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Heel-to-toe, here we go
When my son started walking (at the age of 12 months), his posture and gait was very strange: Alex started walking on his tip-toes, and while walking (or running), my little ‘ballet-dancer’ didn’t swing his arms – his arms were dangling along his body.
Not knowing much at the time, I tried to correct his idiosyncratic movements the way I could:
Whenever and wherever we went, I was singing (while coordinating his arm-leg movement – his right leg stepped forward, I raised his arm, and vice versa):
“Heels first, then toes,
Heel-to-toe, here we go,
Heels first, then toes, one-two, three-four
We are marching, we are marching…
Right leg – left arm, left leg – right arm
We are marching, we are marching…”
Of course, it cannot be called a song – rather commenting on what was happening to his body), but, surprisingly, it worked – in 5-6 months, Alex was toe-walking just about 5-10% of the time, and in a year his walking style improved considerably (as well as his interaction with his environment!).
However, his gait (with toes turned outward) looked unusual…
Toe walking is a gait pattern with no contact between the heels and the ground, and it is quite common in the typical gait development in children. However, if it persists in children older than 2-3 years it is referred to as idiopathic toe-walking. There might be a connection between idiopathic toe-walking and vestibular dysfunction and/or proprioceptive sensibility. Children with neurodevelopmental disorders (autism, language and cognitive disorders) often have it. (Soto Insuga et al. 2018). Idiopathic toe-walking may contribute to secondary shortening of the Achilles's tendon (Valagussa et al. 2018). In this case, surgical correction might be necessary (Leyden et al. 2019).
Research studies also identified various other gait abnormalities in children with ASD. For example, children have an awkward or unusual gait; toe walking; they may have limited or a preferred movement strategy when preparing the foot for ground contact (Eggleston et al. 2020); they may exhibit greater stiffness in pre-swing, and thus, produce inefficient propulsive forces during walking (Eggleston et al. 2018) and external tibial torsion (Arik et al. 2018).
Autism is also associated with a wider step width, slower walking speed, longer gait cycle, longer stance time and longer step time, though there is greater intra-individual variability on measures of stride length, stride time and walking speed (Lum et al. 2020) and the findings concerning which aspects of gait are affected are inconsistent, particularly for the occurrence of toe walking and gait symmetry between feet (Gong et al. 2020).
A better understanding of gait development in autistic children may improve the development of treatment programmes and thus, better outcomes.