What it means?
Toe walking means child walks over the balls of their feet without the heels touching the ground. It usually involves both feet but sometimes only one feet can also be involved
Those children who walks on toes on one side may have underlying brain, nerves, muscles or bone alignment or limb length problems which requires further evaluation to find out the cause.
What causes it?
Child walks on toes both sides without any underlying cause could be idiopathic or Habitual toe walkers
Child having toe walking on one side could be due to unilateral clubfoot, leg length difference, hip dislocation, cerebral palsy, other neuromuscular condition.
Child walks on toes both side could be due to Charcot Marie Tooth disease, Autism spectrum disorder, cerebral palsy
How child will present like?
- Baby walks on the ball of foot since started walking
- Child may have frequent trip and fall due to walking on the ball of the toes
- Child may complain pain or fatigue in their legs, especially calf region
- Child will be able to stand with their heels flat on the ground when prompted but when walking or running they are typically on the balls of their feet
What are the tests required?
- Thorough details about birth history, developmental milestones, any history of pain or limping
- Child will be made to walk to assess the walking pattern, range of movements of hip, knee, ankle and foot, neurologic examination
- If the child have muscle or nerve differences then referral to a Pediatric neurologist is needed to assess any underlying neuromuscular or developmental cause
What are the treatment options?
- Child who toe walks on both feet have normal range of motion, typically do not need treatment
- Toe walking child with tight Achilles and calf muscles will require plastic braces or stretching casts followed by physical therapy
- Toe walking child with neuromuscular problem like cerebral palsy can be treated with Botulinum toxin A injections in calf muscles and can be combined with plastic braces or stretching casts if required
- Those children with toe walking not got corrected with conservative treatment may require surgical correction in the form of lengthening the Achilles tendon at the mid calf or ankle level
What will be outcome?
- Toe walking will not cause serious long term problems except skin callosity, stress fractures, foot or calf pain, muscle fatigue
- Majority of children with toe walking will resolves by age of 10 years
- Those children with toe walking secondary to underlying cause are at greater risk of persistent toe walking or return of toe walking after treatment. Hence these children require long term bracing and regular follow up visits with Pediatric Orthopaedic surgeon