skip to main content

Idiopathic toe walking — DCH MCQ

Instant feedback + full explanation. One question, done properly.

ModerateDevelopmentIdiopathic toe walkingDCH

A 6-year-old boy has walked intermittently on his toes on both sides since he began walking. His development is normal, and he runs, jumps and climbs stairs without pain, falls or loss of skills. He can walk heel-to-toe when asked, stand and squat with both heels flat, and has full passive ankle dorsiflexion. Examination shows normal power, tone, reflexes and spine, with no calf hypertrophy or Gowers sign. He has no bowel or bladder symptoms. What is the most appropriate advice for his parents?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Reassure, offer heel-down activity advice and provide safety-netting

This is flexible, bilateral idiopathic toe walking: it has been present since early walking, the child can voluntarily achieve a heel-toe gait and place both heels flat, ankle dorsiflexion is preserved, and neurological and developmental examinations are normal. Reassurance, optional heel-down activities and safety-netting are appropriate; many children improve without active treatment. Baclofen is inappropriate without spasticity. Achilles lengthening is not indicated without fixed equinus or significant Achilles contracture. Duchenne muscular dystrophy would be suggested by progressive proximal weakness, Gowers sign, calf hypertrophy or loss of motor skills. Urgent spinal MRI is reserved for concerning features such as new or asymmetric toe walking, abnormal neurology, back pain, spinal abnormalities, or bowel or bladder dysfunction. Parents should seek review if pain, falls, weakness, asymmetry or loss of heel contact develops.

Reference: Royal Berkshire NHS Foundation Trust, Toe walking, section 'How is toe walking treated?', May 2025. https://www.royalberkshire.nhs.uk/media/zssjysc0/toe-walking_may25.pdf