Idiopathic Toe-Walking: A Review from 1967 to 2021

Abstract

Idiopathic toe-walking (ITW) is considered a diagnosis of exclusion for which no underlying neurological, neuromuscular, neurodevelopmental, or orthopedic condition can be identified. The purpose of this review was to examine multiple aspects of ITW: natural history, evaluation, treatment, musculoskeletal manifestations, and developmental issues through the review of studies from the initial description of condition in 1967 to the present. From a PubMed search and review of reference lists of individual articles, 64 articles were selected and reviewed. The studied samples were variably described and often not well-defined. Gait analysis found gait characteristics associated with ITW that varied from normal. Children with ITW can be differentiated from children with cerebral palsy on the basis of several gait pattern features, but findings from electromyographic comparisons were variable. Treatments included orthoses, casting, botulinum toxin type A, and surgery. The evidence to support any specific treatment is limited by the small sample size and short duration of follow-up in the majority of studies. The inadequacy of the current literature suggests the need for a longitudinal multi-center study to more clearly define the population of children with ITW and to determine indications, timing, and effectiveness of the various available treatments.

Gut Microbiome Dysbiosis as a Potential Risk Factor for Idiopathic Toe-Walking in Children: A Review

“…Regular physical exercise is not only essential for maintaining good health, but it can also help restore various bodily functions that have been impaired by chronic medical conditions. Furthermore, shoe orthoses represent one of the more conservative approaches to treating ITW [11,14]. Although a small study showed no significant reduction in physical activity among children with ITW, engaging in physical activity can significantly enhance their quality of life [175] and reduce the duration of ITW [176].…”

“…Although ITW has been known for more than half a century, we still do not know much about its etiology [14,15]. Currently, there is a growing interest in the diagnosis, treatment, classification, and causes of ITW.…”