Toe walking
Toe walking refers to a condition where a person walks on their toes without putting much or any weight on the heel or any other part of the foot. This term also includes the inability to connect one's foot fully to the ground while in the standing phase of the walking cycle. Toe walking in toddlers is common. Children who toe walk as toddlers commonly adopt a heel-toe walking pattern as they grow older. If a child continues to walk on their toes past the age of three, or can't get their heels to the  ground at all, they should be evaluated by a health professional who is experienced in assessing children's walking. Toe walking can be caused by a number of health conditions. When there is no medical reason for toe walking, health professionals will commonly refer to it as "idiopathic" toe walking. This is not a formal or recognised diagnosis, but how it is referred to because a reason for toe walking can't be found. Idiopathic toe walking should only be considered after all other conditions have been excluded. Other causes for toe walking include a congenital short Achilles tendon, muscle  spasticity (commonly associated with cerebral palsy) or genetic diseases muscle disease such as Duchenne muscular dystrophy. Toe walking may also be caused by a bone block located at the ankle which prevents the ankle from moving. This may be as the result of trauma or arthritis. Toe walking may also be one way of accommodating a separate condition, foot drop. Persistent toe walking in children has been identified as a potential early sign of autism. Toe walking is commonly found in children who have been placed on the autism spectrum. In a recent study, 68% of children on the autism  spectrum report experiencing a walking abnormality. It is estimated that 5% of healthy children have no reason for their toe walking (idiopathic toe walking). Idiopathic toe walking has also been observed more in males than females when very large groups of children with toe walking are observed. One study looked for a family history of toe walking, and found a connection with family members all toe walking with no medical reason (idiopathic toe walking). This means there may be a genetic link with idiopathic toe walking. Cause. Idiopathic toe walking is always bilateral and has no orthopedic or neurological cause . It is diagnosed after if it continues past the age of three. In this condition, children are able to voluntarily walk with the typical heel-toe pattern, but prefer to walk on their tip toes. In order for it to be considered idiopathic, the child's medical history should be clear of any neurological, orthopedic, or neuro-psychiatric conditions including other gait abnormalities. It is thought to be related to sensory processing challenges. Two classifications of idiopathic toe walking have been established. The Alvarez's classification identifies the severity of the toe walking based upon kinematics and ankle rockers. The  Pomarino classification identifies the toe walking according to the individual's specific characteristics and characterizes them into three types based on the signs presented. Cerebral palsy. Studies have been performed to determine the source of the association between toe walking and cerebral palsy. One study suggests that the toe walking—sometimes called an equinus gait—associated with cerebral palsy presents with an abnormally short medial and lateral gastrocnemius and soleus—the primary muscles involved in plantarflexion. A separate study found that the gait could be a compensatory movement due to weakened plantarflexion muscles. In people who have cerebral palsy and  toe walk, there is greater plantarflexion force required for normal heel-to-toe walking than for toe walking. When typically developing children are tasked to perform different types of toe walking, their toe walking could not reduce the force to the levels that children who toe walking with cerebral palsy have when they walk. This suggests that toe walking associated with cerebral palsy may be due to abnormally weakened plantarflexion that can only manage toe walking. Diagnosis. There are many health professionals who assess and treat toe walking. Family physicians, neurologists, orthopaedic surgeons, pediatricians, physical therapists, physiotherapists and podiatrists are  all commonly consulted. Treatment will depend on the cause of the condition. Treatment. For idiopathic toe walking in young children, health professionals may prefer to watch and wait: as the child may "outgrow" the toe walking with time. There are limited treatments that demonstrate long term walking change. Many treatments instead focus on any tightness in the calf muscles that can be associated with the toe walking. Common treatments for idiopathic toe walking can include: For toe walking which results from other medical conditions, additional specialists may need to be consulted.