Abstract
Toe walking is described by the incapacity to achieve heel strike during the stance phase of the gait cycle. When a child presents with toe walking beyond three years of age, a thorough evaluation is crucial. We report a case of a seven-year-old female presented with painless toe walking that started two years prior to presentation. Medical history and physical examination were unremarkable. Various investigations were done to rule out the central causes of tip-toeing. MRI revealed a 50x76x62 mm lesion within the posterior mediastinum extending through the left neural foramina of T6 that caused right-sided spinal deviation without spinal cord compression. MRI findings were suggestive of a tethered spinal cord secondary to ganglioneuroma. The tumor was excised surgically, and the patient underwent bilateral Achilles tendon lengthening using the hoke technique. Three months after surgery, with the help of physical therapy, both feet were in plantigrade, and the deformity was resolved. Moreover, the patient walked with normal gait, alignment, and full range of motion. Toe walking in children under three years of age is often viewed as a normal gait variant during the time of independent locomotion. However, it is important to rule out underlying causes when it persists beyond three years of age.