Habitual Toe Walkers

By Dr. John Goodner

At the beginning of independent walking, toddlers may walk on their toes. Within three to six months the heel should be touching the ground during gait. Intermittent toe walking may be present in normal children until age six or seven.  

Most children who present as persistent toe walkers are able to lower their heels to the ground when standing but not walking. Walking heel-toe is possible for a few steps but usually awkwardly due to tight calf muscles. Toe walkers are more common in boys and in many cases are a cause of concern.  

Treatment of habitual toe walkers may be necessary to avoid problems that can occur secondary to compensating for the abnormal posture. Compensation may occur by hyperextending the knee, rotating the entire leg towards the outside or having the foot turn down or out, causing a flat foot. It is important to assess the degree of muscle tightness in the hips, knees and legs. Spontaneous resolution may take place in some cases. If the gastroc soleus (calf muscles) are not severely tight, stretching at home may be of benefit. Usually casting the foot and leg is necessary to stretch out the tight muscle group. Casts may be applied every two weeks for four to eight weeks. Spontaneous resolution may take place in some cases.


Tightness of the calf muscles

Neurological disorders must always be ruled out


Inability to walk in a normal heel-toe gait

Persistently on the ball of the foot

Bouncing type gait or gait that appears abnormal

Pain in legs, especially at night

Feet pointing to the outside

Arch very flat

Arched lower back (hyperlordosis)


Pain in the legs especially during activity

Pain in the legs at night

Fatigue in the feet and legs with activity


Thorough history and physical exam. Neurologic causes must be ruled out.

Mild cases may require stretching exercises and night splints.

 Moderate cases require casting the leg to stretch the calf muscles. The cast is weightbearing and may be necessary for four to eight weeks. There is no pain involved. The child can resume almost all activities in the cast, including riding a bicycle and walking briskly.  

Following cast removal, splints at night may be needed. Casting the leg is especially important if the child is flat footed. If untreated, the arch will flatten, causing long-term foot, ankle, knee and back problems.

Casting is almost always successful in the younger child if the degree of tightness is not severe.

Failure to stretch the muscle group with casting the extremity may necessitate surgically lengthening the Achilles tendon or calf muscle. This is done by making three small incisions on the back of the leg, each about one-twelfth of an inch or a small cut in the gastroc aponeurosis. Casts are applied postoperatively for six weeks and night splinting for six to twelve months to maintain the correction. Doing this procedure may have a positive impact on these children for the rest of their life. They can avoid long-term problems with the extremities and back by having this procedure done properly.

  • Dr. John Goodner is a Board Qualified Reconstructive Foot and Ankle Surgeon with the Foot, Ankle and Leg Specialists of South Florida and specializes in sports medicine foot and ankle injuries, foot and ankle arthroscopy, lower extremity trauma, and lower extremity deformities in infants, children, teens and adults. The South Florida Institute of Sports Medicine in Plantation is located at 220 S.W. 84th Avenue, Suite 102, (954) 720-1530. The practice website is www.SOUTHFLORIDASPORTSMEDICINE.com. Instagram @SouthFloridaSportsMedicine. Twitter @SFLSportsMed.