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Interesting Case of an adult toe walker

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Ann PT, May 29, 2014.

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  1. Ann PT

    Ann PT Active Member


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    I was asked to consult on a patient being followed by another PT. The patient is a 36 y.o. female runner (started running in 2010) who developed bilateral achilles pain (L>R) with running and had to stop running last November. She appears to have a congenital gastroc-soleus equinus on the left. On the right she does improve from 5 to 15 degrees of DF with knee extended to flexed so equinus may be more gastroc on the right. The interesting thing is that she has walked on her toes her whole life. Her resting standing position is up on her toes and she walks and runs on her toes if wearing sneakers or barefoot. When not in sneakers she always wears high heels (surprise!) She does have some compensatory genu recurvatum but no obvious compensatory midtarsal or subtalar joint pronation. She also has a longer right leg. She states her brothers also walk on their toes. To her knowledge, nothing was ever mentioned when she was a child about her persistent toe walking as she got older. What I find interesting is that she has developed a pattern of walking that requires muscular effort- walking on her toes- rather than a more passive compensatory pattern of midtarsal and subtalar joint pronation. Has anyone seen a patient like this? When she is supine she rests in so much plantarflexion that the bottoms of her feet are almost flat on the table. Although I did not have time to do a complete evaluation of her hips today, it is clear she has significant restriction at both hips, particularly in rotation, and she only has about 90 degrees of right hip flexion. Clearly she needs further evaluation but again I was curious if anyone had seen a patient with significant equinus who developed a gait pattern that would use so much energy like toe walking!
     
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