Understanding Toe Walking: Seeking Answers
I’m a 39-year-old Asian American woman, standing at 5 feet tall and weighing 125 pounds. I have been prescribed several medications, including Adderall, Metoprolol, Wellbutrin, and Vraylar, and carry diagnoses of bipolar disorder, autism, and ADHD. I don’t partake in alcohol, smoking, or recreational drugs. For the last five years, I have consistently found myself walking on my toes. The exact onset of this behavior is unclear to me, but one day I simply noticed that I could not keep my heels down when standing. I underwent physical therapy aimed at stretching my calf muscles, which allowed me to force my heels down temporarily. However, considerable resistance remains, requiring intentional effort to maintain that position. My physical therapist suggested that my condition may require more than just therapy, leading me to try braces; unfortunately, my heel would continuously pop up, regardless of how tightly I secured the straps. My feet wouldn't cooperate and remain stable in the necessary alignment. I’ve undergone several tests, all of which returned normal results. These include an MRI of my lower spine, EMG/nerve conduction studies, and blood tests for vitamins B12, copper, and zinc. A neurologist evaluated me and recommended that I consult an orthopedist since she suspected that my issues were not neurological in nature. However, the orthopedist disagreed, stating that my foot's level of resistance to dorsiflexion was beyond what he typically observed in orthopedic cases. During his examination, he noted the presence of clonus but did not clarify its implications. He prescribed Baclofen, yet it did not yield any improvement. When re-evaluated by the neurologist, she observed signs of spasticity and suggested resuming physical therapy. She alluded to the concept of functional dystonia, but was not definitive in her diagnosis. What might be the underlying cause of this persistent toe walking? Would it be more beneficial for me to pursue treatment with a neurologist or an orthopedist?
Answers (1)
3/20/2025, 1:21:00 AM
OpenHealth AI
Toe walking, particularly when persistent in adulthood, can be complex and may result from various underlying conditions. Given your history and assessments so far, potential reasons for your toe walking might include neurological factors, such as spasticity or dystonia, especially since you have mentioned both clonus and signs of spasticity. Your history of ADHD, bipolar disorder, and autism can complicate the presentation, possibly influencing your motor skills.
Explanation:
- Spasticity: This is characterized by tight or stiff muscles and can result from several neurological conditions. It may lead to difficulty with normal foot positioning, encouraging toe walking.
- Dystonia: This refers to unwanted muscle contractions that may result in abnormal postures or movements. It's potentially why you experience resistance despite physical therapy.
- Functional vs. Neurological: The distinction between functional dystonia and a primary neurological issue can be tricky and important for treatment. Your neurologist seems to believe there’s a neurological aspect, while the orthopedist does not.
Next Steps:
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Focus on Neurological Follow-Up: Since your neurologist has identified signs indicating spasticity, continuing discussions with a neurologist may offer more targeted treatments or therapies that address the neurological aspects of your condition.
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Consider Interdisciplinary Approach: Engage both specialties—neurologists for managing spasticity/dystonia symptoms and physical therapists for motor functions and conditioning. Strengthening your calf muscles may help.
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Pursue Additional Therapies: Ask about options like occupational therapy or specialized physical therapy focusing on functional training. Techniques such as botulinum toxin injections could also be discussed for muscle control if spasticity is confirmed.
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Monitor Your Symptoms: Keep a daily log of your toe walking and any accompanying symptoms or triggers. This information can assist your healthcare providers in fine-tuning your treatment plans.
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Explore Adjustment of Current Medications: Review your medication regimen with your providers, as some medications may impact muscle control or exacerbate spasms.
Reassurance:
It's understandable to feel frustrated given the complexity of symptoms. Each professional brings valuable insight, and maintaining collaboration among them can lead to better understanding and management of your toe walking. Focus on small, consistent efforts, and reach out whenever you have questions—you're working towards improving your quality of life.
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