TOE walking refers to people who walk on their toes or the balls of their feet. This gait is very common in young children when they first learn to walk, but will usually stop by the age of five.

If a child continues with this gait after five, it is advisable that they are evaluated by a podiatrist or paediatrician. As long as your child is growing and developing normally, toe walking on its own is unlikely to be cause for concern.

Causes

There are five main causes for a toe-walking gait.

1. Habit

Idiopathic toe walking is when the cause is not due to a specific condition. Some people just habitually walk that way.

2. A short Achilles tendon

This is the tendon that links the lower leg muscle to the back of the heel bone. When it is short, it can prevent the heel from touching the ground. This can be due to congenital reasons, poor footwear, trauma, and arthritis.

3. Muscular dystrophy

This is a genetic paralytic disease where muscle fibres are susceptible to damage and weaken over time. In the case of this disease, most children would have started off walking normally and later on develop a toe-walking gait.

4. Cerebral palsy

This is a disorder of movement, muscle tone, spasticity, and posture. It is caused by injury or abnormal development in parts of the immature brain that control muscle function.

5. Autism

Toe walking has been identified as an early sign of autism. Autism is a complexed spectrum of disorders that affect a child’s ability to communicate and interact with others.

Persistent toe walking may increase a patients risk of falling and also result in the social stigma of a child if he or she is perceived as different by his or her peers. Diagnosis is based on a physical and neurological examination.

Treatment

As said before, most children will outgrow toe walking if there is no underlying pathology. If there is, this should be treated appropriately. Other treatment options include:

• Physiotherapy and stretching exercises.

• Leg braces, splints, orthotics, and shoe modifications.

• Serial casting: This is where a series of below-the-knee casts are issued to progressively improve the ability of bringing the toes towards the shin.

• Surgery: If conventional methods fail, surgery may be recommended to lengthen the muscles and tendons.

• Botox therapy can be used to paralyze the calf muscle. This reduces the opposition of the muscles and may stretch the Achilles tendon.

Angela Davis BSc (Hons) DPodM MChS is a podiatrist with offices in Montego Bay (293- 7119), Mandeville (962-2100), Ocho Rios (974-6339), Kingston (978-8392), and Savanna-la-Mar (955-3154). She is a member of the Health and Care Professions Council in the United Kingdom.