A case studied in our second-year medical school curriculum involves a boy with a tip toe gait. The differential diagnosis includes “idiopathic toe walking”. My lovely wife, Jennifer, thought that this topic might be of interest to our dear readers. Here’s an explanation of what is known about this disorder from the introduction to a 2006 paper from Hemo et al in the Journal of Pediatric Orthopedics:
“Persistent tiptoe gait after the age of 2 years in children without discernible neurological or orthopedic abnormality is termed "idiopathic toe walking" (ITW). This diagnosis is made after other disease processes have been excluded. The most common cause of toe walking in childhood is cerebral palsy; however, the differential diagnosis of toe walking includes conditions such as muscular dystrophies, tethered cord syndrome, diastematomyelia, and other neuromuscular diseases. Typically, patients with ITW commence this toe-to-toe gait at the initiation of walking, which occurs at a normal age. There is a positive family history in about 30% of cases.
If left untreated, this pattern of gait has a tendency to persist, and although initially, there is full passive dorsiflexion, an equinus contracture develops with time.”
By the way, according to MediLexicon.com “diastematomyelia” is defined as “complete or incomplete sagittal division of the spinal cord by an osseous or fibrocartilaginous septum.”
Full reference: Hemo Y. Macdessi SJ. Pierce RA. Aiona MD. Sussman MD. Outcome of patients after Achilles tendon lengthening for treatment of idiopathic toe walking. [Journal Article] Journal of Pediatric Orthopedics. 26(3):336-40, 2006 May-Jun.
“Persistent tiptoe gait after the age of 2 years in children without discernible neurological or orthopedic abnormality is termed "idiopathic toe walking" (ITW). This diagnosis is made after other disease processes have been excluded. The most common cause of toe walking in childhood is cerebral palsy; however, the differential diagnosis of toe walking includes conditions such as muscular dystrophies, tethered cord syndrome, diastematomyelia, and other neuromuscular diseases. Typically, patients with ITW commence this toe-to-toe gait at the initiation of walking, which occurs at a normal age. There is a positive family history in about 30% of cases.
If left untreated, this pattern of gait has a tendency to persist, and although initially, there is full passive dorsiflexion, an equinus contracture develops with time.”
By the way, according to MediLexicon.com “diastematomyelia” is defined as “complete or incomplete sagittal division of the spinal cord by an osseous or fibrocartilaginous septum.”
Full reference: Hemo Y. Macdessi SJ. Pierce RA. Aiona MD. Sussman MD. Outcome of patients after Achilles tendon lengthening for treatment of idiopathic toe walking. [Journal Article] Journal of Pediatric Orthopedics. 26(3):336-40, 2006 May-Jun.