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On Call: Walking on Tiptoes

Q. My 5-year-old stepson walks on his tiptoes a lot. Now he's complaining that his shoes hurt. Could there be a problem?

A. Yes, especially if he's complaining of pain. I've had little patients who walked on their tiptoes simply out of habit, but doing it can also be, in rare instances, a sign of a neurologic or muscle problem. So if a parent mentions to me that her child is toe walking, I always have them come to see me.

I check to see if the child can walk with her feet flat on the floor (I get more worried if she can't), and look carefully at her muscles and reflexes to see if anything seems abnormal. If it does, I do some testing (blood tests or radiologic tests like an MRI, depending on the circumstances) and may refer her to an orthopedist or neurologist.

Chances are, your stepson's fine. But even if it's just a habit, he may need physical therapy to help him walk normally and to ease his discomfort, which is most likely coming from his shoes' rubbing against his feet. So either way, it's definitely worth a trip to the doctor.