Heel-to-toe, here we go When my son started walkin...
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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.
Vocabulary & Translations
Heel
pięta
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