Idiopathic toe-walking is a diagnosis of exclusion when a child presents with 
bilateral toe-to-toe gait. Although toe-walking is considered part of the normal 
gait spectrum in development, it is abnormal when persisting past the age of 
two. Toe-walking may be caused by cerebral palsy, congenital contracture of the 
Achilles tendon or paralytic muscular disorders such as Duchenne Muscular 
Dystrophy. Idiopathic toe-walking may be associated with developmental disorders 
such as autism or other myopathic or neuropathic disorders. The majority of 
disorders causing toe-walking can be ruled out through the history and physical 
examination, resulting in a diagnosis of idiopathic toe-walking. However, it may 
be difficult to differentiate mild forms of cerebral palsy, specifically mild 
spastic diplegia, and idiopathic toe-walking. The treatment options for 
idiopathic toe-walking include observation, conservative methods and surgical 
methods. Most children can be treated in the primary care setting with either 
observation or conservative treatment. Patients with severe contracture of the 
Achilles tendon, or persistent toe-walking, may need surgical intervention. The 
prognosis of idiopathic toe-walking is favorable with both conservative and 
surgical treatment allowing children to attain normal function and range of 
plantarflexion. The following article provides an overview of the background 
information, differential diagnosis and treatment options for idiopathic 
toe-walking.