Toe Walking: A Neurological Perspective After Referral From Pediatric Orthopaedic Surgeons

Haynes, Katherine B.; Wimberly, Robert L.; VanPelt, Jonathan M.; Jo, Chan Hee; Riccio, Anthony I.; Delgado, Mauricio R.

doi:10.1097/bpo.0000000000001115

Cited by 22 publications

(27 citation statements)

References 12 publications

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“…The vast majority of reasons for toe walking gait are neurological in origin [ 23 ]. These is building evidence of ITW also resulting from subtle neurological differences between toe walking and non-toe walking peers [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Children with idiopathic toe walking display differences in lower limb joint ranges and strength compared to peers: a case control study

Caserta

Morgan

McKay

et al. 2022

Journal of Foot and Ankle Research

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Background Idiopathic toe walking (ITW) is an exclusionary diagnosis. There has been limited exploration of lower limb active range of motion and strength measures in children with ITW. This researched aimed to determine any differences in lower limb muscle active range of motion and strength in children who have ITW, compared to normative data collected from children who displayed typical gait. Methods Children were recruited with had a diagnosis of ITW, aged between 4 and 10 years, and no recent treatment. Data collected included parent reported data such as time spent toe walking, percentage of time spent toe walking, and clinician collected data such as age, height and weight. Joint ranges of motion and strength measures were collected by an experience clinician. Active and weight bearing joint ranges of motion were evaluated with a goniometer or digital inclinometer. Lower limb muscle strength measures were evaluated with a hand-held dynamometer. Published normative data sets were used for comparison. Measures were analysed with regression analyses to determine differences between groups in different measures, considering measures known to impact range and strength. Odds ratios (OR), 95% confidence intervals (CI) and p values were reported. Results Twenty-six children with ITW participated. Reduced weight bearing ankle range of motion, when measured with the knee bent, was associated with being in the ITW group (p = 0.009), being older (p < 0.001) and weighing less (p < 0.001). Reduced ankle plantar flexion range was only associated with being in the ITW group (p = 0.015). For all lower limb strength measures, excluding hip external rotation, children who displayed greater strength, did not toe walk (p < 0.002), were older (p < 0.001) and weighed more (p < 0.014). with ITW. Conclusion Children with ITW displayed reduced overall plantar and dorsiflexion at the ankle, compared to non-toe walking children. Reduced plantarflexion is children with ITW has not been described before, however reduced dorsiflexion is commonly reported. Children with ITW were weaker in many lower limb measures, even when age and weight were considered. This should lead clinicians and researchers to pay greater attention to lower limb strength measures in this population.

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Section: Discussionmentioning

confidence: 99%

Children with idiopathic toe walking display differences in lower limb joint ranges and strength compared to peers: a case control study

Caserta

Morgan

McKay

et al. 2022

Journal of Foot and Ankle Research

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“…Recent studies have focused on the correlation with toe walking and other underlying disorders. Haynes reported that 62% of patients referred to neurology for toe walking had an underlying disorder including cerebral palsy, peripheral neuropathy, autism spectrum disorder (ASD), and hereditary spastic paraparesis 49. Leyden et al50 found a higher prevalence of prolonged toe walking in children with ASD.…”

Section: Resultsmentioning

confidence: 99%

What is New in Pediatric Orthopaedic Foot and Ankle

Tileston

Baskar

Frick

2022

Journal of Pediatric Orthopaedics

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Background: This paper aims to report on the last 5 years of relevant research on pediatric foot and ankle pathology with specific focus on clubfoot, congenital vertical talus, toe walking, tarsal coalitions, pes planovalgus with or without accessory navicular, foot and ankle trauma, and talar dome osteochondritis dessicans. Methods: The Browzine platform was used to review the table of contents for all papers published in the following target journals related to the treatment of pediatric foot and ankle conditions. Search results were further refined to include clinical trials and randomized controlled trials published from March 1, 2015 to November 15, 2021. Results: A total of 73 papers were selected for review based on new findings and significant contributions in treatment of clubfoot, congenital vertical talus, toe walking, tarsal coalitions, pes planovalgus with or without accessory navicular, foot and ankle trauma, and talar dome osteochondritis dessicans. Also included were several papers that did not fit into any of these categories but provided new insight into specific foot and ankle pathologies. Conclusions: Treatment strategies for children with foot and ankle pathology are continually evolving. We review many of the most recent publications with the goal of improving understanding of these pathologies and highlighting current best practices. Level of Evidence: Level III.

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“…An important finding was that 71% of children with asymmetric TW had an eventual diagnosis of hemiplegic CP. 3 Although no single examination measurement is diagnostic, a comprehensive examination, including the foot, spine, general gait, and ROM, and neurologic examination are important. On visual gait examination, it is important to determine whether the child can walk in a heel-toe manner when asked.…”

Section: Diagnosismentioning

confidence: 99%

“…15 When history or physical examination findings are abnormal, a consultation with a neurologist is warranted. Haynes et al 3 found in their series of children with abnormal or asymmetric ITW referred to pediatric neurology from pediatric orthopaedics, 62% were determined to have an underlying pathologic cause. If those children with autism and ADHD are excluded, the diagnosis of a pathologic cause was still 47%.…”

Section: Geneticsmentioning

confidence: 99%

Idiopathic Toe Walking: An Update on Natural History, Diagnosis, and Treatment

Bauer

Sienko

Davids

2022

J Am Acad Orthop Surg

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Toe walking is a common presenting report to an orthopaedic practice. Evaluation of a child with toe walking includes a thorough history and physical examination to elucidate the diagnosis. When no other diagnosis is suspected, a diagnosis of idiopathic toe walking is often given. Despite the high prevalence of the condition, there is notable controversy of the nomenclature of the disease. Recent research has shed more light on both the natural history and the genetic basis. The use of motion analysis, including EMG and multisegment foot model, may help both differentiate children with mild forms of cerebral palsy and evaluate outcomes after treatment. Early treatment for young children with adequate range of motion (ROM) is generally reassurance because most young children with idiopathic toe walking are expected to resolve spontaneously. When the toe walking persists, treatment options include both surgical and nonsurgical management. Nonsurgical management centers on obtaining ROM through stretching and serial casting, followed by gait retraining and bracing treatment. Surgical lengthening at either the Achilles or gastrocnemius level improves the ROM of the ankle and then similarly requires therapy and bracing treatment to obtain a more normalized gait.

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Toe Walking: A Neurological Perspective After Referral From Pediatric Orthopaedic Surgeons

Abstract: Level III-retrospective cohort.

Cited by 22 publications

References 12 publications

Children with idiopathic toe walking display differences in lower limb joint ranges and strength compared to peers: a case control study

Children with idiopathic toe walking display differences in lower limb joint ranges and strength compared to peers: a case control study

What is New in Pediatric Orthopaedic Foot and Ankle

Idiopathic Toe Walking: An Update on Natural History, Diagnosis, and Treatment

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