Toe walking in children
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Toe walking, commonly seen in early walkers, usually resolves on its own as children mature. However, if it persists beyond toddlerhood, it may become habitual. Generally, as long as a child is progressing normally in growth and development, toe walking is typically not worrisome. Yet, in some cases, it may be associated with conditions like cerebral palsy, muscular dystrophy, or autism spectrum disorder.
Symptoms
Toe walking, characterized by walking on the toes or ball of the foot, should prompt a discussion with a doctor if observed in children beyond the age of 2. It is advisable to seek medical attention sooner if additional symptoms such as tight leg muscles, Achilles tendon stiffness, or lack of muscle coordination are present.
Causes
Toe walking typically develops as a habit when a child learns to walk. However, in some cases, it may be caused by underlying conditions such as:
- Short achilles tendon: This tendon, connecting lower leg muscles to the back of the heel bone, may be too short, preventing the heel from touching the ground.
- Autism: Toe walking has been associated with autism spectrum disorders, impacting a child’s communication and social interaction abilities.
- Muscular dystrophy: In this genetic disease where muscle fibers are prone to damage and weaken over time, toe walking may occur, especially if the child initially walked normally.
- Cerebral palsy: A disorder affecting movement, muscle tone, or posture due to injury or abnormal development in parts of the immature brain controlling muscle function can lead to toe walking.
Risk factors
Habitual toe walking, referred to as idiopathic toe walking, can occasionally have a familial tendency.
Diagnosis
During a physical examination, toe walking may be noted, prompting further investigation such as gait analysis or electromyography (EMG). EMG involves inserting a thin needle electrode into a leg muscle to measure its electrical activity, useful in diagnosing conditions like cerebral palsy or autism. If developmental delays are suspected, neurological exams or testing may also be recommended by the doctor.
Treatment
If your child is habitually toe walking, no specific treatment is usually required, as they are likely to naturally outgrow this habit. Your doctor may choose to observe your child’s gait during regular office visits.
In cases where a physical issue is causing toe walking, potential treatment options may involve:
- Leg braces or splints: These aids may be beneficial in encouraging a more typical gait.
- Physical therapy: Delicate stretching of the leg and foot muscles can potentially enhance your child’s walking pattern.
- Serial casting: If physical therapy or leg braces prove ineffective, your doctor may propose a series of below-the-knee casts to gradually enhance the ability to flex the toes toward the shin.
- Onabotulinumtoxin: Injections into the calf muscles are occasionally utilized to support the development of a normal gait.
- Surgery: If conservative treatments are unsuccessful, surgery to lengthen the muscles or tendons in the back of the lower leg might be recommended by the doctor.
If toe walking is linked to cerebral palsy, autism, or other issues, the treatment centers around addressing the root cause or underlying condition.
