INTRODUCTION: Idiopathic toe-walking (ITW) is described as a gait pattern with 
no contact between the heels and the ground in children older than 3years. The 
diagnosis is clinical, making it necessary to rule out other neurological and 
orthopaedic conditions. A relationship between ITW and vestibular dysfunction 
and/or proprioceptive sensibility has been proposed. Children with 
neurodevelopmental disorders (autism, language and cognitive disorders) often 
have ITW.
OBJECTIVES: To determine the frequency of ITW in children with attention deficit 
disorder and hyperactivity (ADHD).
PATIENTS AND METHOD: A study was conducted on children diagnosed with ADHD, with 
normal neurological examination, with no alterations in MRI scan, cognitive 
disorder or autism. A complete clinical anamnesis was performed and Achilles 
shortening was measured with a goniometer.
RESULTS: The study included 312 children with a mean age of 11 years (73.7% 
boys). The ADHD combined subtype was the most frequent (53.8%), followed by the 
inattentive (44.9%), and hyperactive (1.3%). ITW was observed in 20.8% of 
patients, particularly in the combined subtype (P=.054). Only 32 of them (49.2%) 
had Achilles shortening. ITW was associated with sociability disorders (P=.01), 
absence of pain in legs (P=.022), and family history of ITW (P=.004). Only 11% 
had previously visited a doctor for this reason.
CONCLUSIONS: As in other neurodevelopmental disorders, children with ADHD have 
frequently more ITW and Achilles shortening than controls, especially if they 
presented with a social communication disorder or a family history of ITW. An 
early diagnosis is essential to establish effective treatments.