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We are a little concerned but not sure what to say or do. Our little granddaughter has been up and walking for a year now. She's two and a half years old and still walking up on her tip toes. Is this normal? Should we say something about getting it checked out? We try not to interfere but it seems too odd to ignore.

Occasionally, a child will learn to walk up on toes rather than the more typical heel-toe pattern we are used to seeing. It's not really something to be concerned about unless it continues as the child gets older. Children who are still toe walking after age two should be evaluated more closely by their pediatrician or perhaps even referred to a specialist such as an orthopedic surgeon. There are many possible causes for this type of persistent gait (walking) pattern. The list includes muscular dystrophy, cerebral palsy, autism, spina bifida, and even schizophrenia. Other possible causes have been reported such as a general ("global") developmental delay, leg length difference, or a neurologic disorder known as Charcot-Marie-Tooth disease. Most of the time, the condition is referred to as idiopathic, in other words: cause unknown. The diagnosis may take some time as the physician examines the child, considers the history, and conducts some specific tests. The calf muscle will be tested for tightness called a contracture. A neurologic exam will be performed. Although toe walking in young children can be a sign of a true developmental problem, most of the time, it is not. That's when it's referred to as idiopathic toe walking. Idiopathic toe walking is just one of those things adults can't explain and kids outgrow. In cases where it persists past age two, efforts should be made to lengthen the calf muscle. This can be attempted first with a conservative approach with surgery as the backup plan. Children with an underlying neuromuscular or neurologic cause for their toe walking may be treated differently. Depending on your relationship with your adult children (the parents of the child), you may be able to at least bring up your concern. It's possible they have already been to the doctor's for this but don't want to worry you. Asking if the pediatrician has said anything about the cause of the walking pattern may open the door for further communication.

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