Question
Why is it essential to screen for other medical conditions in children who toe walk?
Answer
Toe walking can be a symptom of various neurological, orthopedic, and genetic conditions, making differential diagnosis a critical component of evaluating children with persistent toe walking. While ITW is a diagnosis of exclusion, a thorough assessment is necessary to rule out conditions such as cerebral palsy, muscular dystrophy, tethered cord syndrome, hereditary spastic paraplegia, and sensory processing disorders. Screening for upper and lower motor neuron signs, abnormal deep tendon reflexes, and unilateral or asymmetric toe walking is essential in identifying children who require further medical evaluation.
Several red flags warrant immediate referral, including late-onset toe walking after age three, loss of motor skills, regression in gait function, bowel or bladder dysfunction, and abnormal muscle tone. Additionally, a family history of hereditary neuropathies, unexplained weakness, or difficulties with standing from the floor may indicate an underlying neuromuscular disorder such as Duchenne muscular dystrophy or Charcot-Marie-Tooth disease. Early identification of these conditions is critical, as many benefit from early intervention, targeted therapies, or medical management to optimize functional outcomes and prevent long-term complications.
This Ask the Expert is an edited excerpt from the course, "Idiopathic Toe Walking: Part 1," presented by Sally Le Cras, PT, DPT, PCS.
