Paediatric orthopaedics: idiopathic toe walking: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Paediatric orthopaedics: idiopathic toe walking

Sample item

A 3-year-old has walked on tiptoe since starting to walk. Neurological examination and development are normal, she can stand flat-footed on request, and ankle dorsiflexion is full. What is the best initial approach?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Observation, with stretching if tightness develops

Idiopathic toe walking is a diagnosis of exclusion in a developmentally normal child with full range at the ankle, and it often resolves. Initial management is observation, with stretching, casting or botulinum toxin considered if contracture develops. Surgery is rarely needed.

Option by option

  • A. Botulinum toxin injection

    Toxin is an adjunct for persistent tightness, not the first step in a supple foot.

  • B. MRI of brain and spine

    Neuroimaging is not needed when examination and development are normal.

  • C. Immediate Achilles tendon lengthening

    Surgical lengthening is reserved for fixed contracture after non-operative treatment fails.

  • D. Observation, with stretching if tightness develops (correct)

    Correct. A neurologically normal child with supple ankles is observed first.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, Observation, with stretching if tightness develops. Idiopathic toe walking is a diagnosis of exclusion in a developmentally normal child with full range at the ankle, and it often resolves.

Why is "Botulinum toxin injection" not the answer?

Toxin is an adjunct for persistent tightness, not the first step in a supple foot.

Why is "MRI of brain and spine" not the answer?

Neuroimaging is not needed when examination and development are normal.

Why is "Immediate Achilles tendon lengthening" not the answer?

Surgical lengthening is reserved for fixed contracture after non-operative treatment fails.

What concept does this question test?

It tests Paediatric orthopaedics: idiopathic toe walking in Orthopaedics. Initial management is observation, with stretching, casting or botulinum toxin considered if contracture develops. Surgery is rarely needed.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric orthopaedics: idiopathic toe walking?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.