Toe Walking (Child Development Service)

Child Development Service

Useful Management Information

  • For children older than 3 years of age, with ankle range of motion <-10 degrees passive ankle dorsiflexion range (tested with ankle in subtalar neutral position with knee extended) who have been assessed and are appropriate for serial casting can also be managed in the private sector.
  • Early referral is essential as children older than 3 years of age. Boney alignment, especially in the foot, is at a greater risk for deformities prior to the age of four.
  • Skeletal changes are less likely to respond to intervention after four years of age.
  • A child's balance reactions and stability strategies are consistent, reliable, and predictable at the age of 3, therefore, a walking pattern is much less likely to respond to intervention after that age.

Clinician Resources:

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?
Category 1 (appointment within 30 calendar days)
  • No category 1 criteria
Category 2 (appointment within 90 calendar days)
  • For children under 3 years of age, the child has a persistent pattern of toe walking (50-100% of the time) that has been present for greater than 6 months after the commencement of independent walking
  • Asymmetrical toe walking or any neurological concerns
  • Children older than 3 years of age, where there is a functional deterioration affecting safety and development of motor skills (e.g., frequent falling)
  • Children with difficulty standing on flat feet
Category 3 (appointment within 365 calendar days)

Recommended to be seen within 90 - 180 calendar days

  • Children older than 3 years of age (up to the commencement of school) with:
    • Persistent pattern of toe walking (50-100% of the time)
    • Passive ankle dorsiflexion (0o or less) that is affecting function (e.g., multiple falls, difficulties with squatting) and motor skill development. The child may be unable to walk on their heels, or actively dorsiflex ankle beyond neutral

Recommended to be seen within 365 calendar days

  • For children referred over 3 years of age with full range of motion who have a persistent pattern of toe walking (50-100% of the time) who have motor skill delay or multiple falls

If your patient does not meet the minimum referral criteria

  • Assessment and management information may be found on a range of conditions at HealthPathways
  • If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Essential Referral Information

  • Family history of toe walking
  • Age of onset / duration of persistent toe walking
  • Percentage of time in toe walking
  • Muscle range of motion limitation
  • Any previous management for persistent toe walking, and if family were able to follow on with suggested ongoing treatment
  • Any previous medical investigations (e.g., Creatinine phosphokinase (CPK)
  • Balance / history of falls (e.g., multiple times a day)
  • Presence of pain
  • Spine examination abnormalities
  • Presence of leg length discrepancy

Additional Referral Information

  • History of use of any baby walkers, jolly jumpers etc.
  • Type of shoe/orthoses used by child
  • Calf size
  • Participation impact for child
  • Gait assessment description
  • Any functional impact information
  • Are there any sensory processing concerns that may need referral and assessment by an Occupational Therapist.
  • Are there are visual concerns that may need referral to Ophthalmologist
  • Are there any vestibular concerns (e.g., gets car sick frequently, loves spinning)
  • Is there any sensitivity to sensory stimulation (e.g., dislikes having their feet touched)
  • Although rare, need to exclude any other significant conditions (e.g., muscular dystrophy and cerebral palsy)
Last updated 7 December 2021

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Child Community Health MO Account: GQ4215000TL HL EDI: qldcomch

Internal Referrals


(07) 5687 4497


Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215


(07) 5687 9141

Related HealthPathways

No directly related pathways found

Service Availability

Dr Francoise Butel
Medical Director Children's Community Health


Gold Coast University Hospital
Southport Health Precinct
Palm Beach Community Health Centre
Helensvale Community Health Centre
Upper Coomera Child Health
Early Years Centre Coomera Springs
Norfolk Village State School Health & Education Hub

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Child Safety

If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, contact Department of Children, Youth Justice and Multicultural Services . Please consider if mandatory reporting applies.

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