Toe walking is quite common between the ages of 10 to 18 months when
the child is learning to take his first steps. However, if toe walking
persists beyond 18 months, it should be checked by a physician to see
if there is any problem. There are many causes of toe walking, but the
three major causes are as follows.
- Muscle spasticity in the Calf muscles, especially the Gastrocnemius
and Soleus muscles. This is often a manifestation
of Cerebral Palsy, due to anoxia (lack of oxygen) to the brain around
the time of birth. Other muscles in the body may also be affected, but
the calf muscles become tight over time, causing the ankle to be fixed
in Equinus (the foot points downwards). In the
early stages, a thermoplastic brace (AFO) may control the equinus, but
over time, surgery to lengthen the heel cord (Achilles tendon) is necessary.
- Congenital tight heel cords occur in some
children. There is no problem with any other muscles in the body. Only
the heel cords are tight. Could this be an isolated form of cerebral
palsy, or could the child be born with just tight heel cords? No one
knows. But the treatment is the same - use of a thermoplastic brace
(AFO) or surgery in the more severe cases.
- Habitual toe walking. Some children persist
in toe walking, even though examination reveals their heel cords are
not tight. When asked to walk normally with a heel-toe gait, they can.
But when not concentrating, they naturally get up on their toes. Nagging
does not help. Very often, the problem resolves by itself. In the more
persistent cases, using a thermoplastic brace (AFO) to enforce plantigrade
walking for 3 to 6 months may help.