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BACKGROUNDCongenital vascular malformationsare uncommon and often asymptomatic.(1) Venous malformations are by far the commonest and can be localized or diffuse.(1) Idiopathic toewalking (ITW) is commonly reported in up to 12% of healthy children.(2) It is diagnosed after exclusion of central, neuromuscular, developmental andorthopaedic aetiologies.                       CASE REPORTA 13-year-old was referredbecause of toe-walking and increasing muscle cramps more marked on the right side.  This was first noticed on the right side when she was 3 years old. Subsequently, this had become bilateral but was still more noticeable on the right. A presumptive diagnosis of ITW was made. She underwent several stretching exercises and serial castings but without benefit. There was no significant birth, developmental, past or family histories. On gait examination, she had a persistent right-sided forefoot contact on the stance phase. She had a prominent right calf with enlargement of the lateral gastrocnemius muscle. She had a fixed right ankle dorsiflexion at about 10 degrees. The rest of the examination was unremarkable. Ultrasound scanning demonstrated a diffuse echogenic mass over the lateral aspect of the right calf. MRI revealed multiple cystic and tubular lesions infiltrating the posterior and lateral muscle group of the right calf with surrounding intervening fatty change and soft tissue oedema. This was in keeping with an extensive venous anomaly. DISCUSSION & CONCLUSIONThis vascular lesion had probably caused necrosis and fibrosis thus shortening the right gastroc-soleus complex. Vascular malformations should be included in the differential diagnosis of asymmetric toe walking.

toe walking; vascular malformation