condition which is causing it. In cases in which idiopathic toe walking has been diagnosed, there are a variety of alternatives such a behavioural treatments, stretching, vibration treatment, plaster casting and Botox injections. If all that fails, a surgical lengthening of the Achilles tendon can be done. Many cases do have a tendency to come right after a while, so mild cases could just be monitored to let it resolve or later make the diagnosis of a condition that is underlying the toe walking. All cases should be taken seriously and further looked into.