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Neurology (Expert Forum)
tiptoe walking
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tiptoe walking
by starflowersunrise, Jan 24, 2007 12:00AM
My daughter has just turned 6 yrs and has developed late onset tiptoe walking over the past 18 mnths and pes cavus feet. Prior to this she had normal gait. We have seen a paediatrician, who has diagnosed mild spastic diplegic cerebral palsy. She also had kinase levels taken as her grandfather had some form of muscular dystrophy (he died around 60 yrs old) - but this came back normal. Is it possible to diagnose c.p. from just a clinical examination , as I know many other conditions appear similar. She has not been offered an MRI / EMG - would it be reasonable to exect this? Also, could it still possibly be a muscular dystrophy type condition if kinase levels are normal?
I would appreciate your views on this very much. Many thanks.
p.s. she has seen a physio who gave stretching exersises - but she struggled to do them + now cannot do the heel walking exersise.
I would appreciate your views on this very much. Many thanks.
p.s. she has seen a physio who gave stretching exersises - but she struggled to do them + now cannot do the heel walking exersise.
Doctor's Answer
by CCF-Neuro-M.D.-SH, Feb 12, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
I share your concern that other conditions besides cerebral palsy (CP) can present with toe walking. With the symptoms of inability to heel walk, and pes cavus an alternative condition is possible charcot-marie tooth (CMT) neuropathy. As you suggest there are many different forms of muscular dystrophies [MD](although this is not a typical presentation of MD, which is large calf muscles and weakness with standing from a sitting position) and many genetic and protein test are available. That being said, tests such as MRI and EMG are not easily obtained in children. They often (almost always) require general anesthesia to complete the test, which is not without its own risk. I would recommend that you see a pediatric neurologist in a major academic center who will be able to decide which tests to send and if a EMG/MRI is indicated. If the EMG/MRI is decided on, then it can often be done on the same day, under the same anesthesia.
I hope this has been helpful.
I share your concern that other conditions besides cerebral palsy (CP) can present with toe walking. With the symptoms of inability to heel walk, and pes cavus an alternative condition is possible charcot-marie tooth (CMT) neuropathy. As you suggest there are many different forms of muscular dystrophies [MD](although this is not a typical presentation of MD, which is large calf muscles and weakness with standing from a sitting position) and many genetic and protein test are available. That being said, tests such as MRI and EMG are not easily obtained in children. They often (almost always) require general anesthesia to complete the test, which is not without its own risk. I would recommend that you see a pediatric neurologist in a major academic center who will be able to decide which tests to send and if a EMG/MRI is indicated. If the EMG/MRI is decided on, then it can often be done on the same day, under the same anesthesia.
I hope this has been helpful.
Hope that helps.
Fiona
I am not a doctor and I cannot advise you on your child. Often times we are faced with these particle absolutes and it is awful.
The situation with tip-toe walking is actually a common presentation in children with MD.
But-MD is hereditary, in many cases.
Good Luck!
JCmcc.
My daughter is now booked for an MRI under GA. She is also going to have Botox injections in her legs. If she did have CMT and not cerebral palsy, would the Botox have a beneficial effect?