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Toe Walking as the First Sign of a Developmental Problem
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Posted on: 05/22/2012
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Occasionally, a child will learn to walk up on toes rather than the more typical heel-toe pattern we are used to seeing. It's not really something to be concerned about unless it continues as the child gets older. Children who are still toe walking after age two should be evaluated more closely by their pediatrician or perhaps even referred to a specialist such as an orthopedic surgeon.
There are many possible causes for this type of persistent gait (walking) pattern. The list includes muscular dystrophy, cerebral palsy, autism, spina bifida, and even schizophrenia. Other possible causes have been reported such as a general ("global") developmental delay, leg length difference, or a neurologic disorder known as Charcot-Marie-Tooth disease.
Most of the time, the condition is referred to as idiopathic, in other words: cause unknown. The diagnosis may take some time as the physician examines the child, considers the history, and conducts some specific tests. The calf muscle will be tested for tightness called a contracture. A neurologic exam will be performed.
More advanced testing such as EMGs (electromyography) of the muscles and computerized gait analysis may help identify unusual patterns of muscle activation. In the case of true idiopathic toe walking where there is no neuromuscular or neurologic problem, treatment depends on the age of the child. For example, children who have not reached their second birthday may just be observed carefully. It is possible that over time, the child will start to walk more normally.
After age two, then the condition of the muscles is rechecked. If there is no contracture, the child may be helped by stretching exercises. Casting the leg or wearing a special brace may help as well. When the muscle is contracted and the ankle cannot move past neutral, then surgery to lengthen the muscle may be advised. Surgery may also be required when conservative care with stretching and bracing or casting hasn't worked.
In summary, although toe walking in young children can be a sign of a true developmental problem, most of the time, it is not. That's when it's referred to as idiopathic toe walking. Idiopathic toe walking is just one of those things adults can't explain and kids outgrow. In cases where it persists past age two, efforts should be made to lengthen the calf muscle. This can be attempted first with a conservative approach with surgery as the backup plan. Children with an underlying neuromuscular or neurologic cause for their toe walking may be treated differently.
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References:
Matthew E. Oetgen, MD, and Sean Peden, MD. Idiopathic Toe Walking. In Journal of the American Academy of Orthopaedic Surgeons. May 2012. Vol. 20. No. 5. Pp. 292-300.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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