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Common childhood orthopedic condition – Toe walking

What is Toe-walking?

• As would seem apparent with the name, toe walking is also known as walking on the toes of the foot.
• This condition is very common in kids especially for those who are just learning to walk.
• Not a cause to worry, most of these kids get rid of this habit as they grow.
• For parents, it is fine to ignore this in their children as long as their development is normal.

However, toe walking is sometimes due to:
• Cerebral palsy
• Muscular dystrophy
• Other generalized diseases that affects the nerves
• Disease that affects muscles
• Children with autism

When to see a doctor?

Notwithstanding what has been written above, if the toe walking is accompanied by conditions such as tight leg muscles and a lack of muscle coordination, then it is advised to consult a doctor in regards to this condition.

Causes of Toe-Walking

– A short Achilles tendon
• This tendon links the muscles in the lower leg and also links them to the back of the heel bone.
• If this link turns out to be too short, then the heel remains off the ground and this cause the person to walk on toes.

– Cerebral palsy
• Another cause of Toe walking is cerebral palsy, which is a disorder of movement.
• The disease is also a disorder of muscle tone or posture, which can be caused due to an injury or can be due to abnormal growth in the brain when it is immature.
• This problem originates mostly often before or around the time of birth.

– Muscular dystrophy
• Toe walking also is a problem when the affected person has muscular dystrophy.
• This is primarily a genetic disease and in this condition, the muscle fibers are susceptible to damage and also weaken over time.
• Unlike the other cases, in this case, the diagnosis is based on the present condition of walking, but the child might have walked properly in their childhood.

– Autism
• Toe walking is connected to autism (which is a complex group of disorders that affects a child’s ability to communicate) and gives rise to problems preventing the child from interacting normally with others.

Tests and diagnosis for Toe-Walking

• Toe walking can be detected through a physical exam.
• In addition to the initial exam, the doctor might do an in-depth gait analysis, with this examination being also known as electromyography.

Steps involved in the process of Electromyography?

• A thin needle having an electrode is inserted into a muscle in the leg.
• This electrode measures the electrical activity in the affected nerve or muscle.
After the results of the initial exam, the doctor may consider cerebral palsy or autism as the cause, then the doctor would recommend a neurological exam. Further, the doctor will do more advanced testing for developmental delays.

If toe walking is prolonged and not going away, it can be seen as a physical problem. After this, the following treatments may apply:
– Physical therapy advised in such cases:
• Gently stretch the leg and foot muscles of the child.
• This therapy in most cases would improve the child’s gait.

– Leg braces or splints
• Sometimes leg braces or splints help to achieve a normal gait.

– Serial casting
• If physical therapy or leg braces do not prove useful, then the next treatment is to try a series of below-the-knee casts.
• These shall progressively improve the ability to bring the toes toward the shin.

– Surgery
• The doctor may suggest surgery to lengthen the muscles or tendons which are at the back of the lower leg.
• This is suggested when all other treatments fail.

The Foot Book Clinical Pediatric Orthopedics The Foot: problems in podiatry and dermatology

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