Toddler standing on top of his left foot

[KristiD]

My 11 month old son was diagnosed with epilepsy at 4 months old.  It's very well controlled with 8 ml of Phenobarbital, daily.  He has typically been ahead of the developmental curve...he was sitting early and crawling, pulling up, climbing and cruising before 6 months old.  We thought for sure that he'd be an early walker.  That doesn't seem to be the case.  When he pulls to stand, he stands with his toes curled, so basically on the top of his left foot.  He will do this for awhile and then correct his foot.  He only does this with his left foot.  He does not like to practice walking (i.e., hold our hands and take steps).  He will immediately sit down if we try to do that.  He can stand independently and can do so for minutes at a time, but when he wants to go somewhere away from furniture, he gets down and crawls.  We also noticed that he kind of crawls funny.  He swings his hips and it looks like he doesn't necessarily move his legs forward, but just slides them on the ground.  The tops of his socks wear out because he drags his feet.

He saw his neurologist in late September and his advice was to just keep an eye on things.  His pediatrician suggested trying a walker to get him used to the "one foot in front of the other" motion.  He can move around pretty well in the walker, but not on his own.

I'd also like to mention that a brother of mine was diagnosed with mild (very mild) CP at about age 5.  He's absolutely fine and you would never know it at this point.  My older son was evaluated for mild CP due to walking on his toes for such a long time, but that seemed to be more idiopathic than anything else and has gotten better.

Should I be concerned??

Thanks,

Kristi

[Stotte]

Hi Kristi. I was online looking for possible others who children have been diagnoised with Cervical Dystonia which is what my son has. I just wanted to mention that my son was diagnosed with Seizures at 1 month old as well. He would lock his head and his eyes would shake but his EEG was completely normaly. They treated him with Phenobarbital as well. He is ahead of the learning curve, speaks great and developed normally physically. Eventually the Dr thought he may have something called Dopa Responsive Dystonia. It is recognized first by tip toe walking.  Often times children progress normally and once they walk they have an abnormal gait with tip toe walking. Then they can continue to progress into Cebral Palsy like syptoms and are often misdiagnosed with Cerbal palsy. It basically is a malfunction in the Basal Ganglia in the brain where the brain can't communicate with the muscles. Your son may have nothing like this but in cases I read up on sometimes it took years for neurologists and doctors to diagnois these children. If you want to I would check http://www.dystonia-foundation.org and read up on it just in case your son eventually shows syptoms of this. Obviously he could have nothing like this but I figure knowing what things to watch for is half the battle when trying to figure out what is going on. Good luck to you and your son.

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to obtain a history and examine your son I can not comment on whether or not he has a motor abnormality however I will try to provide you with some information.

Toe walking is usually considered a normal finding in children up to the age of 3. It may be habitual in such cases, as the child learns to walk. Toe walking may also be related to a congenitally short achilles tendon (the tendon between the ankle and foot, and by congenital I mean it was present from birth). In such cases, the toe walking is symmetric, meaning it occurs to the same extent in both feet. However, when it is asymmetric, meaning when it is preferentially done with one leg only, it may be suggestive of increased tone, what is medically referred to as spasticity. This is usually evidence on examination as a sort of tightness or decreased range of motion. Toe walking due to spasticity can be seen in the setting of cerebral palsy as you mentioned above. The causes of cerebral palsy are many but often include prenatal, perinatal, or postnatal injury. It is conceivable if he has a focal epilepsy (as opposed to a generalized epilepsy) that there is a lesion in the right side of the brain leading to both seizures and spasticity in the left leg. However, the two may be entirely unrelated. Other causes of toe walking include certain types of muscular problems such as muscular dystrophy. However again as I mentioned it is difficult for me to clearly give an opinion without examining him. It is good that he has a pediatric neurologist following him, as serial examinations and close follow up to keep an eye on things is probably the best way to follow him and to ensure that if any problem should arise that it is caught early.

Thank you for using the forum, I hope you find this information useful, good luck.