Idiopathic Toe Walking
Some children may walk on their tiptoes. This condition is called idiopathic toe walking. Tiptoeing is due to the several reasons. It is more common in boys. Even-though, most of the children may walk on tiptoes, majority of them walk on their heels down by the age of three years. All children still tiptoeing after 3 years of age needs to be evaluated, if not yet.
What may cause tiptoeing?
Even tiptoeing is habitual in most children, it should be evaluated. The children tiptoeing since the started to walk should be examined for cerebral palsy. Whereas the children who started to walk normally and tiptoe later in life need to be evaluated for muscular dystrophy , central, spinal, and peripheral nerve system disorders. Also, children tiptoeing on only one foot should be meticulously evaluated for limb length discrepancy and other neurological problems. If there is no underlying problems, it is called either as idiopathic toe walker or habitual toe walker.
What is done for evaluation?
Physical Examination is the main asset for evaluating tiptoeing. Habitual toe walkers show no signs of hypertonicity, normal deep tendon reflexes, normal muscle power, no pathological reflexes and no other abnormal neurological symptoms. Although the ankle range of motion is within normal limits in the beginning, some may develop limitation in dorsiflexion due to shortened heel cord.
If there is an underlying disease, treatment should be planned accordingly. Stretching and strengthening exercises are recommended in the beginning. Parents and household are warned no to address tiptoeing problem at all. It is important to follow this children for the development of Achilles tendon shortening. Because once the shortening develops serial casting for children younger than 4 years of age and surgical lengthening for the children older than 4 years of age. If there is no shortening, children may benefit from botox injection to break the habit.
do you see any recurrence in surgically treated cases?
No, I have not. As a matter of fact recurrence rate is very low after surgery.