Toe walking covers less than 1% of diagnoses when visiting the physiatrist. In this inadequate kinematics of walking, the child’s initial foot contact pattern is on forefoot, rather than common heel strike. For those children who nevertheless make heel contact on the surface their gait is often accompanied by biomechanical compensation, irregular posture, and lack of movement coordination. Toe walking can be embedded within the first developmental stage of bipedal walking. In most toe-walking children with a normal range of ankle movements spontaneous normalization of gait occurs. However, in some, toe walking persists, and clinical evaluation and treatment are needed. This clinical entity has a broad differential diagnosis and there is also a possibility of genetic inheritance. The diagnosis of idiopathic toe walking is made by exclusion. Sometimes a clear differentiation between idiopathic toe walking and other diseases associated with toe walking, like musculoskeletal, neurological diseases, or sensory information processing disorders, could be clinically challenging due to a similar clinical presentation. A sophisticated assessment of ankle biomechanics can be done in laboratories for quantitative gait analysis by applying systems based on an inverse dynamic approach and with wearable measurement systems. Numerous treatment modalities are limited in evidence-based praxis. The need for treatment and selection of an individual optimal modality should be based on clinical examination and quantitative gait analysis assessment in a laboratory equipped for this purpose. Toe walking covers less than 1% of diagnoses when visiting the physiatrist. In this inadequate kinematics of walking, the child’s initial foot contact pattern is on forefoot, rather than common heel strike. For those children who nevertheless make heel contact on the surface their gait is often accompanied by biomechanical compensation, irregular posture, and lack of movement coordination. Toe walking can be embedded within the first developmental stage of bipedal walking. In most toe-walking children with a normal range of ankle movements spontaneous normalization of gait occurs. However, in some, toe walking persists, and clinical evaluation and treatment are needed. This clinical entity has a broad differential diagnosis and there is also a possibility of genetic inheritance. The diagnosis of idiopathic toe walking is made by exclusion. Sometimes a clear differentiation between idiopathic toe walking and other diseases associated with toe walking, like musculoskeletal, neurological diseases, or sensory information processing disorders, could be clinically challenging due to a similar clinical presentation. A sophisticated assessment of ankle biomechanics can be done in laboratories for quantitative gait analysis by applying systems based on an inverse dynamic approach and with wearable measurement systems. Numerous treatment modalities are limited in evidence-based praxis. The need for treatment and selection of an individual optimal modality should be based on clinical examination and quantitative gait analysis assessment in a laboratory equipped for this purpose.