Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
Is Idiopathic Toe Walking Really Idiopathic? The Motor Skills and Sensory Processing Abilities Associated With Idiopathic Toe Walking Gait. Williams CM, Tinley P, Curtin M, Wakefield S, Nielsen S. J Child Neurol. 2013 Jan 24
This study aimed to investigate any differences between the motor skills and sensory processing abilities of children between the ages of 4 and 8, who do and do not have an idiopathic toe walking gait. Children in each cohort were tested with a number of norm referenced assessments. A total of 60 children participated, 30 within each cohort. Those with an idiopathic toe walking gait were found to have different Sensory Profile quadrant scores (P = .002), poorer performance on the Bruininks-Oseretsky Test of Motor Proficiency (P ≤ .001), a lower vibration perception threshold (P = .001), and poorer performance on the Standing Walking Balance subtest of the Sensory Integration and Praxis Test (P = .047), compared with non-toe walking peers. Although this research does not give a causative factor for toe walking gait, it provides a number of theories as to why this gait may not be idiopathic in nature.
Idiopathic toe walking (ITW) has been associated with ankle equinus, and while equinus has been linked with foot deformity in adults, there has been limited investigation on its impact on structural foot change in children. This study used the weight bearing lunge (WBL) test and Foot Posture Index-6 (FPI-6) to evaluate the foot and ankle measures of children with an ITW gait.
Sixty children between the ages of four and eight years were grouped into an ITW (N=30) and a non-toe walking (NTW) (N=30) cohort. The ankle range of movement and FPI-6 was calculated during appropriate weight–bearing test and stance.
There was a highly significant difference in the WBL test measures between the ITW cohort and the NTW cohort. The FPI-6 comparison was not significant. The WBL test was also not predictive of an abnormal FPI-6 in the ITW cohort.
These results demonstrate that ITW gait style impacts only on the available dorsiflexion at the ankle. The WBL measure may be utilised within the clinical setting to guide and monitor treatment interventions.
When children walk on their toes for no known reason, the condition is called Idiopathic ToeWalking (ITW). Assessing the true severity of ITW can be difficult because children can alter their gait while under observation in clinic. The ability to monitor the foot angle during daily life outside of clinic may improve the assessment of ITW. A foot-worn, battery-powered inertial sensing device has been designed to monitor patients’ foot angle during daily activities. The monitor includes a 3-axis accelerometer, 2-axis gyroscope, and a low-power microcontroller. The device is necessarily small, with limited battery capacity and processing power. Therefore a high-accuracy but low-complexity inertial sensing algorithm is needed. This paper compares several low-complexity algorithms’ aptitude for foot-angle measurement: accelerometer-only measurement, finite impulse response (FIR) and infinite impulse response (IIR) complementary filtering, and a new dynamic predict-correct style algorithm developed using fuzzy c-means clustering. A total of 11 subjects each walked 20m with theinertial sensing device fixed to one foot; 10m with normal gait and 10m simulating toe walking. A cross-validation scheme was used to obtain a low-bias estimate of each algorithm's angle measurement accuracy. The new predict-correct algorithm achieved the lowest angle measurement error: <5° mean error during normal and toe walking. The IIR complementary filtering algorithm achieved almost-asgood accuracy with less computational complexity. These two algorithms seem to have good aptitude for the foot-angle measurement problem, and would be good candidates for use in a long-term monitoring device for toe-walking assessment.
Foot and Ankle Characteristics of Children with an Idiopathic Toe-Walking Gait
Cylie Williams, BASci (Pod), MHSci (Hlth Ed & Prom), PhD*, Paul D. Tinley, PhD†, Michael Curtin, BOccThy, MPhil, EdD‡ and Sharon Nielsen, BAppSc, DipEd, Grad Cert Biom, MPhil§ J Am Podiatr Med Assoc 103(5): 374–379, 2013
Background: Idiopathic toe-walking (ITW) in children has been associated with ankle equinus. Although equinus has been linked to foot deformity in adults, there has been limited investigation of the impact of equinus on structural foot change in children. We used the weightbearing lunge test and the six-item version of the Foot Posture Index (FPI-6) to evaluate the weightbearing foot and ankle measures of children with an ITW gait and to compare these with their age-matched peers.
Methods: Sixty 4-to 6-year-old children were grouped into ITW (n = 30) and non–toe-walking (n = 30) cohorts using a validated ITW tool. Ankle range of motion was determined with weightbearing lunge tests. The FPI-6 was calculated during weightbearing stance.
Results: There was a highly significant difference in the weightbearing lunge test measures between the ITW cohort and the non–toe-walking cohort. The FPI-6 comparison was not significant. The straight-leg lunge test had a statistically significant relationship with the FPI-6 in the ITW cohort.
Conclusion: Children with an ITW gait demonstrated reduced flexibility at the ankle joint but similar weightbearing foot posture compared with non–toe-walking children, showing that for children 4 to 8 years old, an ITW gait affects the available ankle dorsiflexion but seems to have a limited effect on weightbearing foot posture as measured by the FPI-6.
Outcome after conservative and operative treatment of children with idiopathic toe walking: a systematic review of literature
A. F. van Bemmel, V. A. van de Graaf, M. P. J. van den Bekerom, D. A. Vergroesen MUSCULOSKELETAL SURGERY; January 2014
When toe walking persists after the age of 2 years in the absence of any neurological or orthopedic abnormalities, it is referred to as idiopathic toe walking (ITW). When the plantar flexion persists, an equinus contracture can develop. There is inconsistency in the treatment of choice of this condition. A systematic review of observational studies comparing cast and operative treatment of children with ITW or equinus contracture was undertaken. Ten trials involving 298 participants were included. Ankle dorsiflexion increased 3.1° (median follow-up 3 years) in the cast treatment group and 14.2° (median follow-up 3.3 years) in the surgical group. No significant differences between groups were found in terms of persistent toe walking and complications after treatment. We have found favorable results in improvement of dorsiflexion for children treated by surgery. However, due to heterogeneity of patient groups, sample size and follow-up, no firm conclusions on a favorable role of surgery or cast treatment could be drawn in the treatment of ITW or equinus contracture.
[b]Is Idiopathic Toe Walking Really Idiopathic?24[/url]
Yes of course it is, the question is self defining. Idiopathic means arising from an unknown cause, a disease having an unknown cause. Therefore once a disease's cause is discovered then it is no longer unknown
Descartes seems to consider here that beliefs formed by pure reasoning are less doubtful than those formed through perception.
Background: Idiopathic toe-walking (ITW) is a condition commonly seen by podiatric physicians. Because a toe-walking gait style is also caused by or associated with many other medical conditions, podiatric physicians should pay particular attention to ensuring an accurate diagnosis. There are many reported treatment options available for ITW. Therefore, a literature review was conducted to determine what treatment options are supported by the evidence as having the best long-term effect on ITW gait.
Methods: After extraction of relevant articles, 21 manuscripts reporting treatment options for ITW gait were appraised against the levels of evidence.
Results: From these articles, there was no single treatment option reported as having a long-term effect on the gait of children with ITW. There was support in the literature for surgical interventions, serial casting, and the use of botulinum toxin type A. There was limited evidence that footwear or orthoses changed the gait pattern.
Conclusions: This review updates the knowledge of podiatric physicians, enhances how children who present with this gait style can be managed, and highlights areas for future research.
This critical review examines the current research on the association between idiopathic toe
walking and language delay. A completed literature search using computerized databases and
examination of the retrieved articles yielded four studies. Overall, the literature review
revealed an association between idiopathic toe walking and language delays, supporting
idiopathic toe walking as a marker for developmental problems. Clinical implication and
recommendations for future research are discussed.
A Comparison of the Birth Characteristics of Idiopathic Toe Walking and Toe Walking Gait Due to Medical Reasons
Stephanie Baber, BPTAdvRes(Hons), Joanne Michalitsis, BSc, BAppSc(Pod), Michael Fahey, MBBS (Hons), PhD, FRACP, Barry Rawicki, MBBS, FAFRM(RACP), FACRM, Terry Haines, BPhysio(Hons), GradCertHlthEcon, PhD, Cylie Williams, BAppSc (Pod), MHlthSci(HlthEd&Prom), PhD The Journal of Pediatrics; 16 January 2016
To determine and compare the birth history or postnatal complications of idiopathic toe walking (ITW) and toe walking known to be associated with a medical condition.
This was a retrospective chart review of parent-reported birth histories of children who presented to a dedicated toe-walking clinic between 2010 and 2014. This cohort comprised children diagnosed with ITW and children with a medical reason for their toe-walking gait. Data were compared with Australian Perinatal statistical normative data.
Ninety-five children (60 males, 63%) were diagnosed with ITW, with a mean (SD) age of 5.8 (2.9) years. Children with an ITW gait were found to have greater rates of prematurity (OR 2.4; 95% CI 1.43-4.03), greater rates of admission to a special care nursery or neonatal intensive care unit (OR 1.98; 95% CI 1.23-3.18), and lower birth weights (OR 6.6; 95% CI 3.48-12.5) than the normative population. Children with a medical reason for toe walking (n = 28, 68% males) also had greater rates of prematurity (OR 2.4; 95% CI 0.94-6.09) than the normative population and more instrumented births than the ITW cohort (OR 1.56; 95% CI 0.64-3.77). No association was found between assisted-birth intervention and the ITW cohort compared with the normative population or group with a medical cause for toe walking.
ITW gait was associated with greater rates of complications during and after delivery. Such complications have been associated previously as risk factors for neurologic insult affecting motor development.
The aim of this study is to provide clinical examination methods that were designed specifically to assess the level of severity among children with idiopathic toe walking (ITW). The idiopathic toe-walking pattern of 836 children was recorded and analyzed during 4 years. Questionnaires and clinical measurements were evaluated, along with differential tests, assessing the occurrence and severity of toe walking. Questions about family history and onset of toe walking were evaluated along with special tests and measurements assessing the occurrence and severity of toe walking. The different measurements apply during this study, ankle dorsiflexion, lumbar lordosis angle, as well as the clinical spin test, walking after spin test, and heel walking test revealed in all cases that children with a positive family predisposition were significantly more affected than children with negative family predisposition. It is concluded that children with ITW and a positive family predisposition were more intensively affected during all performed clinical tests than children with no family predisposition. The tests used during this study have not being used by any other researches, even though they showed significant differences between the children with ITW and children with a normal gait pattern.
Background: Recent studies have reported many possibilities for the treatment of idiopathic toe walking (ITW); however, none of them have been sufficiently documented. The purpose of this case study was to document the evolution of the gait pattern of a child with severe ITW using the Gillette Gait Index before and after the third and sixth weeks, a nonsurgical treatment program and then every 3 months to 1 year from the start of the treatment. This is significant because the case study shows that a nonsurgical treatment program can be an alternative treatment method for children with severe ITW.
Case description: The case study involved a 5-year-old boy diagnosed with severe ITW. An orthopedist recommended a surgical treatment, but his parents refused to provide consent.
Intervention: The subject participated in a 12-week nonsurgical treatment program that used tone-inhibiting casts (TICs) combined with physiotherapy based on neurodevelopmental treatment principles. The treatment protocol included the following: 1) precast preparation; 2) TICs with treatment; and 3) post-cast treatment to improve the gait pattern.
Outcomes: After treatment with TICs, the range of motion of ankle dorsiflexion during stance had increased, resulting in an almost normalized gait. The patient stopped toe walking for at least 1 year.
Discussion: This study demonstrates that nonsurgical treatment should be considered first, with surgical options reserved for resistant cases; however, further research is required given the current lack of knowledge about treatment outcomes using TICs and the wide use of this treatment modality in children with ITW.
Purpose: To compare distal vibratory perception threshold and sensation in children who toe walked (TW) and controls.
Methods: Vibration perception threshold was measured at the metacarpal and metatarsal phalangeal (MCP and MTP) joints in 11 TW and 15 age-matched controls. Mean vibratory threshold (MVT) was calculated for each site; a Pearson correlation coefficient was determined for MVT at MCP and MTP joints. Groups were compared using a Mann-Whitney U test. Parent/caregiver responses on the Short Sensory Profile (SSP) were compared using a [chi]2 test.
Results: MVTs at the MCP and MTP joints were highly correlated in both groups. MVT was higher in TW compared with controls at each site. Children who TW were more likely to have a total SSP score in the "probable difference" or "definite difference" categories compared with the "no difference" category.
Conclusion: Sensation should not be overlooked in the evaluation and clinical management of toe walking.
Idiopathic toe walking, a differential diagnosis for neurological and orthopaedic disorders, has been associated with neurodevelopmental alterations. Neurodevelopmental assessment at early ages using specific tests may improve management and follow-up of these patients. The aim of our study is to analyse the neurodevelopmental characteristics of preschool idiopathic toe-walkers (ITW) by comparing them to a control group.
Our descriptive cross-sectional study compared possible risk factors, neurodevelopmental characteristics, and scores on the Child Neuropsychological Maturity Questionnaire (CUMANIN) between a group of 56 ITWs aged 3 to 6 and a control group including 40 children.
The proportion of males was significantly higher in the ITW group (P=.008). The percentage of patients with a family history (P=.000) and biological risk factors during the perinatal period (P=.032) was also higher in this group. According to the parents' reports, motor coordination in ITWs was significantly poorer (59%; P=.009). ITWs scored significantly lower on CUMANIN subscales of psychomotricity (=0,001) and memory (P=.001), as well as in verbal development (P=.000), non-verbal development (P=.026), and overall development (P=.004). Foot preference was less marked in the ITW group (P=.047).
The neurodevelopmental characteristics of our sample suggest that idiopathic toe walking is a marker of neurodevelopmental impairment. However, further studies are necessary to confirm these findings.
It tends to be idiopathic to most providers because they have not studied the reflexes inherent in altered posture. I repeatedly find unilateral toe walking with a fixed spinal rotation. usually the spinal rotation is compensated with a pelvic rotation and compensatory apparent short leg compensated by the toe walking. Bilateral toe walking is usually compensation for a fixation of the center of gravity too far forward just as heel walking is compensation for fixation of the center of gravity too far back.