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What Is Toe Walking & Its Causes? What Is the Prognosis (Outlook) for Children Who Walk on Their Toes?

Introduction:

Toe walking refers to the abnormality commonly seen in the walking patterns of infants, characterized by the use of balls of their feet instead of their heels during the gait cycle (repetitive events of walking). The absence of proper heel-to-floor contact may cause deformities in the toes of the feet.

Overview of Toe Walking:

In most cases, toe walking in children does not cause any concern, and it is considered a normal part of their development and learning during the early walking stages. Most children usually start walking normally on their own without intervention. However, persistent toe walking needs to be evaluated .

What Is Meant by Idiopathic Toe-Walking?

Idiopathic toe-walking refers to toe walking in healthy children due to unknown reasons. This may include older children who continue to toe walk out of habit, behavioral reasons, or tightened tendon muscles due to prolonged toe walking. Many children develop the habit of toe walking due to unknown causes. This condition is called idiopathic toe-walking.

What Are the Causes of Toe Walking?

Some underlying conditions too may be associated with toe-walking in children which include:

  • Neurological Defects:
  1. Cerebral Palsy:Persons with cerebral palsy exhibit difficulty in movement and loss of balance during walking. This may result in stiff toe muscles, leading to the use of toe rather than feet during the gait cycle.
  2. Autism Spectrum Disorder (ASD):Autism is an inherited neurological disorder. Children with autism find it difficult to socialize and communicate and may develop habitual toe-walking.
  • Congenital Spinal Abnormalities:

Birth defects like congenital spinal abnormalities make it difficult to maintain the body’s balance, leading to toe walking in children.

  • Muscular Dystrophy:

Muscular dystrophy is an inherent genetic disorder that causes progressive weakening of muscles. As a result of muscle loss, weakening of muscle fibers, and posture changes, the affected child may start to toe walk to keep the body stable while walking.

  • Achilles’ Tendon Defects:

Achilles’ tendons are muscles connecting the calf muscle to the heel bone. Children with congenital abnormal foot structure or with short Achilles tendon muscles may toe walk.

What Are the Symptoms of Toe Walking?

The most common noticeable symptom of toe walking is the inability to walk with feet planted on the ground . The affected child may experience difficulty wearing shoes, participating in sports activities, and stabilizing the body while walking. Other symptoms include:

  • Stiffness of muscle tendons
  • Weakness or inability to walk flat
  • Difficulty in movements, such as running, sprinting
  • Tripping and falling too often

When to Consult a Doctor?

Fortunately, toe walking does not cause any life-threatening illness. It is considered a common learning stage of early walking in infants. In most cases, children begin to walk flat-footed with their heels touching the ground without any medical interventions.

However, if your child experiences chronic conditions of toe walking (beyond age 2 ) or a walking difficulty, or if toe walking recurs after a period of normal walking, it is advisable to seek immediate medical help.

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How is Toe Walking Diagnosed?

Your doctor or pediatrician will perform a general physical examination of your foot muscles, tendons, and skeletal structure to rule out any major medical issues. These physical examinations are usually enough to diagnose most toe-walking conditions. However, if the doctor suspects any other underlying condition, he/she may recommend further evaluation by specialized orthopedic surgeons or neurologists.

How Is Toe Walking Treated?

The treatment for toe walking largely depends on the foot condition and the affected person’s age. In mild and moderate cases, non-surgical options are followed. For severely deformed toe structures, surgical options are recommended.

1. Non-Surgical Methods to Treat Toe Walking:

  • Physiotherapy: For early, mild, and moderate cases of toe walking in infants, stretch exercises and gentle massage of the foot muscles might improve the walking pattern.
  • Leg Braces-Ankle-Foot Orthosis: An ankle-foot orthosis is a special kind of brace designed to support the ankle in the correct position. These braces reduce the pressure in toe muscles caused by prolonged toe walking. An ankle-foot orthosis improves the foot’s range of motion and helps relax foot muscles.
  • Medications- Onabotulinum toxin A: Onabotulinum toxin A is site-specific injection (acts only on the injected site). These are widely used to treat muscular hypertrophy (loss of muscle and weakness) in children. These injections are also used in combination with a leg brace to promote stretching of foot muscles.

2. Surgical Methods to Treat Toe Walking:

  • Surgery: Gastrocnemius Lengthening

Surgical treatment of toe walking is considered as the final option if other conservative treatments prove inefficient. Surgery for toe walking involves surgical lengthening of the Achilles tendon in the foot muscle. This lengthening of tendons promotes a greater range of motion and allows proper foot and ankle function.

What Complications Are Associated With Toe Walking?

Toe walking puts excess stress on the toe muscle. This prolonged pressure of body weight on the toe may cause Achilles tendons and calf muscles to tighten over time. This limits the normal range of the toe muscle,  leading to difficulty in walking.

How to Prevent Toe Walking in Children?

There is no standard prevention of toe walking as the child usually adopts normal walking over a period. Certain physical exercises and muscle stretching in children below six years of age may prevent the likelihood of adopting or practicing toe walking later.

Conclusion – Outlook and Prognosis:

The outlook largely depends on the extent of abnormality in walk patterns, foot deformities, and habitual causes. But most children with abnormal walking patterns (toe walking) improve over a period with medical assistance and lead a normal life with no walking difficulties. However, in some cases, toe-walking recurs after a period of normal walking.

Frequently Asked Questions (FAQS):

  1. How can I help my child  if he or she is walking on the toe?

If your child is experiencing any signs and symptoms of toe walking, the following practices may promote a heel-to-floor connection:

  • Stretching and gentle massage of the child’s foot improves blood circulation.
  • Encourage your child to practice bilateral foot jumping to improve the foot-to-ground contact.
  • When you observe your child toe walking, make sure to correct them. This prevents habitual toe-walking.
  1. Is toe walking a sign of ADHD?

Children with Attention Deficit Hyperactivity Disorder (ADHD) are highly susceptible to toe walking and Achilles shortening.

  1. At what age should toe walking stop?

Generally, toe walking in children stops on its own by the age of 5.

  1. What are some treatments generally suggested for toe walking?

Your doctor may suggest one of the following treatment methods,

  • Support braces
  • Surgery
  • Special leg casts
  • Botox injection
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