Tip toe walking is common in the beginning of walking and effects approximately 5-12 % of children. This walking pattern can be considered normal till to age 2 years unless there is an underlying neurological pathology. However, professional help can be required if it persists.

In 90% of the cases, there is no known cause of tip toe walking and it may be habitual. Even if this is the case, those children must be followed for a certain period of time and treatment may be required since persistent tip toe walking may cause permanent foot deformities.

Neurologic problems like cerebral palsy, autism and muscle contractions may be present in 10% of the cases. For this reason, tip toe walking children must be evaluated by pediatric neurologist also.

Treatment of tip toe walking can be done by conservative and surgical methods. Conservative methods should be tried first. Physical therapy and Achilles stretching exercises managed by the family are very important. If tip toe walking continues despite regular stretching and therapy, day and night time used AFO devices may be advised. The aim of the device is passive stretching of the Achilles tendon. In resistant cases, serial casting repeated at 3-4 weeks intervals can be tried. If there is no underlying neurologic problem, most of the cases resolve with patience.

Surgery is required in resistant cases despite conservative treatment or if there is an underlying neurologic pathology like cerebral palsy. In surgery, the Achilles tendon is lengthened either through the muscle or the tendon itself. It is a safe and low morbidity operation that requires 4-6 weeks time for casting. Than after physical therapy is usually required to prevent relapse.