Prevalence of toe-walking in childhood

Aim: Parents consult often the neuropaediatrician or the orthopaedist because their child walks on his toes. Primarily pathological toe walking in short calcaneus syndrome or neuromuscular disorders is different from the much more common idiopathic toe walking. We conducted this study to investigate the prevalence of toe-walking and its associated findings in childhood.

Methods: 366 children were analyzed concerning gait pattern, sex, height and ancle flexion. In order to determine the cumulative percentage of toe-walking parents answered 448 questionnaires that also asked for developmental milestones, associated diseases and social status.

Results: The prevalence of toe-walking was 5.2% (n=19) with a median of 62 months. Out of them were 68% boys. Toe-walkers were of the same height as children with normal gait pattern (both average percentile rank 50.4). The ancle flexion in toe-walkers was slightly reduced (12.3°) compared to plantigrades (16.2°). There were retrospective periods of intermittent or persistent toe-walking in 13.9% (n=62). Plantigrades started walking at an average age of 13.2 months and speaking with 16.0 months, while toe-walkers began walking with 15.7 months respectively speaking with 18.2 months. Families of toe-walkers have an average lower education status than those of non-toe-walkers.

Conclusion: Toe walking is a common variant of gait pattern in childhood with a prevalence in infants of about 5%, while the cumulative percentage is up to three times higher. It correlates with a reduced ancle flexion (probably caused secondarily), slight development retardation and a lower social status, but not with height.