Toe walking is quite common between the ages of 10 to 18 months when the child is learning to take his first steps. However, if toe walking persists beyond 18 months, it should be checked by a physician to see if there is any problem. There are many causes of toe walking, but the three major causes are as follows.

1. Muscle spasticity in the Calf muscles, especially the Gastrocnemius and Soleus muscles. This is often a manifestation of Cerebral Palsy, due to anoxia (lack of oxygen) to the brain around the time of birth. Other muscles in the body may also be affected, but the calf muscles become tight over time, causing the ankle to be fixed in Equinus (the foot points downwards). In the early stages, a thermoplastic brace (AFO) may control the equinus, but over time, surgery to lengthen the heel cord (Achilles tendon) is necessary.
2. Congenital tight heel cords occur in some children. There is no problem with any other muscles in the body. Only the heel cords are tight. Could this be an isolated form of cerebral palsy, or could the child be born with just tight heel cords? No one knows. But the treatment is the same - use of a thermoplastic brace (AFO) or surgery in the more severe cases.
3. Habitual toe walking. Some children persist in toe walking, even though examination reveals their heel cords are not tight. When asked to walk normally with a heel-toe gait, they can. But when not concentrating, they naturally get up on their toes. Nagging does not help. Very often, the problem resolves by itself. In the more persistent cases, using a thermoplastic brace (AFO) to enforce plantigrade walking for 3 to 6 months may help.