Walking is such a notable milestone, and if it is not typical, it is often a concern for parents. Toe walking is walking on the toes or the ball of the foot. As long as your child is growing and developing normally, toe walking on its own is unlikely to be a cause for concern.Toe walking is sometimes the result of cerebral palsy, muscular dystrophy or another generalized disease of nerve and muscle. Children with autism also may walk on their toes or the balls of their feet.

Toe walking is a concern If child is still toe walking after the age of 2 years. Toe walking is always accompanied by stiffness in Achilles tendon and lack of muscle coordination Walks awkwardly, stumbles, or has a waddling gait, Cannot bear weight on flat floor.

Tardieu scale helps in assessing about the tightness and fixed contractures in the muscles around ankle joint thereby helps in planning the treatment protocol

If the distance between R1 and R2 is more and R2 is at end range of joint motion then physical therapy treatment like stretching of achilles tendon, serial casting it is a procedure which involves wearing a cast to stretch out the tendon. In most cases, the cast is applied every two weeks for a total of 6 to 8 weeks. Task oriented lower limb activity training plays a major role. If the distance between R1 and R2 is less and R2 is not at the end range and if the joint becomes very stiff sometimes surgery is indicated A dysfunctional vestibular system, a common problem in autism, may be responsible for toe walking. The vestibular system provides the brain with feedback regarding body motion and position. It may be possible to reduce or eliminate toe walking by providing the person with therapeutic vestibular stimulation (e.g., being swung on a glider swing).

Check out these links for
relevant information: Neurological physiotherapy, paediatric neuro.

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