How Much Is Enough? The Orthotic Management of Idiopathic Toe Walking

Toe walking can be associated with a number of comorbid diagnoses. Children with cerebral palsy, certain myopathies, and autism may adopt this gait pattern. However, this presentation also occurs in cases where these diagnoses have been ruled out and there are no other underlying orthopedic or neurologic causes. In such instances, an otherwise healthy child with normal muscle strength and adequate muscle length appears to simply choose this gait pattern. Frequently, such children can walk without this pattern when they choose to, but seem to prefer ambulating on their toes and balls of their feet. Idiopathic toe walking (ITW) is thus a diagnosis of exclusion. When all other possible causes have been excluded, the medical community can only shrug their collective shoulders and, uncertain of the underlying cause, attach the unsatisfying term idiopathic, a Greek word meaning “one’s own suffering,” or “a disease of its own kind.”