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IS THERE A LINK BETWEEN TIPTOE WALKING AND AUTISM SPECTRUM DISORDER (ASD)?

By 14 de March de 2022No Comments

Tiptoe walking and autism spectrum disorder

Walking is a complex activity that requires consideration of a large amount of information found both from the environment and the body itself.

In children, the motor and perceptual systemsdevelop independently through exploration, Thus, central and peripheral structures involved in motor control undergo progressive development and functional integration, resulting in leading to increasingly complex and coordinated behaviour. (1)

Toes on tiptoe

The impairment of one or both of these systems and the consequent deficient formation of the body schema could be limiting factors for the development of a correct and adaptive gait pattern. For this reason, it is essentialto carry out a series of explorations in the infant assessment that allow us to find out the development of the different perceptual, cognitive and motor skills in each child, linked to the progressive maturation process of the central nervous system. (3)

Studies have linked children with impaired motor control, spasticity, visuoperception and/or language with a gait pattern that is quite common in children, tiptoeing. (4)(5)

Children who walk on tiptoe are those who from the beginning of walking usually walk without heel support, however, if they are asked or concentrate on their gait they are able to perform a gait with initial heel strike. Normally these children can stand with both feet fully supported when they are not walking.

The association of this type of gait with alterations in child development has been described by several authors. It requires a thorough assessment of neurodevelopmental problems.

It has been considered normal for a child to walk on tiptoe for the first 2-3 months after the onset of walking. It starts to be considered abnormal from the age of 2 years and in all cases after the age of 3 years when the child should be carefully, because at this age he would already be in a position to acquire a mature gait, having reached the necessary neurological, biomechanical, psychological and environmental development.

This type of gaitis more common in boys than in girls, in a proportion ranging from 50 to 80%.

If there is no history to suggest neurological damage, it is most likely to be of idiopathic aetiology and the course is satisfactory without treatment. The first check-up should be carried out by the paediatrician and its evaluation and treatment will depend will depend mainly on the findings or warning signs that may appear in the clinical history and/or examination. (19)

Autism is a neurodevelopmental disorder characterised by early onset difficulties, affecting 1 in 68 years. More than 70% of the of the population with Autism Spectrum Disorder (ASD) have some type of medical, psychiatric, developmental or motor condition. (19)

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder. It is characterised by difficulties in socialisation with circumscribed interests and a tendency towards routinisation. It affects the way of communicating and interacting with other people. The symptomatology of autism manifests itself more between two and three years of life.

Children diagnosed later in ASD show greater delays in motor milestones, leading to postural asymmetries and gait disturbances. These alterations in ambulation occur in order to achieve greater stability to counterbalance the alterations in balance and proprioception that they present. One of the variations is walking. Tiptoeing is present in 15-45 % of children with ASD; the aetiology of this alteration is related to the dysregulation of infantile reflexes, if these do not develop naturally, they will cause alterations of the vestibular and visual system; both problems lead to changes in posture and gait. The prevalence of external tibial torsion in children with ASD is 32.9%, which increases the risk for the development of toe walking. (19)

Soto Insuga et al. describe the frequency of idiopathic toe walking (equine gait) — a condition that prevents the child from performing a heel-supported gait–in children with a diagnosis of ADHD and neurological examination. For to do so, they used a sample of 312 patients with ADHD selected from the neuropaediatrics clinics of a university hospital. The authors describe a prevalence of idiopathic toe walking of 20.8% (65/312) in their setting (65/132) in addition to other disorders associated with ADHD (e.g. language disorders [33%][33%], tics[15%] [15%], oppositional defiant disorder [15%][15%]). (20)

Bibliography

  1. Zwart, R., Ledebt, A., Fong, B. F., De Vries, H. y Savelsbergh, G. J. P. 2005. Theaffordance of gap crossing in toddlers. Infant Behavior & Development.2005;28:145- 154.
  2. Metcalfe, J. S. y Clark, J. E. Sensory information affords exploration of posture innewly walking infants and toddlers. Infant Behavior & Development.2000; 23:391- 405
  3. Portellano, J. A. (2007). Neuropsicología infantil. Madrid: Síntesis
  4. Shulman LH, Sala DS, Chu MLY, McCaul PR, Sandler BJ. Developmental implications of idiopathic toe walking. J Pediatr. 1997;4:541—6
  5. Futagi Y, Toribe Y, Ueda H, Suzuki Y. Neurodevelopmental outcome of childrenwith idiopathic toe-walking. No To Hattatsu. 2001;33:511—6
  6. Sala DA, Shulman LH, Kennedy RF, Grant AD, Chu ML. Idiopathic toe-walking:Areview. Dev Med Child Neurol. 1999;41:846—8
  7. Fox A, Deakin S, Pettigrew G, Paton R. Serial casting in the treatment of idiopathic toe-walkers and review of the literature. Acta Orthop Belg. 2006;72:722—30.
  8. Fragnière B, Garoflid N, Dutoit M. Mon enfant marche sur la pointe des pieds.RevMed Suisse Romande. 2000;120:811—4.
  9. Stricker SJ. Evaluation and treatment of the child with tiptoe gait. Int Pediatr. 2006;21:91—8.
  10. Brunt D, Woo R, Kim HD, Ko MS, Senesac C, Li S. Effect of botulinumtoxintype A on gait of children who are idiopathic toe-walkers. J Surg Orthop Adv. 2004;13:149—55.
  11. Westberry DE, Davids JR, Davis RB, de Morais MC. Idiopathic toe walking: Akinematic and kinetic profile. J Pediatr Orthop. 2008;28:352—8.
  12. Stott NS, Walt SE, Lobb GA, Reynolds N, Nicol RO. Treatment for idiopathictoe-walking: Results at skeletal maturity. J Pediatr Orthop. 2004;24:63—9.
  13. Eastwood DM, Menelaus MB, Dickens DR, Broughton NS, Cole WG. Idiopathictoe-walking: Does treatment alter the natural history? J Pediatr OrthopB. 2000;9:47—9.
  14. Hirsch G, Wagner B. The natural history of idiopathic toewalking: Along-termfollow-up of fourteen conservatively treated children. Acta Paediatr. 2004;93:196—9
  15. Pascual R, López P, Alonso C. Marcha infantil. Rev Esp Podol. 2001;XII(2):89- 96.
  16. Stricker S, Angulo J. Idiopathic toe walking: a comparison of treatment methods. J Pediatr Orthop. 1998;18:289-93
  17. Tidwell M. The Child with Tip-Toe Gait. Int Pediatr. 1999;14(4):235-8.
  18. Taussig G, Delouvée E. La marche en équin idiopathique de l’enfant. Diagnosticet évolution spontanée. Ann Readapt Med Phys. 2001;44:333-9.
  19. Blanca García Podadera1 , Paula Gil Pinzón1 , David Hurtado Bermúdez1 , Joaquín Páez Moguer.Búsqueda bibliográfica: relación entre el autismo y la marcha en puntillas en niños. revista española de podología.2020;31(1)
  20. Soto Insuga V, Moreno Vinués B, Losada del Pozo R, Rodrigo Moreno M, Martínez González M, Cutillas Ruiz R, et al. ¿Caminan de manera diferente los niños con TDAH? Relación entre marcha de puntillas idiopática y TDAH. An Pediatr. 2017. Disponible en: http://doi.org/10.1016/j.anpedi.2017.01.010
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