Transient dystonic toe‐walking: differentiation from cerebral palsy and a rare explanation for some unexplained cases of idiopathic toe‐walking

Abstract

We report on seven children (five males, two females) who presented with marked, often asymmetrical, toe‐walking from onset of independent walking, associated with abnormal foot postures and increased tone at the ankles with characteristics of dystonia. Most of the children had presented with unusual pre‐walking locomotion and a mild delay in independent walking. They did not fit into the usual categories of ‘habitual’ toe‐walking or congenital short tendo calcaneus but nor did they have the clinical signs of spastic diplegia or of a peripheral neuromuscular disease. Normalization occurred progressively in the second to fourth years of life. The children were re‐examined several years later (1 to 11y) and were normal. We believe that their persistent toe‐walking corresponded to a variant of ‘transient focal dystonia of infancy’. Knowledge of its existence may justify a period of observation without special investigations, surgery, or casting.

Transient idiopathic dystonia in infancy

“…This group of children presents with what some authors call ‘development dystonia’. The aetiology of this is still unknown, assuming that there is a genetic susceptibility to functional changes including a localized and transient imbalance of neurotransmitters in a period of rapid maturation of CNS (1,2,5,6).…”

Reliability and Validity of the Toe Walking Tool in Turkish Idiopathic Toe Walking Children

“…Idiopathic toe walkers' walking is symmetrical, symptoms are mostly intermittent, and they tend to resolve on their own within a few weeks or months. Children who diagnosed with ITW walk on tiptoes, but when they concentrate on their walking or when requested they can show foot contact (8). According to the results of many studies, children have a family history.…”

Serial ankle casts for patients with idiopathic toe walking: Effects on functional gait parameters

“…5 If spontaneous correction of the muscular imbalance does not occur, shortening of the plantar muscles with a decreased range of movement (ROM) in the ankle joint becomes structurally manifest and the ITW gait persists. 6,7 This leads to severe postural problems that are objectively measurable as a pathological gait pattern. [8][9][10][11][12] During adolescence and adulthood, impaired athletic performance can then result in severe social problems for the children affected.…”