Idiopathic Toe Walking

Preventing leg cramps at night

Q: I am a 65 y.o. retired office worker. My problem is I experience leg cramps at night about once or twice a week. I usually wake up because of the pain although the cramps usually subside after a minute or so. What causes cramps? Will it help if I take calcium supplements and eat bananas as some people have suggested? Is there a drug that is effective in this condition? --mario33@yahoo.com

MANILA, Philippines -- A: Cramps, which are involuntary and painful sudden spasms of a skeletal muscle or a group of skeletal muscles, can be caused by a variety of conditions. Often, they are simply due to muscle fatigue such as those that occur during or after vigorous exercise. They can also be the result of fluid and electrolyte imbalance (e.g., low sodium, potassium and calcium),which occurs when a person becomes dehydrated due to profuse sweating or loose bowel movement; or, looses electrolytes secondary to intake of medications such as diuretics.

Occasionally, cramps may be a symptom of a systemic disease such as advanced kidney or liver disease, diabetes mellitus, Parkinson’s disease, diseases of the central and peripheral nervous systems, hyper or hypothyroidism and hyperparathyroidism.

But by and large, leg cramps that occur at night during sleep, when the normal muscle reflex is often exaggerated and muscles are prone to contract spontaneously, fall under a category of muscle disorder called idiopathic leg cramps.

Idiopathic leg cramps usually involve the calf, thigh and small muscles of the foot. They are common among the elderly. About a third of people over 60 years of age and half of people over 80 suffer from this condition. Of these, 40 percent experience more than three attacks per week.

The term idiopathic means “from an unknown cause” hence, the reason why people get idiopathic leg cramps has not been identified yet.

Idiopathic Toe Walking in Children

Most children toe walk occasionally, eg. when they are bare feet on a cold floor or when they are first learning to walk and cruising along furniture. Some kids do it on and off for fun when playing games, role-playing or doing ballet moves. But if your child is older than 3 years of age and consistently walking on his/her toes, then you should take your child to see a Paediatrician, Orthopaedic Specialist and/or Physiotherapist.

What Causes Toe Walking?

There are many reasons for toe walking. One of them is a condition called idiopathic or “habitual” toe walking. With this diagnosis ultimately the cause is unknown. A diagnosis of idiopathic toe walking is made after assessing the child to rule out any neuromuscular or orthopaedic problems such as cerebral palsy (brain injury at birth), injury to the spinal cord, or paralytic muscle disease including muscular dystrophy. Once these diagnoses are ruled out a diagnosis of Idiopathic toe walking may be made.

Idiopathic toe walking first appears when the child is a toddler and walking begins. Often the child can walk flatfooted when prompted to do so. But when the child is unaware he/she is being observed their preferred position is to walk on his/her toes.

A child with idiopathic toe walking may walk on his or her toes due to hyper or hyposensitivity. The child may not like the feeling of different surfaces on their bare feet causing them to rise up on their toes to decrease the surface of their foot in contact with the floor. In this case you may notice the child dislikes tight clothing, stepping in the sand, and/or on the grass, dislike certain textured foods, and/or dislike vestibular input such as, swinging, jumping, etc. Many times idiopathic toe walking is associated with language delays, and with certain forms of autism. Therefore it is important to make sure that your child is not having any delays with communication or social skills. In this case, a developmental assessment may be appropriate.

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