Some people, often young children, walk on their toes rather than any other part of foot. Such people walk with their toes pointed inwards. This condition is referred to as in-toe walking or pigeon-toed. Generally, as time passes, young children adopt to normal walking. Some people may continue with their toe walking. People of any age may suffer from this disease condition. Pain is usually not indicated, however, frequent falling in people is noticed.
Different factors exists that causes in-toe walking in people. Some form of orthopedic or genetic condition or neurological immaturity may cause in-toeing. Typically, the causes are classified into three types:
- Metatarsus adductus/ Curved foot
In some people, the feet remains bend inward from middle of foot to the toes. This curved leg condition is known as metatarsus adductus. In most cases, this condition improves within 4-6 months time. For mild condition, special shoes or casts will be used for treatment. They provide very high rate of success. In severe cases, the a clubfoot deformity is seen in foot. Such cases are treated using surgery.
- Tibia torsion/ Twisted Shin
In-toe walking is sometimes seen in people who have inward twisted tibia. Moulding during pregnancy is the main cause of twisted lower leg. However, in-toe walking usually disappears after a short time period without any treatment. This condition has no affect on the functionality of leg. Due to twisted tibia, feet turns inward. Splints, braces or plasters do not improve the condition. Surgery is often a recommended treatment option.
- Femoral Anteversion/ Twisted thighbone
Femoral anteversion is a condition where the thighbone of the patient is turned inward. This condition is more common at the age of 5-6 years. The twist in the thighbone causes the hip to turn inward. As a result during walking, both knee and feet points inward. People with such condition often sit in W position. Conservative methods such as braces, special shoes or exercises do not help in its treatment. Severe cases with tripping and gait instability are corrected using surgery. The surgery involves proper aligning of thighbone.
The common symptoms of in-toe walking include:
- Use of toes for walking
- Poor physical coordination
- Irregular body balance
- Bouncy gait
The treatment for in-toe walking is basically not given to children below 2 years. Such children are carefully observed to see if the condition spontaneously resolves with time. For persistent toe walking, non-surgical treatment is opted. Surgery is seldom chosen.
- Non-surgical Treatment:
The common non-surgical treatments for toe walking include physical therapy, night splinting, casting and stretching. In case simple stretching is not helpful, a splint or cast will also be used. They provide constant stretching. As a result, the tight heel cord will loosen. In recent time, botulinum toxin (Botox) has been included in the treatment. Botox are usually given through injections. They are useful to tighten the calf muscles.
In people who does not respond to any of the non-surgical treatments, surgery is chosen as the last resort. The patient is kept under full anesthesia. The surgery mainly aims to lengthen the tight heel cord. This allows landing of heel before toes. As a result, heels are used in movement of leg. A variety of methods are used to do this surgery. However, proper protective measures should be used cover the operated part from further injury.
The patient can leave the hospital after 2 days stay. Regular cleaning of wound is essential. Casts may be used in the affected part after surgery. This ensures that tissues do not loosen while healing. The recovery varies for every patient.
Commonly seen risks in toe-walking treatment are:
- Abnormality in walking
- Swelling and tenderness