Early onset toe-walking in toddlers: a cause for concern?

摘要

Achild 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.