Idiopathic toe-walking is defined as persistent toe-walking in a normal child in 
the absence of developmental, neurological or neuromuscular conditions. True 
idiopathic toe-walking is a rare referral, representing approximately 1:100 new 
patients seen in the Paediatric Orthopaedic Clinic. A prospective study of 
idiopathic toe-walking (ITW) was organised between 1999 and 2003. Patients 
underwent full history, neurological examination and assessment of ankle 
dorsiflexion, followed by below-knee weight-bearing casting. Forty four 
developmentally normal children with no delay in walking age were in this study. 
There was an age range on presentation from 2 years to 14 years 4 months, with 
median 60.5 months. Sixty eight percent were male. Thirty four percent had a 
family history of the condition. Following casting, 66% of patients had improved 
gait on patient and clinician determined outcomes, with the majority of children 
ceasing to toe-walk. Ankle dorsiflexion significantly improved in those children 
who were successfully treated (p = 0.001).