Toe Walking – FAQs

Toe Walking – FAQs

Q. My 2 and ½ year old daughter is toe walking since she was 1 year and 3 months. I am concerned. Please advise.

When a young child begins to walk, toe walking is common and is considered within a broad range of normal, particularly when the child can stand with his foot flat when not walking. During normal gait development, “heel strike” (1st event in gait cycle) should occur by the age of 3 yr. It is very natural for the parents to assume that persistence of toe walking is just a force of habit and nothing else. That is fine in the 1st two years of life but persistence beyond 3 years needs to be taken seriously. One needs to rule out medical causes before attributing the condition to mere habit. A thorough assessment in form of a detailed history and a physical examination is necessary. In persistent toe-walking, neurological causes like mild cerebral palsy need to be ruled out. The other possible reason for this can be a shortened tendo-achilles tendon/ heel cord, which pulls the ankle and foot down (plantar flexion). When no cause is found for this, it is termed as ‘Idiopathic’. The condition thus, is called “Idiopathic Toe Walking” and may have been present in the older family members in their childhood. Basis of treatment in both is to correct the deformity around the ankle and maintain it to allow a normal heel-toe gait pattern.

One starts by stretching the tendo-achilles at regular intervals, using short-leg casts after stretching to maintain correction initially; followed by orthotic/brace support. In Idiopathic cases, surgical lengthening of heel cord is generally delayed for several years and is the last resort. The condition is known to take a long time to respond and patience needs to be in abundance. For toe walking due to mild cerebral palsy (CP), a proper rehabilitation program (physical and occupational therapy) in addition, needs to be tailored for the patient. As CP itself cannot be eradicated, its effect on lower limb joints needs to be monitored during growth, and managed accordingly.

You are please advised to seek appointment and consult.

Dr Ramani Narasimhan Senior Consultant Pediatric Orthopaedic Surgery Indraprastha Apollo Hospitals, New Delhi E mail:
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