Toe walking can be seen in an average of up to 15 percent of children. Bilateral toe walking is 30 percent familial and usually begins before the 18th month and resolves before the age of 3; This group accounts for the majority of cases. However, there may be many serious reasons for tiptoe walking.
In case of unilateral tiptoe walking, problems such as leg shortness, unilateral hip dislocation, unilateral nerve, muscle and tendon problems, and unilateral brain damage are evaluated while bilateral fingertip walking is evaluated. The first condition to be excluded in walking is cerebral palsy. Cerebral palsy is a disease that affects the nervous, muscular and skeletal systems and occurs as a result of damage to the developing brain during pregnancy, birth or the immediate postnatal period. Gait is impaired due to spasticity (excessive contraction) in the muscles, weakness, balance and coordination disorders, joint stiffness and deformities. Another important disease in which bilateral toe walking can be seen is the muscle disease called muscular dystrophy. The first symptoms usually appear between the ages of 2 and 5. While a slight drop foot gait is observed in the early period, toe walking is added to this in the late period. Apart from these, bilateral toe walking may be observed in spinal cord compression and some neuropathies.
Children with toe walking should be evaluated in detail by physical therapy, orthopedics and, if necessary, pediatric neurologists.
Treatment. Although it varies depending on the diagnosis and duration of diagnosis, it is evaluated how long the toe pressing has been present, whether deformity and limitation of movements have started in the ankle, and if the ankle is flexible, frequent repetitive and long-term stretching exercises for the calf muscles, relaxation for spastic muscles, and strengthening of weak muscles are evaluated. exercises are given. In cases resistant to exercise, long boots and orthoses, serial casting methods and botox treatment for shortened muscles may be recommended. In cases that cannot be resolved with these methods, various surgical methods are applied.
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