Open Access Highly Accessed Research article

Idiopathic toe-walking in children, adolescents and young adults: a matter of local or generalised stiffness?

Raoul Engelbert12*, Jan Willem Gorter3, Cuno Uiterwaal4, Elise van de Putte5 and Paul Helders6

Author Affiliations

1 Education of Physical Therapy, Amsterdam School of Health Professions, University of Applied Sciences (Hogeschool van Amsterdam), Amsterdam, The Netherlands

2 Department of Rehabilitation, Academic Medical Center, Amsterdam, The Netherlands

3 CanChild, Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Canada

4 Julius Centre for Health Sciences and Primary Care, University Hospital for Children and Youth 'Wilhelmina Children's Hospital', University Medical Center Utrecht, Utrecht, the Netherlands

5 Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands

6 Department of Pediatric Physical Therapy and Pediatric Exercise Physiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands

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BMC Musculoskeletal Disorders 2011, 12:61  doi:10.1186/1471-2474-12-61

Published: 21 March 2011



Idiopathic Toe Walking (ITW) is present in children older than 3 years of age still walking on their toes without signs of neurological, orthopaedic or psychiatric diseases. ITW has been estimated to occur in 7% to 24% of the childhood population. To study associations between Idiopathic Toe Walking (ITW) and decrease in range of joint motion of the ankle joint. To study associations between ITW (with stiff ankles) and stiffness in other joints, muscle strength and bone density.


In a cross-sectional study, 362 healthy children, adolescents and young adults (mean age (sd): 14.2 (3.9) years) participated. Range of joint motion (ROM), muscle strength, anthropometrics sport activities and bone density were measured.


A prevalence of 12% of ITW was found. Nine percent had ITW and severely restricted ROM of the ankle joint. Children with ITW had three times higher chance of severe ROM restriction of the ankle joint. Participants with ITW and stiff ankle joints had a decreased ROM in other joints, whereas bone density and muscle strength were comparable.


ITW and a decrease in ankle joint ROM might be due to local stiffness. Differential etiological diagnosis should be considered.