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SINGAPORE : At the age of 18 months, my daughter suddenly began walking on her toes.
The sight of her tiptoeing everywhere she went, like a ballerina, was amusing at first, but by the third or fourth week, I was a little worried.
Tiptoeing, as the name suggests, involves walking on the toes without putting much weight on other parts of the foot.
"It is not a normal way of walking and long-term issues may include stress and uneven weight distribution on the foot. This could lead to ligament stretching, joint problems and abnormal development of the foot. It also puts a strain on the knees, hips and lower back," said Dr Chong Shang Chee, head and consultant of the Child Development Unit at National University Hospital's (NUH) University Children Medical Institute.
Normal walking involves a heel-toe gait. This means that as one leg moves forward, the heel lands on the ground first and then rises onto the toes before the other leg swings forward, explained Dr Chong.
When learning to walk, most children tend to adopt a "flat-foot to flat-foot pattern", a wide-based gait with stiff knee position, added Dr Phuah Huan Kee, a neuro-paediatrician at Healthway Medical Specialist Practice group's Singapore Baby and Child.
"A more mature heel-toe gait pattern should become consistent by the time they are two years old," Dr Phuah said.
According to the paediatricians, toe-walking is quite common in younger children who are learning to walk. For some, it may even become a habit.
However, in some instances, tiptoeing in children may also point to more sinister medical problems.
"Toe-walking could be a posture a child adopts because of imbalances or tightness of the muscles or tendons that are involved in walking," said Dr Chong.
He said this could occur in children with cerebral palsy - in which the calf muscles can be overly "tight" - a shortened Achilles' tendon (which is just above the heel) or conditions causing muscle weakness.
Interestingly, the tiptoe gait is also sometimes found in autistic children, or those with learning disabilities or mental retardation, said Dr Phuah.
Explaining why autistic children toe-walk, Dr Chong said: "It is unknown why children with autism walk this way, but some believe that this is associated with problems involving their balancing and spatial awareness, or abnormalities in perceiving sensory stimuli. They may hence toe-walk when excited, or when they find contact with the floor aversive."
However, Dr Phuah stressed that those who toe-walk may not necessarily have these conditions.
"Most children grow out of habitual toe-walking by about two to three years old. If it is associated with medical reasons, it is important that it should be corrected," said Dr Chong.
Thankfully for me, my worries were unfounded - my toddler eventually got tired of pottering about on her toes and realised that it is far less tiring to move around normally.
- TODAY/il
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