Babb Aaron, Carlson Walter O
Georgetown University, Washington, DC, USA.
S D Med. 2008 Feb;61(2):53, 55-7.
Idiopathic toe-walking is a diagnosis of exclusion when a child presents with bilateral toe-to-toe gait. Although toe-walking is considered part of the normal gait spectrum in development, it is abnormal when persisting past the age of two. Toe-walking may be caused by cerebral palsy, congenital contracture of the Achilles tendon or paralytic muscular disorders such as Duchenne Muscular Dystrophy. Idiopathic toe-walking may be associated with developmental disorders such as autism or other myopathic or neuropathic disorders. The majority of disorders causing toe-walking can be ruled out through the history and physical examination, resulting in a diagnosis of idiopathic toe-walking. However, it may be difficult to differentiate mild forms of cerebral palsy, specifically mild spastic diplegia, and idiopathic toe-walking. The treatment options for idiopathic toe-walking include observation, conservative methods and surgical methods. Most children can be treated in the primary care setting with either observation or conservative treatment. Patients with severe contracture of the Achilles tendon, or persistent toe-walking, may need surgical intervention. The prognosis of idiopathic toe-walking is favorable with both conservative and surgical treatment allowing children to attain normal function and range of plantarflexion. The following article provides an overview of the background information, differential diagnosis and treatment options for idiopathic toe-walking.
当儿童出现双侧足尖行走步态时，特发性足尖行走是一种排除性诊断。尽管足尖行走在发育过程中被认为是正常步态范围的一部分，但如果持续到两岁以后则是异常的。足尖行走可能由脑瘫、跟腱先天性挛缩或麻痹性肌肉疾病如杜氏肌营养不良症引起。特发性足尖行走可能与发育障碍如自闭症或其他肌病或神经病性疾病有关。大多数导致足尖行走的疾病可以通过病史和体格检查排除，从而诊断为特发性足尖行走。然而，可能难以区分轻度脑瘫形式，特别是轻度痉挛性双侧瘫和特发性足尖行走。特发性足尖行走的治疗选择包括观察、保守方法和手术方法。大多数儿童可以在初级保健机构接受观察或保守治疗。跟腱严重挛缩或持续足尖行走的患者可能需要手术干预。特发性足尖行走无论是采用保守治疗还是手术治疗，预后都较好，可使儿童获得正常功能和跖屈范围。以下文章概述了特发性足尖行走的背景信息、鉴别诊断和治疗选择。
