Toe movement in children

Parents often turn to Turner Children's Traumatology and Orthopedics Research Center. Questioning why their children walk on their toes is a common problem parents face at Turner Children's Traumatology and Orthopedics Research Center. In this article you will find answers to frequently asked questions about this pathology.

Toe walking in toddlers: treat or wait?

Young parents hear a lot of different, sometimes even contradictory, advice. Toddler tiptoe walking is no exception. Some say it's normal for a child to walk on their toes, while others insist it's a medical problem that should be treated urgently. MedAboutMe explains why both opinions are partially correct and when a child needs a doctor.

Why does my child walk on their toes?

If you notice that your child walks 'ballet-like' when he steps on his toes, you should not panic or ignore the phenomenon, but take a closer look. Children can run this way if:

• When they are just learning to walk – in the early stages almost all babies can walk on their toes.
• You have to pay attention to something that is high up.
• They experiment with their bodies and their gait.
• They are often placed in a walker in which the child does not reach the ground with the whole foot and gets used to walking on tiptoes without supporting themselves with the whole foot.
• Due to hyperactivity: Different types of walking help release excess energy. We wrote about other symptoms of hyperactivity in babies in a separate article.
• He likes it better this way. This is usually due to a family member paying increased attention to toe walking, and the baby changes his or her gait to attract this attention.
• Rarely, but it does happen: your child's shoes have an uncomfortable heel and it simply rubs against the foot.

However, if the child is tipping his toes not just occasionally but regularly, it's worth taking a closer look. Such a gait pattern can indicate the following:

• Hypertonicity of muscles due to neurological causes. It is most commonly caused by hypoxia before or during birth.
• Muscular dystonia. In healthy infants, it is relieved by encouraging active movement and massaging the legs.
• Muscle spasticity, an early symptom of cerebral palsy (infantile cerebral palsy).

Only a specialist can determine what is causing the swaying on the toes and whether something should be done.

Straightening of the fingers when walking and tiptoeing can be a sign of a serious neurological abnormality with impaired muscle tone. However, it should be borne in mind that such diseases are noticeable not only through a change in gait, but also through many other very noticeable symptoms.

Method for completely restoring gait

There is a method for completely restoring the movement of the muscles of the child's foot - the Nikonov method. It was developed by me, a doctor and myologist, and has been used successfully for 30 years. Exposing the muscles using the Nikonov method with fixation of the problem muscle eliminates the swelling of the foot muscles. As a result, they begin to stretch easily and painlessly. The child begins to walk on one full foot.

For detailed disclosure I have to write the opinions of pediatricians, pediatric neurologists and orthopedists, but with my comments..

Pediatricians and child neurologists believe that the cause of toe walking lies in childhood:

One of the defects is infantile spina bifida, in which the vertebrae do not completely enclose the serum nerves. A cervical spinal cord injury is associated with a number of problems. Such a child has learning difficulties, suffers from poor memory and has difficulty concentrating on an object. It is this crevice that causes the need to tiptoe.

My opinionThe only thing that affects a child's gait are their muscles. If the muscles were stretched normally, the child would walk properly, regardless of the damage to the spine. The cleft existed in the womb and the child's body 'strengthened' the muscles by swelling in order to be born alive. The swelling of the muscles prevents the baby's spinal bones from moving. Otherwise, the spinal bones would separate during birth.

When performing muscle manipulations using the Nikonov method on babies walking on their toes, I found that the diagnoses made by neurologists do not affect the muscle regeneration process.

The tension and relaxation of various muscles is necessary to maintain a certain body position.

Neurologists and orthopedists assume that the central nervous system controls the strength of tension and relaxation. The muscles respond to signals that come from the brain in the form of nerve impulses. If a muscle is very tense, the muscle becomes hypertonic, which from the neurologist's point of view can be recognized by the following symptoms:

1. The child assumes a bent position during all movements.
2. The arms are bent and brought towards the body or extended and rotated into the forearms with the palms facing down.
3. There is increased resistance to extension and flexion of the limbs during passive movements.

Disorders of the musculoskeletal system

Walking on tiptoes is one of the symptoms. Be particularly vigilant and consult a specialist if there is an accompanying problem:

• impairment of motor coordination;
• delay in language and/or mental development;
• autism spectrum disorders;
• Sleep disorders;
• Drowsiness or hyperactivity.
• Increased tension in various muscle groups;
• Gait disorders;
• Deformities of the feet and Achilles tendon.

Such disorders require treatment. Parents who do not consult a neurologist in a timely manner may find that their child's motor impairment has not changed. Even at an older age - after the age of five - walking on tiptoes did not stop.

Muscle dysfunction usually occurs as a result of negative effects on brain structures during pregnancy and childbirth. Symptoms can also occur after illnesses or vaccinations. If it is a pathology, it is difficult not to notice it. Parents who notice that their child is walking on tiptoes should check the condition of the feet and Achilles tendons and pay attention to their gait. If the child walks on tiptoes, this is completely normal and there are no signs of pathology.

How is the disorder diagnosed?

For an accurate diagnosis, you must first visit a neurologist. You can also go to a doctor who is an orthopedist and traumatologist. To make a diagnosis, a number of tests must be carried out:

MRI scans are performed not only of the brain but also of the spinal cord. It is important to obtain the clearest possible images of the brain to assess its condition. Movement disorders are usually associated with damage to various brain centers.

Once the diagnosis is made, the doctor will recommend treatment.

Why does my child walk on their toes? reasons

Toddlers under 3 years old are just learning to walk. They try to walk in different ways, including on tiptoes. Sometimes a child walks on tiptoes because the muscle tone in the legs is uneven when walking (dystonia).

Other causes of tiptoe walking:

• Frequent use of a stroller. In the stroller, the child learns to take his first steps on his toes and may have difficulty learning to place his foot in a different way again;
• High activity level. With excess energy, babies can walk on their toes;
• Thirst for knowledge, curiosity and the desire to grow faster;
• Imitation of mother in high heels, ballerinas;
• CEREBRAL PALSY. But there are other symptoms of this condition too;
• birth trauma affecting the child's brain (usually detected and treated long before the first steps);
• abnormalities in the part of the nervous system responsible for moving the body (pyramidal insufficiency);
• Psychological problems that arise from family problems. Due to the internal tension, the child unconsciously walks on tiptoes, as if crawling;
• If the child continues to walk on tiptoes at age 4 or older, a neurological disorder may be the cause;

In addition, children can walk on tiptoes after the age of 3:

Is it possible to stop your child from rocking on their toes?

Yes, this is possible if you do gymnastics with your child every day. Swimming, fitball classes and walking on orthopedic mats also work well.

Parents who are concerned that their child is constantly walking on their toes should see a pediatric neurologist. The specialist will determine whether there are symptoms suggestive of neurological abnormalities and, if necessary, prescribe tests.

If swaying on toes is related to muscular dystonia, the child needs more exercise - standing, climbing, crawling, duck walking, walking on all fours, on sloping and soft surfaces, barefoot.

Depending on the cause, the neurologist may recommend the following:

• physiotherapy, electrophoresis;
• baths with herbal teas (chamomile, succulent, thyme, lavender);
• remedial gymnastics, swimming;
• paraffin shoes (on medical prescription only);
• proper orthopedic footwear.

Many recommend massages that can be done at home. During the massage, parents should:

1. 'draw' the 'number eight' on the child's foot with the thumb;
2. caress the child's feet from the tips of the toes to the hips;
3. Rub the calf muscles with your thumb and forefinger;
4. Move your feet away from each other and then towards each other;
5. Roll the child on the fitball so that he steps on the ball;
6. Shake your baby's feet;
7. Massage each toe individually;
8. Tap the child's foot with your toes.

The decision about the need for exercise should be made in consultation with a pediatric neurologist. The doctor will assess the child's neurological condition and determine whether this type of walking is pathological or normal. However, physical activity will definitely not harm a healthy child. Don't forget that your child should have comfortable running shoes in the right size.

Walking on tiptoes in healthy children

Many parents notice that toe-walking occurs at certain stages of development, especially when infants are just beginning to learn this skill. This is a phase in the child's normal physiological development. A phase in the normal physiological development of walking..

Some infants take their first steps standing on all feet, but later they can still walk on their toes. This is because young children often tend to have increased calf muscle tension. If a child walks on tiptoes at the age of one and a half, doctors advise parents not to worry.

At the age of two The corticoparietal pathway that connects the cerebral cortex with the underlying structures of the nervous system is usually completed. The execution of motor actions is controlled via this pathway. At this age, the child should already be able to walk normally on one whole foot. If this is not the case and toe walking persists beyond the age of two, a pediatrician or pediatric neurologist should be consulted to determine the cause.

If toe walking continues past the age of two and beyond, there is no need to panic. Because the maturation of the nervous system is a complex individual process. Some children mature earlier. For others, this process takes up to 2.5-3 years.

Possible causes of impairment

Impairment can be caused by various factors, from the parents' desire to accelerate the child's development with help to the presence of a serious illness. The most common causes are listed below.

Disturbance of the natural development process

Some parents want to help their child by buying them special orthopedic shoes. orthopedic shoes for children who have just started walking. However, experts are very skeptical. They are convinced that orthopedic shoes disrupt the natural process of forming the arch of the child's foot and are not suitable for healthy infants.

Doctors believe that the use of walkers is another factor that contributes to toe walking in children. Baby walker. Parents usually use them to speed up their child's learning to walk. However, the end result is often the exact opposite.

Experts are now convinced that the use of baby walkers in healthy children impairs their normal development. Such devices are acceptable only if the child has some type of movement disorder. In all other cases, the use of a walking aid by a child whose arch is not yet ready for normal walking provokes a reflexive increase in muscle tone, which then leads to tiptoe walking.

Mental retardation

children with mental retardation can also walk on tiptoes. Researchers believe this is due to the immaturity of the cortical pyramidal tract, which controls the act of movement. In addition, these children are prone to certain compulsive movements, rituals and habitual activities, which include tiptoe walking. Here are some other habits that occur in children with developmental delays:

neurological disorders

In case of Neurological disorders Increased muscle tone has been present since the birth of the child. The increased muscle tone also affects other muscle groups. Such children often suffer from delayed motor development, impaired coordination and a number of other symptoms that are identified by a neurologist.

What conditions can cause valgus in a child?

In general, there are four groups of disorders that can cause valgus in a child: The cause lies in the brain.

The most common cause related to the brain is mild cerebral palsy. If the child has a complicated history, if he was born prematurely, was hypoxic, has delayed development.

For exampleA child who is not yet able to stand on his feet between one and a half and two years of age begins to walk and tiptoe at the age of two. If the ultrasound examination shows severe tone in the legs and enlarged cerebral ventricles, it is also necessary to consult a specialist - for example, a neurologist and an orthopedist. Neurologist and orthopedist, among others..

The cause lies in the area of the spinal cord:

1. – Congenital anomalies of the spinal cord, e.g. B. a spinal fatoma, a benign tumor that is often located in the lumbar region.
2. – Spina bifida (but not occulta L5-S1, which many people in the population have, but true vertebral discordance, sometimes with herniation at the level of the cleft).
3. – Immobilization of the spinal cord. The spinal cord itself is a tube of nerves that runs inside the vertebrae. If these nerves are compressed at any level, it can also cause toe-twisting.

However, there are many nuances. For example, if it is spinal cord fixation syndrome (the spinal cord is attached to the vertebrae), then as the child grows, the vertebrae stretch and the spinal cord becomes stretched, meaning it does not straighten as it should. This leads to gait disturbances.

Above all, urological disorders (urinary incontinence, fecal incontinence) are the most common. Sensation in the lower limbs is often reduced. These are earlier symptoms than toe walking. The cause lies at the level of the nerves that run from the brain to the muscles. The nerves are our lines to the muscles.

One of the largest groups of diseases are polyneuropathies. These can occur for a variety of reasons. One of the largest groups are the hereditary sensorimotor polyneuropathies, which also include Charcot-Marie-Tooth disease.

Diagnosis of the cause of toe walking

In most cases (around 90 %) the cause of toe walking cannot be determined. This is called idiopathic toe walking. However, in order to make this diagnosis, it is important to rule out the diseases mentioned above.

The MI Mechnikov Scientific and Research Center for Children's Traumatology and Orthopedics of the GI Turner Russian Ministry of Health recommends a special examination protocol:

• Ultrasound of the brain and lower back in children up to about 3-4 years of age,
• over 3-4 years – magnetic resonance imaging.
• Electroneuromyography – Tests that show the speed of impulse conduction along a nerve.
• Mainly blood tests for CPK, ALT, AST, LDH.

If the values, especially creatine phosphokinase (CPK), are in the tens of thousands, you should definitely see a neurologist and orthopedist.

As a rule, in 90 percent of patients who walk on tiptoes, the cause is unclear, but is usually related to increased anxiety.

Anxious children are at higher risk of developing toe walking - it's like a 'stuttering gait'. Toe Walking in Autism Spectrum Disorders According to the literature, up to 40 % of children with ASD have some form of gait disorder, including toe walking.

In most cases, children with ASD tiptoe because they walk too fast or are stereotyped. It is not yet known why children with ASD walk on their tiptoes. Parents often ask if it will pass. This is the case for some children, but not for others. Behavioral therapy can help with toe walking with ASD.

Should I buy a walking frame?

Over the years, adults have developed all kinds of walking aids to help a child learn to walk. Once upon a time, the walker - a special chair on wheels in which the child could sit by stretching his feet on the floor - was particularly popular among development products. By applying pressure to the toes, the child was able to gradually move around the room.

However, the debate about strollers continues to this day. There are parents who are convinced that this is how the baby learns to walk. However, this is not entirely true. This is the point to understand:

• The walker is strictly prohibited for children who sit only with support or not at all: the posture in this device has a negative effect on the development of the spine;
• the child is not safe in the stroller - never leave the child alone in this 'means of transport' (children can fall over, the child can get into the closet and reach for dangerous objects, etc.).

If you bought this product hoping that it would help your child learn to walk quickly, you may be disappointed. It is absolutely useless for teaching because it does not develop the necessary skills - it does not help train muscles, it does not help develop coordination, it does not teach balance. The only advantage of walkers is that the toddler is in the same room as his parents and does not ask for their hands because he can move around without help.

Important: More than 30 minutes in a baby walker is harmful! They put unnecessary strain on the spine.

What your child does when walking on tiptoes

As long as your child is still learning to take their first steps, toe walking is completely normal. It simply shows that the calf muscles are well developed. They are responsible for the movement of the foot. When the child supports himself on the floor, he automatically extends his foot and stands on his toes. All you need to do is give your child a special massage so that he can walk with his whole foot.

Sometimes walking on tiptoes indicates neurological problems - that's right. However, such problems do not only occur when walking; other worrying symptoms must also appear. If these do not occur, there is no need to worry. If they cannot be reassured, a pediatric neurologist should be consulted.

What are the causes of pyramidal insufficiency in childhood?

Pyramidal insufficiency in children is a symptom that occurs in various diseases of the nervous system. Other names for this condition include central or spastic paralysis, paresis and spastic ataxia. It occurs when a projection area of the cerebral cortex is affected. These are different areas of the brain that are responsible for muscle movements in different parts of the body. Based on the severity of the child's symptoms, the doctor can determine in which area of the brain the source of the disease is located.

Causes of spastic paralysis can be the following:

• Congenital anomalies of the nervous system;
• trauma to the fetal head during birth;
• Acute hypoxia during pregnancy or childbirth;
• Infectious lesions of the brain;
• abnormalities that result in abnormal outflow of cerebrospinal fluid from the ventricles;
• tumors or abscesses;
• bleeding that may result from premature birth or trauma;
• Meningitis – inflammation of the brain, inflammation of the meninges.

Acute hypoxia is dangerous for the baby. This condition can develop during pregnancy and childbirth. In cases of severe fetal distress, an emergency cesarean section may be necessary. However, surgery cannot always help. In severe prematurity, damage to brain cells occurs while the baby is being cared for in the neonatal intensive care unit. Low birth weight babies are more susceptible to brain hemorrhages, which can lead to damage to the pyramidal tract.

This can be caused by birth trauma or fetal hypoxia.

Birth trauma to the brain can also occur during a normal pregnancy. If labor begins too quickly and the fetus's head does not have time to reform as it travels through the birth canal, there is a high chance that it will be compressed by the bony structures.

Clinical manifestations

Spastic ataxia involves damage to the Betz cells or their axons, leading to muscle spasms and paralysis. The nerve cells produce excessive electrical signals. Muscle tension remains high, tremors and abnormal reflexes appear.

Any signs of muscle hypertonicity that appear before the age of 3 months are not considered pathological. On the other hand, reduced tone, the absence or underdevelopment of the grasp reflex indicate a pathology. Increased tone and most reflexes disappear with age. However, a neurologist may determine that they persist. This is an indication for careful examination and monitoring of the child.

Symptoms of spastic ataxia may include:

• trembling of the arms, legs, or chin;
• tilting the head back;
• tipping of toes when the child tries to sit on a table;
• Older children walk on their toes without heel support.

A 1-2 month old baby may have a chin tremor when stimulated. However, this symptom should not occur at rest or later in life.

Pyramidal insufficiency is often only recognized when the baby tries to move upright. Early symptoms include persistence of the Babinski tendon reflex at 2-3 months of age and the sudden return of tendon reflexes in the hands. A bad symptom is the slow disappearance of automatic walking or crawling, the Moreau reflex.

In healthy infants, the muscles on both sides are equally tense. If the child lies on his stomach, slightly bends his shins and feels the calf muscles, they are tense to varying degrees in the pathology.

Pyramidal insufficiency is a dangerous condition. Their consequences lead to a motor dysfunction syndrome that is difficult to correct. These children will sit, stand and walk later in life. The long-term consequences can be as follows:

Tiptoe – abnormalities

The causes of tiptoe walking are varied. Many inexperienced parents speed up their child's learning to walk by using a walker. However, many doctors are of the opinion that the walker in particular can interfere with the normal process of learning to walk. Standing prematurely in this way causes hypertonicity of the muscles, resulting in tiptoe walking. The walker is recommended for those with limited motor activity.

Abnormalities in mental development

In most cases, delayed mental development is due to the immaturity of the cortical pyramidal tract, which is responsible for motor activity. Such children are characterized by compulsive movements and the performance of habitual actions and rituals, which may include tiptoe walking. Such children also have habits like:

Neurological abnormalities.

If a child has developed the ability to walk, but does not stand on his heel, this is a reason to look for neurological abnormalities.

Premature babies are at risk, as are infants with birth trauma, hemolytic diseases and intrauterine infections.

The defect is also associated with abnormalities of the nervous and muscular systems.

• Hereditary symptom if one parent walked on their toes as a child;
• Shortening of the Achilles tendon (or heel) or calf muscle;
• Inflammation of the heel bone;
• psychological causes. Stress and hyperactivity lead to stimulation of the nervous system and can contribute to toe walking. This symptom occurs more often during periods of emotional tension.

Additionally, tiptoe walking can indicate autism and cerebral palsy in children. These disorders are accompanied by other symptoms. They are detected at the age of 1-2 years, when the child is just beginning to actively explore the world.

Toe walking in healthy children

Gait in children is developed before the age of 2, and if the child occasionally walks on tiptoes, there is no need for advice. The maturation of the neuromuscular system is a complex and lengthy process that lasts up to 2.5 years of age. If your child is still walking on their toes after this age, it is worth consulting a specialist, unless there are developmental abnormalities.

Only a pediatric orthopedist can diagnose a child's walking abnormality. Walking on tiptoes is normal and should not be a cause for concern in children:

• is developing and has no visible signs of developmental delay;
• occasionally walks on tiptoes
• is able to walk on toes or heels without experiencing pain or discomfort in the foot area;
• is able to control his movements but shows no coordination problems);
• is able to walk on toes with both feet at the same time;
• gradually improves his motor skills according to his age-appropriate physiology.

However, if toe walking persists for more than six months and the child has motor and developmental disorders, one should contact professionals: primarily the pediatrician, who will refer the child to a neurologist or orthopedist.

When should a toe walker be examined by a doctor?

Doctors typically recommend a visit to a pediatrician, neurologist, or podiatrist if idiopathic toe walking persists for more than three years. In this case, the doctor should assess the child's gross and fine motor skills and determine whether toe walking has damaged the Achilles tendon and calf muscles.

If the doctor finds that toe walking is harmful to the child's health and development, he or she may recommend physiotherapy, exercise and massage and, in extreme cases, refer the child for surgery.

If other neurological syndromes are present, a diagnosis is also made to rule out autism and cerebral palsy.

However, toe walking is not always without a cause. What conditions can be a sign of this?

Unfortunately, toe walking is not always harmless and can be a symptom of a muscle disease or a specific nervous system disorder.

• Research shows that toe walking (along with heel walking) may be one of the manifestations of autism and autism spectrum disorders. A Swedish study of 1,400 children found that 41 percent of children with ASD walked or ran on their toes.
• Walking on tiptoes after age six can be a sign of shortened Achilles tendons or calf muscles. The condition is treated surgically, but researchers believe treatment could also be non-invasive in the future.
• Toe movements, incoordination, and motor deficits can be a symptom of periventricular leukomalacia, a form of lesion of the brain's white matter that occurs in premature babies.
• Toe movement may be a mild form of cerebral palsy in premature babies.

As already mentioned, all of these diseases are inevitably accompanied by other symptoms and must be monitored by doctors.

• Causes of tiptoe walking in babies.
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