Interventions for idiopathic toe walking

Williams, Cylie; Pacey, Verity; Bakker, Pauline B. de; Caserta, Antoni; Gray, Kelly; Engelbert, Raoul

doi:10.1002/14651858.cd012363

Cited by 18 publications

(12 citation statements)

References 55 publications

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“…Treatments to increase MTU length are often based on the assumption that children who ITW will have developed similar gastrocnemius MTU alterations to those with CP (Alhusaini et al, 2011 ; Brouwer et al, 2000 ; Jahn et al, 2009 ; Kay et al, 2004 ; Williams et al, 2016 ). However, we have shown that the MTU length of children who ITW is composed of a greater muscle to tendon ratio than typical.…”

Section: Discussionmentioning

confidence: 99%

“…As children who ITW ambulate with a similar locomotor dysfunction to many children with CP, it is often assumed that they will have undergone similar muscle and tendon alterations within the gastrocnemius MTU complex. The expectation of shorter muscle belly and MTU lengths would explain why children who ITW are often prescribed with similar interventions as their CP counterparts (Williams et al, 2016 ). However, the muscle and tendon properties have never been measured in children who ITW.…”

Section: Introductionmentioning

confidence: 99%

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Muscle architecture and passive lengthening properties of the gastrocnemius medialis and Achilles tendon in children who idiopathically toe‐walk

et al. 2021

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Children who idiopathically toe‐walk (ITW) habitually operate at greater plantarflexion angles and thus, at shorter muscle‐tendon unit (MTU) lengths than typically developing (TD) children. Therefore, it is often assumed that habitual use of the gastrocnemius muscle in this way will cause remodelling of the muscle‐tendon architecture compared to TD children. However, the gastrocnemius muscle architecture of children who ITW has never been measured. It is essential that we gain a better understanding of these muscle‐tendon properties, to ensure that appropriate clinical interventions can be provided for these children. Five children who ITW (age 8 ± 2 years) and 14 TD children (age 10 ± 2 years) participated in this study. Ultrasound was combined with isokinetic dynamometry and surface electromyography, to measure muscle architecture at common positions and passive lengthening properties of the gastrocnemius muscle and tendon across full range of motion. Regardless of which common condition groups were compared under, both the absolute and normalised to MTU muscle belly and fascicle lengths were always longer, and the Achilles tendon length was always shorter in children who ITW than TD children (p < 0.05; large effect sizes). The passive lengthening properties of the muscle and tendon were not different between groups (p > 0.05); however, passive joint stiffness was greater in children who ITW at maximum dorsiflexion (p = 0.001) and at a joint moment common to all participants (p = 0.029). Consequently, the findings of this pilot study indicate a remodelling of the relative MTU that does not support the concept that children who ITW commonly experience muscle shortening. Therefore, greater consideration of the muscle and tendon properties are required when prescribing clinical interventions that aim to lengthen the MTU, and treatments may be better targeted at the Achilles tendon in children who ITW.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Muscle architecture and passive lengthening properties of the gastrocnemius medialis and Achilles tendon in children who idiopathically toe‐walk

et al. 2021

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“…It was noted that it presented with a nebulous aetiology with variable responses to many interventions. 36 The establishment of criteria therefore required more complex stratification than the closed-ended statements offered in the current survey. Intoeing again was cited as heterogeneous in nature 37 ; however, this achieved the highest frequency of panellists scoring disagree or strongly disagree with panellists reaching a general consensus there was no clear evidence base to indicate off-the-shelf stability therapeutic footwear for this clinical presentation even in the subcategories suggested by the modified statements offered across rounds 2 and 3.…”

Section: Discussionmentioning

confidence: 99%

Defining and grouping children’s therapeutic footwear and criteria for their prescription: an international expert Delphi consensus study

2021

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ObjectivesThis study aimed to achieve an expert consensus on how to define and group footwear interventions for children, with a further focus on the design characteristics and prescription of off-the-shelf stability footwear for children with mobility impairment.SettingA group of multinational professionals, from clinicians to those involved in the footwear industry, were recruited to ensure a spectrum of opinions.ParticipantsThirty panellists were contacted, of which 24 consented to participate and six withdrew before round 1, a further two withdrew after round 1. Sixteen panellists completed the consensus exercise.Primary and secondary outcome measuresA Delphi consensus method was employed with round 1 split into three sections: (1) terms and definitions, (2) specifics of off-the-shelf stability footwear design and (3) criteria for clinical prescription of off-the-shelf stability footwear. The panel was asked to rate their level of agreement with statements and to provide further insights through open-ended questions. The opinions of the experts were analysed to assess consensus set at 75% agreement or to modify or form new statements presented through the subsequent two rounds.ResultsTherapeutic footwear was the agreed term to represent children’s footwear interventions, with grouping and subgrouping of therapeutic footwear being dependent on their intended clinical outcomes (accommodative, corrective or functional). Both the heel counter and topline as well as the stiffness and width of the sole were identified as potentially influencing mediolateral stability in children’s gait. A consensus was achieved in the prescription criteria and outcome measures for off-the-shelf stability therapeutic footwear for cerebral palsy, mobile symptomatic pes planus, Duchenne muscular dystrophy, spina bifida and Down’s syndrome.ConclusionsThrough a structured synthesis of expert opinion, this study has established a standardisation of terminology and groupings along with prescription criteria for the first time. Reported findings have implications for communication between stakeholders, evidence-based clinical intervention and standardised outcome measures to assess effectiveness.

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“…Even if it was not an aim of our study, the research strategy we used can be also considered appropriate to review the literature about treatment of TTB in ASD subjects. There are different studies about many types of conservative interventions (observation, muscles stretching exercises, auditory feedback, footwear, ankle‐foot or foot‐only orthoses, serial casting, and botulinum toxin A) and different types of surgical interventions in idiopathic TW conditions (see the systematic review protocol of Williams et al, ). Since the frequency of TTB in ASD subjects is not low, we were surprised to find only two studies within the screened literature about the treatment of TTB in ASD subjects and only one study includible (since the other did not describe the diagnostic criteria).…”

Section: Discussionmentioning

confidence: 99%

Toe Walking Assessment in Autism Spectrum Disorder Subjects: A Systematic Review

Valagussa

Trentin²,

Signori

et al. 2018

Autism Research

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There is increasing evidence that autism spectrum disorder (ASD) subjects have also motor impairments. Toe walking (TW) is a phenomenon that can be found in ASD subjects during gait, even if this condition was found not to be necessarily related only to walking, since these children often also stand and run on their tiptoes. Since persistent TW in ASD subjects may contribute to secondary shortening of the Achilles's tendon, it becomes important to have an assessment tool and/or outcome measure for both the clinical and rehabilitative settings. The aim of this systematic review is to critically evaluate and describe the methods employed to assess toe walking in ASD subjects. The systematic review protocol was previously registered on PROSPERO. We conducted an extensive literature search in PubMed, CINAHL, PsycINFO, The Cochrane Library, and Scopus databases. There were no restrictions on the types of study design eligible for inclusion. Ten studies were included in the systematic review. Risk of bias of the included studies was conducted using the following instruments depending on the study types: STROBE Statement, Cochrane risk of bias tool, and CARE checklist. Almost all the included studies (8/10) proposed a tip-toe behavior (TTB) assessment only during walking. Nine out of ten of the included studies assessed TTB using a qualitative methodology. The results evidenced the heterogeneity of qualitative methods and a lack of a structured quantitative test to assess toe walking in ASD subjects. Autism Res 2018, 11: 1404-1415. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY ABSTRACT: Toe walking (TW) is a phenomenon that can be found during ASD subject's gait. The persistence of this behavior may contribute to secondary Achilles's tendon shortening. In this perspective it becomes important to have an assessment tool and/or outcome measure for both the clinical and rehabilitative settings. The current systematic review aimed to describe the methods employed to assess TW. The results evidenced the lack and the need of a structured quantitative test to assess TW in ASD subjects.

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Interventions for idiopathic toe walking

Cited by 18 publications

References 55 publications

Muscle architecture and passive lengthening properties of the gastrocnemius medialis and Achilles tendon in children who idiopathically toe‐walk

Muscle architecture and passive lengthening properties of the gastrocnemius medialis and Achilles tendon in children who idiopathically toe‐walk

Defining and grouping children’s therapeutic footwear and criteria for their prescription: an international expert Delphi consensus study

Toe Walking Assessment in Autism Spectrum Disorder Subjects: A Systematic Review

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