Treating pediatric toe walking – is it idiopathic?

Pediatric toe walking is not necessarily idiopathic and can be the result of an underlying deficit, Megan Smith, CO, director of clinical research at Surestep, said at the Association of Children’s Prosthetic-Orthotic Clinics Annual Meeting. She said gait outcomes can be improved with regular physical therapy.

by Shawn M. Carter, Healio O&P News

Researchers conducted a study of 10 patients, aged 3 years to 13 years, diagnosed with idiopathic toe walking. Idiopathic toe walking was defined as a lack of heel strike at least 50% of the time while barefoot without an underlying diagnosis, such as cerebral palsy or Duchenne muscular dystrophy. Patients’ primary deficits included unstable foot and ankle position, anterior weight lines, sensory deficits and plantar-flexor tightness.

According to Smith, data were collected using the parent-reported amount of toe walking and gait data were collected with the Zeno Walkway and Protokinetics software. Gait data included step length, center of pressure location and foot length. Orthotic interventions included Surestep supramalleolar orthoses (SMOs), Surestep SMOs with a posterior extension, Surestep Indy2Stage AFOs and Surestep SMOs with Allard KiddieGait AFOs. Eight patients received regular physical therapy in addition to the orthoses.

In all patients, toe walking decreased and foot length increased with orthoses compared with barefoot and shoes only outcomes. The average step length increased, and the patients’ center of pressure shifted more posterior with the orthoses, Smith noted.

“There are many orthotic treatment options available for toe walking and it is vital to understand the underlying reason for the toe walking before selecting the orthotic treatment,” she said. “Treatment solutions need to address the primary deficit and cannot solely focus on the foot and ankle and blocking plantarflexion. It is also important to remember that orthoses alone will not always solve the underlying issues, but that in most cases, it requires teamwork between the orthotist and physical therapist to address primary deficits.”

Source Healio O&P News

References

Treating Pediatric Toe Walking – Is it Idiopathic? Megan Smith CO, Director of Clinical Research Surestep, South Bend IN. Presented at Association of Children’s Prosthetic-Orthotic Clinics Annual Meeting; March 22-25, 2017; Houston.

Effect of persistent toe walking on ankle equinus. Analysis of 60 idiopathic toe walkers, Sobel E, Caselli MA, Velez Z. J Am Podiatr Med Assoc. 1997 Jan;87(1):17-22.

Changes in foot-function parameters during the first 5 months after the onset of independent walking: a longitudinal follow-up study, Ann Hallemans, Dirk De Clercq, Stefaan Van Dongen, Peter Aert. Gait & Posture 23 (2006) 142–148. doi:10.1016/j.gaitpost.2005.01.003

Perspective on variability in the development of human action, Fetters L. Phys Ther. 2010 Dec;90(12):1860-7. doi: 10.2522/ptj.2010090. Epub 2010 Oct 21.

The Road to Walking: What Learning to Walk Tells Us About Development. Oxford Handbook of Developmental Psychology, Karen E. Adolph and Scott R. Robinson. NY: Oxford University Press 2013. Publised online Dec 2013. DOI: 10.1093/oxfordhb/9780199958450.013.0015