Causes and risk factors
Causes of toe walking beyond age of 2 years include flat footedness, short tendoachilles which limits free movement of the ankle joint. It can be caused due to underlying disease condition called as cerebral palsy, children with disease have spastic hemiplegia, i.e. achillis tendon is short and tight that heel is pulled upwards and toe points downwards. Another type is idiopathic toe walking where cause is unknown but probably toe walking is due to habit. The condition can also be inherited.
Clinical presentation
The child with toe walking may have flat feet. [absence of plantar curves]. The child walks on toes most part of the time. He has stiffness of muscles, has uncoordinated gait. He stumbles on walking. Child has awkward and waddling gait. The child shows lack of development of fine motor skills like buttoning of shirt; tying shoe lace etc. the child loses motor skills which he already had. It appears as if the child can’t bear his own weight due to flat footedness. Risk factors include children with cerebral palsy, autism, are likely to have this condition.
Investigation
Medical history by the patient and Clinical examination by the doctor helps in diagnosis. Electromyography [EMG] is done. In case of underlying disease suspected by the doctor, tests like MRI, CT scan may be recommended. Tests for developmental delays may be performed.
Treatment
No treatment is required for patients who are toe walking due to habit. In case of underlying cause, physiotherapy is required. Mechanical aids like leg braces, splints, serial casting will also help in managing the condition. Surgery to lengthen the muscle or tendon is advised in cases where the above mentioned treatment fails.
Other Modes of treatment
The other modes of treatment can also be effective in treating toe walking if the cause is idiopathic. Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating toe walking.
