["My child walks on his tiptoes"].

Toe walking is a symptom that occurs frequently in the normal childhood population. The management of children who walk in a symmetrical and permanent way on the toes is presented. In most cases no etiology of toe walking is found. Idiopathic Toe Walking (ITW) is considered a diagnosis of exclusion and is employed only when all other possibilities have been eliminated with a meticulous clinical examination and various investigations. If any etiology is found, the treatment should be first non operative whereas heel cord lengthening is the treatment of choice in ITW. This surgical treatment should be limited to children with functional impairement and is ideally carried out as late as possible.