Differential Diagnosis in Children who Toe Walk: Why it Matters

Toe walking is a common pediatric gait abnormality that results in a referral to physical therapy (PT), often without a formal diagnostic work-up. Many conditions are associated with toe walking in children and the PT evaluation, plan of care and expected outcome differs across diagnoses. A national survey of parents of children with idiopathic toe walking (ITW) reported that they received mixed messages about their child’s diagnosis and perceived that physical therapists and other health care providers varied in their knowledge of ITW.(Barkocy 2021) Parents wanted more information about which health care providers diagnose ITW and how a diagnosis of ITW is determined. (Barkocy 2021)
This session will provide information about the typical presentation of children with ITW including birth and developmental history and physical examination. ITW is a diagnosis of exclusion, so information about other medical and neurodevelopmental conditions that can cause toe walking in children, such as cerebral palsy, autism, and muscular dystrophy, will be shared. The role of physical therapists in the differential diagnosis of children who toe walk will be discussed as well as indications for referrals to other health care practitioners.
Early identification of children with cerebral palsy, autism, muscular dystrophy, and other diagnoses associated with toe walking is important for comprehensive and evidence-based management. Current recommendations for timely identification of these diagnoses will be shared. Participants will apply information from this presentation to case studies in small groups and share their clinical reasoning on the differential diagnosis and recommended referrals for improved outcomes.