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Toe walking

  • Initial pre-referral workup

    Clinical history

    Usually idiopathic; family history of toe walking.

    Although rare, rule out significant conditions such as spinal dysraphism, muscular dystrophy and cerebral palsy.

    Physical examination

    • gait assessment
    • inspect spine
    • functional tests – check if able to stand with heels down with trunk straight and able to walk on heels
    • calf length
    • calf size
    • neurological assessment


    If suspicious:

    • spinal X-ray
    • CPK

    GP management

    Consider referral to paediatric physiotherapist for assessment and management.

    Refer parents to Toe walking in children (fact sheet) and guide to calf stretching.

    Indications for specialist referral


    • inability to dorsiflex foot beyond neutral, stand with heels down or walk on heels
    • signs of cerebral palsy with hypertonia, hyperreflexia or ataxia
    • calf hypertrophy
    • asymmetry
    • abnormal spine examination