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To the Editor.—
In Duchenne muscular dystrophy, walking on the toes is commonly seen in later stages of the disease. This is generally attributed to contracture or shortening of the heel cords. It is conceded, however, that toe-walking may be seen early, long before any contracture or weakness in the calf muscles sets in.Having carefully followed up numerous children with Duchenne muscular dystrophy, I believe that toe-walking, in nearly all cases, precedes and results in contracture of the heel cords. The reason for toe-walking is an adjustment for the marked lumbar hyperlordosis and weakness of the hip flexors. Thus, the child makes a postural adjustment and finds it easier to get up on his toes to walk. It is possible that early weakness of the foot dorsiflexors also contributes to this posture. If one should put himself in the position of marked lumbar hyper-lordosis, it can be realized that
Sadjadpour K. Duchenne Muscular Dystrophy. JAMA. 1975;234(4):382. doi:10.1001/jama.1975.03260170018010