Published in: Today Digital
Author: Dr. Ivette C. Reynoso, Medical Rehabilitation, Physical Medicine and Rehabilitation Management of the General Hospital of the Plaza de la Salud.
Today we see in our daily practice cases of children with this type of walking, which is of great concern to parents because they do not know the cause and what this may cause in the future for their child.
The march of tips is the way of walking that a small child can present during his first years, in which we literally see him walk with the tip of his feet or with his fingers, almost at all times, particularly when he tries to run. This characteristic is relatively common and can be considered normal until three years of age.
Most children start walking between twelve and fifteen months of age, and with heel support, at around 18 months. In the early stages of walking, children often put their feet in different positions to walk.
The fact of walking on the tips of the feet without contact between the heels and the ground, is called "walking on tiptoe". This attitude is frequent, especially in the first months of the learning of the march or in the six months after the start of the march. A 7 - 24% of the children population presents tiptoe walking without association with neurological problems, especially in males (68%).
With growth, most adopt a normal gait pattern.
What causes it? Toe walking may be due to many causes.
The most frequent is the idiopathic walking or "idiopathic walking toe", which describes children who walk on the tips of their feet without cause or known pathology, although reduced flexibility in the ankle joint has been demonstrated.
There seems to be a hereditary component with a family history of up to 32-34%. These are otherwise healthy children with normal development. It always occurs symmetrically, on both feet.
But it can also be due to other causes, some of them serious, such as ligament injury (shortening of the Achilles tendon), muscle problems, spinal pathologies, neurological causes (cerebral palsy, autism, etc.).
The clinical history includes:
- Family history of idiopathic tiptoeing in parents, uncles, brothers or cousins. There is a relationship between idiopathic tiptoe walking and various risk factors.
- Biological, neurological and sensorial, visual or auditory risk.
-Weight at birth, low or very low weight, prematurity, characteristics of childbirth and possible complications.
- Bladder, day, night and anal control; Start of crawling, the march.
-Gateo or creep at some point in its development and how to do it.
-User's use of walker or any device to favor the march during the first stages of the same.
-Torpeza, parents' perception of frequent falls or clumsy and uncoordinated appearance with respect to children their age.
Other developmental disorders, such as PDD (generalized developmental disorder) or ASD (autistic spectrum disorder) can affect the development of gait.