Toe-walking is seen in many conditions such as cerebral
palsy, muscular dystrophy, and hemiplegia.
In these conditions, it manifests as a consequence of spasticity and/or
tightness of the calf muscles. However, toe-walking is also frequently seen in
children with autism and sensory processing dysfunction.
There are 3 primary causes of toe-walking:
·
Spasticity and/or tightness of the
tendo-achilles (tendon that attaches the calf muscle to the heel).
·
Decreased proprioceptive input through the calf
muscles.
·
Idiopathy.
Toe-walking secondary to decreased
proprioceptive input through the calf muscles is seen in the presence of
hypotonia. In my clinical experience, I have observed a strong correlation
between vestibular inefficiency, hypotonic muscle tone, and toe-walking.
Inefficient processing through the
vestibular system consequently leads to poor proprioception since there is a
close association between the two sensory systems. Toe-walking is a means of
gaining proprioceptive input through the calf muscles when there is low muscle
tone.
Many children with sensory
processing dysfunction do overcome toe-walking within a few weeks. However, if
it persists over months and beyond the age of 03 years, it takes longer and becomes
challenging to correct it through intervention. Since the brain adapts to any
behavior that persists, toe-walking that persists over years during childhood
then becomes a behavioral pattern of gait, i.e. the child becomes decreasingly
aware of his/her heels on the floor. Hence it becomes crucial to take corrective measures
as earlier as possible.
Treatment for toe-walking
When spasticity is the underlying
cause of toe-walking , the treatment approach is to reduce the spasticity and
improve the muscle flexibility through appropriate neuro-developmental techniques,
stretching, as well as possible use of braces.
When the underlying causes are
decreased vestibular processing and hypotonia , therapeutic activities targeted toward the same become the treatment
choice. Some of these are as follows:
·
Propel the scooter board in sitting.
·
Backward walking.
·
Pushing forward a heavy stroller/ toy cart.
·
Box-skating or walking in shoe boxes.
·
Squatting in a vertically placed barrel.
·
Rubbing foam on heels actively by the child to
encourage awareness of the heels.
·
Improving processing through the vestibular
system warrants a multitude of activities.
An evaluation by a physiotherapist is essential for
identifying the underlying cause of toe-walking, following which the
appropriate treatment should be decided.
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