Tight heel cord can result partly from a contracture (a joint pulled into an abnormal position because the tissue around it shrinks and hardens) and partly from the child's efforts to balance himself in the face of increasing leg weakness.
The two processes are related: Once a child forms the habit of walking up on his toes to help him balance, the development of contractures (a usual part of DMD) is hastened. Holding the joint in an abnormal position for much of the day aids the shrinkage of soft tissues around the joint. The challenge is to separate the harmful contracture from a helpful one encouraged by the child's toe-walking.
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