The Dynamic Baropodometric Profile of Children with Idiopathic Toe-Walking

Abstract

Background: Idiopathic toe-walking (ITW) gait may present in children older than 3 years and in the absence of a medical condition known to cause or be associated with toe-walking gait. It is unknown how this gait type changes pressure distribution in the growing foot. We sought to determine whether children with ITW gait exhibit different plantar pressures and temporal gait features than typically developing children. Methods: Children aged 3 to 6 years were recruited who had either a typical heel-toe gait pattern or a diagnosis of ITW. The ITW diagnosis was reported by the parent/caregiver and confirmed through history and physical examination. Temporal gait measures, peak pressures, and impulse percentages were measured. A minimum of ten unshod footprints were collected. Data were compared with unpaired t tests. Results: The study included 40 children with typical gait and 56 with ITW gait. The ITW group displayed lower peak pressures at the hallux, midfoot, and hindfoot (P < .05) and higher and lower pressure impulse percentages at the forefoot (P < .001) and hindfoot (P < .001), respectively. The ITW group spent a higher percentage of contact time at all areas of the forefoot and less at the midfoot and rearfoot (P < .05). There were no significant differences in total step duration and foot progression angle between groups (P > .05). Conclusions: There were differences in pressure distributions between groups. Understanding these differences may help us better understand the compensations or potential long-term impact that ITW gait may have on a young child's foot. Podiatric physicians may also consider the use of this equipment in the clinical setting to measure outcomes after treatment for ITW.

Idiopathic Toe-Walking: A Review from 1967 to 2021

“…The foot progression angle was not significantly different between the groups. 14 Electromyography during ambulation was analyzed for children with ITW and compared with normal data, typically developing children walking on their toes, or children with CP. For timing of gastrocnemius and tibialis anterior (TA) activity, the majority of the ITW group activated gastrocnemius and soleus earlier in swing phase than normal controls walking on their toes.…”

“…The diagnosis of idiopathic toe-walking (ITW) is reserved for children who walk on their toes, 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 make initial contact (IC) with toes/forefoot, 24 25 26 have toe–toe gait pattern, 27 28 29 30 31 or have the absence of heel strike. 1 14 20 23 31 32 33 34 35 36 37 38 39 40 41 42 43 It is one of exclusion, in which no known neurological, neuromuscular, orthopedic, or neurodevelopmental cause, e.g., cerebral palsy (CP), muscular dystrophy, or autism, can be found for the patient's condition.…”

“…In 1967, Hall et al 9 were the first to describe the condition of ITW in 20 children who walked on their toes with the only other finding being bilateral equinus. Characteristics that have been associated with ITW include the achievement of independent ambulation within normal age range, 10 13 20 24 28 40 toe-walking starting at the onset of independent ambulation, 9 10 11 17 28 44 bilateral involvement, 3 20 ability to stand in plantigrade, 13 17 44 45 ability to not walk on toes upon request, 9 11 13 14 17 22 26 29 35 38 44 46 47 normal developmental gait variant, 4 8 12 19 22 37 47 48 49 50 toe walk for more than 3 months 6 51 or 6 months, 17 19 44 and transient normal stage that becomes pathological if persists beyond 2 10 13 25 28 30 37 45 52 53 or 3 years of age. 1 7 14 18 19 20 23 25 27…”

“…Characteristics that have been associated with ITW include the achievement of independent ambulation within normal age range, 10 13 20 24 28 40 toe-walking starting at the onset of independent ambulation, 9 10 11 17 28 44 bilateral involvement, 3 20 ability to stand in plantigrade, 13 17 44 45 ability to not walk on toes upon request, 9 11 13 14 17 22 26 29 35 38 44 46 47 normal developmental gait variant, 4 8 12 19 22 37 47 48 49 50 toe walk for more than 3 months 6 51 or 6 months, 17 19 44 and transient normal stage that becomes pathological if persists beyond 2 10 13 25 28 30 37 45 52 53 or 3 years of age. 1 7 14 18 19 20 23 25 27 32 33 35 36 …”