Toe Walking
A 4-year-old boy is brought by his parents because he walks on his toes. He has done this since starting to walk at 13 months. He can walk with a heel-toe gait when asked but prefers to toe walk. He is otherwise developmentally normal, participates in sports, and has no history of prematurity or neurological concerns. Examination reveals full passive ankle dorsiflexion beyond neutral with the knee extended, normal muscle strength, and no spasticity or clonus. Regarding idiopathic toe walking (ITW) and its management:
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Idiopathic toe walking is a diagnosis of exclusion in children who habitually walk on their toes wit...
Key examination findings that support ITW over pathological causes include: ability to achieve heel-...
All children with toe walking require MRI of the brain and spine to exclude neurological causes; ele...
The differential diagnosis of toe walking includes cerebral palsy (spastic diplegia), muscular dystr...
Initial management of ITW with maintained passive dorsiflexion includes observation, parental reassu...
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