Is toe walking always a sign of trouble with kids?

My nephew also walks on his toes,also plays basketball,is an excellent student,very smart. I dont think his parents have taken him to a specialist but I know they have talked to his pediatrician about it,and he has never mentioned the child having ADHD,OCD,or any other condition. He is healthy in every way.He only walks on his toes,and they buy him hightops to support his feet. (shrug) Maybe someone with more info/knowledge about this can chime in.

Honestly I don't think it is. My DH and my son both did it and they are fine. My son actually and my daughter walk on the balls of their feet but my DH's mom said that when he was little he used to walk with his toes curled under - so on top of his toes. If she is a straight A student, no problem with other kids or paying attention and listening (as much as a normal kid does) I personally won't worry about it.
That is just my opinion.

If the toe walking is idiopathic, resulting from a shortened achilles tendon, then a child wouldn't necessarily have any other issues. This type of toe walking, while not indicitive of a more serious condition, does come with its own problems - if allowed to continue to toe walk, the contracture of the tendon (shortening of the achilles tendon) can become much worse, resulting in a permanent foot deformity. It sounds like your daughter's toe walking has not responded well to previous treatment and you are still somewhat concerned, therefore I would suggest that you seek out a second (or third) opinion from a pediatric physiatrist or orthopedist. Someone who has long standing experience working with children with disorders like CP, MD, etc. would be your best bet, b/c a doc w/extensive experience working with contractures is what you want. The doc may say do nothing, but better to know than not, and from an expert, kwim?

If she isn't showing any delays from walking on her toes then she's fine. A lot of kids grow out of it as they get older. I never found it to be an issue, other then more strain on the mucles and tendons. Just like as if she were wearing heals. Again though, I've known most kids to grow out of it. It's good she's playing sports, that shows that it doesn't set her back.

I thinking walking on the toes is a sensory thing. I don't think it necessarily means a disability. I have two boys with sensory issues, autism and visual impairment. Sometimes, but not always, they walk on their toes. My cousin walked on her toes and fidgeted all the time, rocking and stuff, but I don't think she was ever diagnosed with anything. If he has no other signs of an issue, I wouldn't worry about it.

Physical therapy isn't bad. If it could do her some good, take her. She may be able to control her muscles better with physical therapy.

My DD was diagnosed with PVL (periventricular leukomalacia) while in the NICU; it is often described as a pre-cursor to CP. She did physical therapy for 7+ years because she was a toe-walker; wore orthotics for most of that time (we opted not to do botox because we never felt she needed it), and is still evaluated on a yearly basis by an orthopaedic specialist just to make sure nothing funky is going on with possible leg length discrepancies or hip/spine alignment (so far, it's not). Nobody would ever suspect that she is considered to have CP (and we don't treat her that way) ... she is a straight A student, plays the viola, plays sports through our park district and on traveling leagues and is a perfectly normal 10 year old. She still is up on her toes most of the time but, in her case, it doesn't mean anything but that the muscles in her leg are a bit tight. I wouldn't worry unless you start to notice other problems.