Autism and toe-walking: Are they related? Trends and treatment patterns between 2005 and 2016

Abstract

Purpose This study quantified toe-walking trends and treatment decisions in patients with autism spectrum disorder (ASD) in the United States between 2005 and 2016 using a large national private-payer database. Methods A retrospective database review was performed on paediatric patients with ASD, and for International Classification of Diseases-9/10 diagnosis codes for toe-walking. Patients were filtered based on treatment type by Current Procedural Terminology (CPT) code. Continued toe-walking rates were assessed for each patient population and treatment group. A Pearson’s chi-squared test was used to evaluate differences in group characteristics. Results Of 2 221 009 paediatric patients in the database, 5739 patients had a diagnosis of ASD, and 8.4% of patients with ASD also had a diagnosis of toe-walking (n = 484). For typically developing children in the database, 0.47% of patients had a diagnosis of persistent toe-walking. In all, 59.3% of ASD patients underwent physical therapy, 7.4% serial casting and 3.3% surgical correction, compared with 38.1%, 3.6% and 1.2% of normally developing children, respectively (chi-square 6.4031; p < 0.040699). Without intervention, 63.6% of patients with ASD continued to toe-walk within ten years of their diagnosis, with 19.3% of patients without ASD (chi-square 82.9762; p < 0.0001). Conclusion This study supports the association between a greater prevalence of toe-walking in children with ASD. We showed that patients with ASD and toe-walking receive surgical correction at nearly triple the rate of children without ASD who toe-walk. The continued rate of toe-walking is comparable between treatment groups as well as between ASD and typically developing children. Typically developing children have higher rates of toe-walking resolution without intervention than children with ASD. Level of evidence Level II

Multiple Vaccinations and the Enigma of Vaccine Injury

“… Bone changes, including reduced bone mineral density and bone cortical thickness in boys, as well as increased risks of hip, spine, and forearm fractures [ 101 , 102 ]. Abnormal posturing and walking on tiptoes [ 103 ], likely indicating idiopathic intracranial hypertension, which can be induced by vitamin A intoxication [ 104 ]. This can cause foot drop, which forces the individual to walk on tiptoes.…”

“…Abnormal posturing and walking on tiptoes [ 103 ], likely indicating idiopathic intracranial hypertension, which can be induced by vitamin A intoxication [ 104 ]. This can cause foot drop, which forces the individual to walk on tiptoes.…”

“…Features of autism spectrum disorder (ASD) also resemble those of acute and chronic hypervitaminosis A. These features of ASD include the following: Abnormal posturing and walking on tiptoes [103], likely indicating idiopathic intracranial hypertension, which can be induced by vitamin A intoxication [104]. This can cause foot drop, which forces the individual to walk on tiptoes.…”

Evaluation of shoe inserts to reduce toe walking in young children with autism

“…Leyden et al. (2019) found that nearly 75% of individuals with ASD who have surgery to reduce ITW begin toe walking again within 2 years.…”

Idiopathic Toe-Walking in Children and Adolescents

“…Furrer and Deonna analyzed “persistent toe-walking” in 28 children, and failure to explain this abnormal gait pattern with known disease processes was diagnosed as “habitual toe-walking.” 8 Today, the literature most commonly uses the term “idiopathic toe walking,” with continued questions about its etiology, natural history, and appropriate treatment 9 . Some studies report a higher incidence of ITW in children with autism spectrum disorder, and thus far, the pathophysiology of this association is unexplained 6,10 .…”