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Toe Walking - Causes, Complications, and Management

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Walking on the toes or balls of the feet, also called toe walking, is fairly common in children who are just starting to walk. Read more about it below.

Written by

Dr. Leenus A. E

Medically reviewed by

Dr. Faisal Abdul Karim Malim

Published At June 23, 2023
Reviewed AtJune 23, 2023

Introduction

When a baby first learns to walk, unusual patterns are prevalent. As they develop and learn to walk, many young toddlers may exhibit an irregular gait for a while. Babies often begin walking around the time they are one year old. They then spend many years that follow refining their balance and leg strength. The age ranges listed below are typical for developmental milestones. However, some kids attend these developmental milestones earlier than others.

  • Babies begin to sit and roll over when they are about six months old.

  • The majority of babies begin to crawl at about nine months.

  • Around 9 to 12 months, infants begin to walk with assistance, but they cannot stand and walk without support.

  • At 16 months old, they can walk on their own.

Therefore, the typical developmental process for learning to walk excludes walking on the toes and progresses progressively to a heel-toe pattern, with a heel-toe gait acquired by age three.

What Is Toe Walking?

When a child walks on their toes or the ball of the foot rather than the heel or other areas of the foot, they are said to be toe walking. Children with this condition prefer to walk on the balls of their feet and do so consistently. They are otherwise neurologically and orthopedically normal.

A typical gait irregularity is toe walking, which is more prevalent in young toddlers just learning to walk. Most of the time, this gets better on its own without help over time. However, kids who first learn to walk properly before switching to walking on their toes or kids who have tight calf muscles or Achilles tendons should be examined by a doctor.

What Is the Cause of Toe Walking?

A kid may walk on their toes for several reasons, sometimes due to an underlying ailment and other times not. The condition can be due to the following:

  • A congenitally short heel cord, overactive calf muscle, or Achilles tendons.

  • Muscle tone imbalance.

  • Unknown central nervous system defects.

  • Autosomal dominant inheritance.

  • Delayed maturation of the corticospinal tract.

  • Times spent in baby walkers.

  • Habitual.

    • Causes associated with cerebral palsy.

    • Muscular dystrophy.

    • Associated with autism.

    • Childhood schizophrenia.

    • Delayed language development and

    • Low IQ (intelligence quotient).

If, however, there are no aberrant findings, the child is most likely suffering from idiopathic toe walking, which is characterized by a preference for toe walking rather than any other known cause.

How Is Toe Walking Diagnosed?

The diagnosis for toe walking gait in the ways listed below:

1. Physical Examination:

  • Assessing the child's gait, range of motion, and muscle tone.
  • Assessment of any neurologic abnormalities that could be contributing to toe walking.

2. History:

a) Prenatal history, including family and maternal history:

  • Obstetric history involves the number of pregnancies, miscarriages, birth weight, and health status of other children.

  • History of having taken any medicines during pregnancy.

  • Length of gestation.

b) Collecting information on intrapartum occurrences, including fetal heart rate, membrane rupture, labor time, maternal drugs, and other problems during labor and delivery, is important.

c) Postnatal history.

  • Fetal distress and hypoxic episodes.

  • Birth weight and length of hospital stay.

3. Gait Evaluation:

These observations are made with the child walking barefoot. A well-coordinated and balanced walk on toes. Ability to run on toes with no falls. Ability to walk forward and backward and to stand on heels.

How Can Toe Walking Be Treated?

Even while habitual toe walking is frequently seen as a temporary delay in a typical developmental stage, it is nevertheless linked to issues that call for urgent treatment. However, the following are some possible therapeutic alternatives:

  • Physical Therapy - Stretching to release the tight leg muscles at home.

  • Bracing - A custom brace to help stretch and encourage a flat foot position.

  • Serial Casting - To improve the foot and ankle position. Benefits improve with botox injection to help with tight muscles.

  • Lengthening - Provides the foot and ankle more range of motion and function. The tight Achilles tendon or gastrocnemius muscle is extended during surgery.

  • Shoe Therapy - The rigid-soled straight shoe prevents the child's metatarsal-phalangeal joint from dorsiflexing, preventing forefoot support and causing the heel to drop to the ground. A wedge can be added to the shoe to improve the sole's stiffness and cause foot abduction, which will further press the heels into the ground. Later, the heel height gradually decreased during subsequent visits over a few months. Frequently, rigid shoes are worn for between six months and two years.

The muscles at the rear of the lower legs of children with idiopathic toe walking are frequently tense when medical experts see them. Stretching, plaster casts or surgery is the most frequent treatments for this tightness.

What Are the Complications Associated With Toe Walking?

The child's calf muscles and Achilles tendons may contract even more due to persistent toe walking. As a result, the kid may find it difficult or impossible to walk flat-footed. Additionally, the kid can have restricted movement in their feet and ankles or trouble donning shoes or other footwear for some sports, including ice skating. If the toe walking is not corrected at the appropriate stage, musculoskeletal issues and other issues may develop as they mature into adults.

Can Toe Walking Be Prevented?

The condition has to be brought to the pediatrician's attention by the child's carer so that they can address it. Stretching the child's Achilles tendons as they age can lower the possibility of toe walking. Choosing shoes that fit well and provide adequate support can further assist.

Conclusion

The cause of the child's toe walking will determine how it can be corrected. Most children with idiopathic toe walking fully recover with therapy and learn to walk properly. They frequently do participate in sports and other leisure activities. Some kids, however, will walk on their toes even after therapy or surgery. Leg braces and other treatment options can be resorted to and will help correct this gait abnormality.

Dr. Faisal Abdul Karim Malim
Dr. Faisal Abdul Karim Malim

Pediatrics

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toe walking
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