Cerebral Palsy and Toe-Walking

A few readers of the article on cerebral palsy (PIR 1984;6:35-42) have indicated that persistent toe-walking may be a "normal" phenomenon. I know of no reported series of normal children who toe-walked at preschool age and older. In my own experience, walking intermittently on the toes without an obvious organic cause does occur. It probably reflects a mannerism whose dynamics remain unexplained. The concern is that persistent toe-walking without an evident organic cause may lead to heel cord contractures. Also, I have noted that toe-walking is seen in children who have personality, behavior, and/or learning problems. Admittedly, this association may simply reflect the type of children referred to me and cannot be applicable to the general population. I have speculated that if toe-walking in beginning walkers reflects the infant's compensatory attempt to throw his or her center of balance behind the hips so as not to fall forward when trying to establish walking balance, then, in those infants with subtle neuromotor balance problems, toe-walking may persist longer than usual. One might further speculate that, in spite of final maturation leading to better balance, toe-walking, which becomes unnecessary for balance, is continued as a "habit."