Early Onset Toe-Walking in Toddlers: A Cause for Concern?

Pernet, Julie; Billiaux, Amandine; Auvin, Stéphane; Rakatovao, Domohina; Morin, Laurence; Presedo, Ana; Mercier, Jean-Christophe; Titomanlio, Luigi

doi:10.1016/j.jpeds.2010.04.070

« Previous Next »The Journal of Pediatrics
Volume 157, Issue 3 , Pages 496-498, September 2010

Early Onset Toe-Walking in Toddlers: A Cause for Concern?

Julie Pernet, MD
- Department of Pediatric Emergency Care, APHP-University Hospital R. Debré, Paris, France
- Contributed equally.
Amandine Billiaux, MD
- Department of Pediatric Emergency Care, APHP-University Hospital R. Debré, Paris, France
- Contributed equally.
Stéphane Auvin, MD, PhD
- Department of Pediatric Neurology, APHP-University Hospital R. Debré, Paris, France
Domohina Rakatovao, MD
- Department of Pediatric Emergency Care, APHP-University Hospital R. Debré, Paris, France
Laurence Morin, MD
- Department of Pediatric Emergency Care, APHP-University Hospital R. Debré, Paris, France
Ana Presedo, MD
- Department of Pediatric Orthopedics, APHP-University Hospital R. Debré, Paris, France
Jean-Christophe Mercier, MD, PhD
- Department of Pediatric Emergency Care, APHP-University Hospital R. Debré, Paris, France
Luigi Titomanlio, MD, PhD
- Department of Pediatric Emergency Care, APHP-University Hospital R. Debré, Paris, France
- Department of Pediatric Neurology, APHP-University Hospital R. Debré, Paris, France
- Reprint requests: Luigi Titomanlio, MD, PhD, Pediatric Emergency Department, Robert Debré University Hospital, 48, Bld Sérurier - 75019 Paris, France.

Received 16 December 2009; received in revised form 26 February 2010; accepted 28 April 2010. published online 18 June 2010.

A child was born to non-consanguineous, healthy parents. Pregnancy and delivery were uneventful. At 17 months, he was seen by the pediatric emergency department because of mild cranial trauma, and clinical examination disclosed a small parietal hematoma. Neurologic examination was normal, except for a bilateral equinus foot position at rest (Figure) and toe-walking (Video 1; available at www.jpeds.com). Passive ankle dorsiflexion was limited to less than 10 degrees and was painful. His gait had a toe-to-toe pattern, and he was unable to rock back into a flat-foot position when cued. The rest of the physical examination results were normal, including normal strength and normal psychomotor development. His parents said he had a flat-foot position at the beginning stage of walking independently (15 months) and then progressively shifted to tip-toe. The family history was negative for toe-walking.