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Toe walking refers to a walking pattern where a child primarily tip toes or walks on their toes or the balls of their feet, without letting their heels touch the ground. This gait pattern is common in toddlers as they are learning to walk, but it typically resolves by the age of two. Persistent toe walking beyond this age can be a cause for concern and may indicate underlying medical or developmental conditions.
Causes and Risk Factors of Toe Walking
Idiopathic Toe Walking: In many cases, no specific cause is identified, and the child develops the habit of walking on their toes.
Shortened Achilles Tendon: Tightness or shortening of the Achilles tendon can make it difficult for the heel to make contact with the ground.
Neurological Conditions: Conditions such as cerebral palsy, muscular dystrophy, or spinal cord abnormalities can contribute to toe walking.
Autism Spectrum Disorder (ASD): Toe walking is sometimes observed in children with ASD.
Congenital Foot and Ankle Deformity: Conditions such as clubfoot may have associated ankle equinus (reduced ankle range), which leads to toe walking.
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Signs and Symptoms of Toe Walking
Walking on Toes or Balls of Feet: The most obvious sign is the consistent absence of heel contact with the ground while walking.
Difficulty Walking Flat-Footed: The child may struggle or refuse to walk with their feet flat on the ground.
Tight Calf Muscles: Persistent toe walking can lead to tightness in the calf muscles.
Balance Issues: Children may appear unsteady or have difficulty maintaining balance.
Frequent Trips and Falls
Delayed Motor Skills: Toe walking may coincide with other delays in gross motor skill development.
Treatment and Management of Toe Walking
The management of toe walking depends on the underlying cause and the severity of the condition. Early assessment and intervention are crucial to reduce the risk of long-term issues. Common treatment options include:
Physical Therapy: Stretching exercises for the calf muscles and Achilles tendon, along with strengthening exercises for the lower legs, can help correct the walking pattern.
Orthotic Devices: Customised insoles, ankle foot orthoses, or supramalleolar orthoses may be used to support the foot and encourage a flat-footed gait.
Shockwave Therapy: May be used to address soft tissue tightness.
Addressing Underlying Conditions: If toe walking is linked to a neurological or developmental condition, treatment will focus on managing the underlying issue.
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