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Chapter 55: Toe Walking in a Child

Christy L. Skura; Bach T. Ly

Description of the Symptom

Toe walking in the pediatric population is a developmental trait that is normal but can be considered pathological if it (1) persists beyond a certain age, (2) presents with a sudden onset, or (3) worsens over time. Toe walking is common in new walkers, and a child who normally walks with a heel-toe pattern may regress to toe walking in order to find greater stability when faced with a more challenging task such as carrying a large object while walking. This chapter describes possible causes of toe walking in a child.

Special Concerns

  • Clumsiness and weakness, especially proximally

  • Sudden onset

  • Signs of shunt (ie, ventricular-peritoneal shunt) malfunction and spinal cord tethering, such as nausea, vomiting, seizures, fever, decline in motor function, and change in affect

CHAPTER PREVIEW: Conditions That May Lead to Toe Walking in a Child
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CHAPTER PREVIEW: Conditions That May Lead to Toe Walking in a Child
T Trauma
COMMON
Post-traumatic weakness 1079
UNCOMMON
Traumatic brain injury 1080
RARE
Traumatic spinal cord injury 1080
I  Inflammation
COMMON
Not applicable
UNCOMMON

Aseptic

Inflammatory muscle diseases:

• Dermatomyositis 1077

Juvenile rheumatoid arthritis 1077

Septic

Not applicable
RARE

Aseptic

Inflammatory muscle diseases:

• Polymyositis 1077

Septic

Poliomyelitis 1079
M  Metabolic
COMMON
Not applicable
UNCOMMON
Not applicable
RARE
Not applicable
Va  Vascular
COMMON
Not applicable
UNCOMMON
Stroke 1079
RARE
Vascular malformation of the calf muscle 1084
De  Degenerative
COMMON
Not applicable
UNCOMMON

Muscular dystrophies:

• Duchenne muscular dystrophy 1078
RARE

Kugelberg-Welander disease (juvenile, Type III) 1078

Muscular dystrophies:

  • Becker muscular dystrophy 1078

  • Congenital myopathy 1078

  • Emery-Dreifuss muscular dystrophy 1078
Tu  Tumor
COMMON
Not applicable
UNCOMMON

Malignant Primary:

Not applicable

Malignant Metastatic:

Not applicable

Benign, such as:

• Syringomyelia 1084
RARE

Malignant Primary, such as:

  • Bone or soft tissue tumors of the lower extremity:

    • Ewing's sarcoma 1080

    • Langerhans' cell histiocytosis 1081

    • Leukemia 1081

    • Lymphoma 1081

    • Nephroblastoma (Wilms' tumor) 1082

    • Neuroblastoma 1082

    • Osteochondroma 1083

    • Osteoid osteoma 1083

    • Osteosarcoma (osteogenic sarcoma) 1083

    • Rhabdomyosarcoma 1083

    • Synovial sarcoma 1084

  • Spinal cord tumor 1084

Malignant Metastatic:

Not applicable

Benign:

Not applicable
Co  Congenital
COMMON

Clubfoot deformity (talipes equinovarus) 1076

Congenital tendo-Achilles contracture 1076

Idiopathic toe walking 1077
UNCOMMON
Tethered cord syndrome 1079
RARE

Hereditary motor and sensory neuropathy Type III (Dejerine-Sottas disease) 1077

Muscular dystrophies:

  • Congenital myotonic muscular dystrophy 1078
Ne  Neurogenic/Psychogenic
COMMON
Spastic cerebral palsy 1079
UNCOMMON
Sensory disturbance 1079
RARE
Not applicable

Note: These are estimates of relative incidence because few data are available for the less common conditions.

Common Ages at Which Toe Walking Presents in a Child
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Common Ages at Which Toe Walking Presents in a Child
APPROXIMATE AGE CAUSES
Birth to 3 Years

Bone or soft tissue tumor of the lower extremity

Clubfoot deformity

Congenital myopathy

Congenital myotonic muscular dystrophy

Congenital tendo-Achilles contracture

Emery-Dreifuss muscular dystrophy

Hereditary motor and sensory neuropathy ...

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