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TIP TOE WALKING IN CHILDREN
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Toe walking

During normal developmental mile stones child usually starts walking by 12 to 15 months of age. As children learn to walk they try different postures and patterns of walking. Tip toe walking might be a part of this normal development. Children as they reach age of two years they walk with their feet flat on the ground and by the age of 3 years they walk with heel to toe pattern.

Definition:

Toe walking refers to pattern of walking in which the child walks on the ball of their feet and the heel is not in contact with ground.

Normal developmental variation:

Parents need not to be worried with toe walking till the age of two years. Some children walk on toes till the age of 5 years which is mostly due to habit of previous walking or for fun. This is also referred to as Idiopathic toe walking. Toe walking beyond five years should be properly evaluated.

Specific causes of toe walking:

Short Achilles tendon

Cerebral palsy

Muscular dystrophy

Generalised neuromuscular diseases

Autistic child

When should you consult orthopaedic Surgeon:

    -Toe walking chronic above 2 to 5 years of age

    -Walking awkwardly

    -Tripping and falling of often

    -Uncoordinated gait

    -Delay in other developmental mile stones

    -Other associated health problems

    -Recurrence of toe walking after a period of normal walking

Evaluation:

    -Examination by paediatrician to rule out any major medical issues.

    -Examination and evaluation by orthopaedic surgeon for tight Achilles tendon, any other muscle, soft tissue contractures and nerve problems

    -Examination of Neurologist to rule out neuromuscular disorders.

Long term implications of Toe walking:

    -Prolonged toe walking causes tightness in Achilles tendon

    -Ankle pain and stiffness

    -Toe deformities

Management:

    -Initial management include gradual stretches of Achilles tendon (physiotherapy)

    -Gait training in bigger children

    -Medications: Muscle relaxants can help

Surgical management:

-In some children with tight Achilles tendon surgery to lengthen it is done – Usually after 6 years.